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Therapist near me: the reasons why your ADHD brain needs more sleep

As a therapist I'm usually a good sleeper.

In fact, sleep and I have a bit of a thing going on. But last night? We weren’t friends at all. I was tossing and turning, my body ached, and my mind raced. I tried all my tricks, but it just wasn't happening. And my alarm went off after I managed maybe a total of 4 hours. So today?

I'm a bit of a mess.

Marcy M. Caldwell, Psy.D. is a licensed clinical psychologist who specializes in the treatment and assessment of adult ADHD Psychologist Philadelphia.

My therapy brain is foggy, each word I type seems to take a century, and oh how annoying everything and everyone around me is!

But, it's been worse. Much worse.

In fact, I have a bright and vivid memory emblazoned on my brain from when my youngest was an infant.

Is it his sweet, toothless grin as he gazed up at me? No. Is it his delicious little thigh rolls? Nope. Not that either—unfortunately, those memories need the aid of photos to call up.

You know what doesn't need any aid? The memory of me dissolving in a puddle of tears in the middle of the kitchen floor, crying, "I'm just so f**king tired!" then continuing this cry all the way up the stairs as my husband directed me to bed. Once on that bed- did I lay down and go to sleep? No! I just sat on the edge, my shoulders heaving as I cried hot, angry tears and my husband tried, fruitlessly, to convince me to lay down and sleep.

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Why do we resist sleep?

Why was I resisting the one thing that would actually help? The truth is that therapy science doesn’t really know why we resist sleep but they do know we are the only mammals that do it. They are also very clear on what happens when we deprive our oh-so-tired brains of the thing they crave the most.

One of the interesting findings when looking at sleep-deprived brains is that ADHD and sleep-deprived neurotypical brains look remarkably similar.

Sleep deprived Neurotypical and ADHD brain comparison

In fact, when scientists look at fMRI scans of ADHD and neurotypical brains deprived of sleep, they see that the two look virtually identical EXCEPT that the sleep-deprived brain actually has a little extra assist in the thalamus (our brains relay station) ADHD brain does not.

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This extra therapy assist that the sleep-deprived brain gives may be why some people with ADHD say they feel better when they don't get enough sleep- they may be benefitting from this extra sleep deprivation boost that they don’t normally get.

The problem is, that extra help?

It doesn't last. And then the sleep-deprived ADHD brain is left with even less fuel in its executive functioning stores and struggles even more.

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What does sleep deprivation do to ADHD brains?

If your ADHD brain could talk after several nights of, even just a little, less sleep it would sound a lot like this.

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Sleep deprivation and ADHD

AHHH, it's like my ADHD symptoms are on steroids!
Sleep deprivation amplifies ADHD symptoms. The exact same areas of the brain are impacted. That means that when you don't sleep- your brain has even less fuel in its executive function stores causing you to reach that “I’ve got absolutely nothing” point before you even get started.

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Moon Bloom Wellness offers online mental health counseling and specializes in anxiety treatment and depression treatment.

Why won't my brain work!!

(AKA "slowed cognitive therapy speed") It’s that feeling of your brain slogging through the swamp wearing oversized galoshes filled with heavy mud—you know the one--- Is, what makes it hard to follow a conversation, put 2 concepts together, or respond quickly. The ADHD brain is often trying to follow so many tracks at the same time that it can struggle to feel quick on a well-rested day. Following all those tracks while also moving at a snail's pace? That can feel impossible.

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Oh, that was important? Whoops!

Already having a hard time staying on top of the essential things, picking out details, and attending to the top priorities? Add some sleep deprivation in and you might as well just watch it all sail on by! Your brain doesn't have enough energy to see all the things it needs to and pick the most important ones so it just lets everything pass by.

Anxiety Treatment Chapel Hill N.C. CBT helps individuals address and treat anxiety, depression, relationship problems, etc. by teaching new skills and ways of coping. For example, someone with social anxiety may work to improve the skill of tolerating being in anxiety-inducing social situations.

Sometimes people with ADHD actually appreciate this feeling- because it can ease some anxiety and struggle. And if it only happens here and there, it’s not too bad because the important things will likely circle back to you. But when this happens repeatedly (or in certain jobs or roles), missing the important things can have a lasting and even devastating impact.

Stimulation Overload

You know how that scratchy sweater is completely intolerable when you are tired? Or how the chances of you not checking that pop-up after pulling an all-nighter are virtually non-existent? That's because your executive attention stores are basically wiped out by lack of sleep. Executive attention is your ability to filter out distracting or extraneous material from your awareness. ADHD brains don't love this to begin with- it takes a lot of its energy- lack of sleep depletes the resource so significantly it can feel like the filter never even existed.

An anxiety disorder can interfere with your everyday life including work, school, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and phobia-related disorders. There are several types of anxiety treatment boulder. To learn more contact WellTalk. Anxiety Disorder Boulder.

Wait, what? You asked me to get milk?

Lack of sleep diminishes your working memory stores, which I like to describe as the table on which you put all the things you need to think about. When something is on the table, you can play with it, use it, or find a place to store it. But the table can get too full, and then things start falling off. The ADHD brain loves to collect things on the table- it likes to have things out and visible. But lack of sleep? That makes your table smaller, so now you don't have room for your grocery list, your to-do list, and what the person in front of you is saying- things start plummeting off the edge of the table- often never to be seen again- sorry grocery list!

Florida therapist near me Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and Online Therapy Florida. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders.

Problem Solving? Forget about it!

This is part of what was going on as I sat on the edge of my bed, crying about being tired. I had lost all of my higher therapy thinking power. My problem-solving capacity was virtually non-existent. There I was literally sitting on the solution, and I couldn't put 2 and 2 together. Problem-solving requires a lot of executive functioning (something the ADHD brain has a limited supply of), so making it harder by lack of sleep? That feels unfair.

ALL the feelings

We are angrier and more easily frustrated when we are tired. Scientists have discovered that a lack of sleep cuts the connection between the emotional part of our brain (the amygdala) and the part of our brain that makes sense of emotion (the prefrontal cortex). So we aren't able to reason through our feelings- we feel them full force.

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Sound familiar? The same thing happens with ADHD. When you are well-rested, your ADHD brain may struggle but still can get some of that communication through, provided it doesn't get too flooded. Sleep-deprived, though? Now all channels are down and out of order and the feelings just come flooding in full force.

Sugar. Fat. Salt. Yes, Please!

When my youngest was an infant, I got into the habit of eating several candy bars a day (and I'm not talking about the fun-size version). I told myself I was nursing and needed the extra calories, but, really? My oh-so-tired brain just wanted that sugar rush. Our sleep-deprived brains overuse and overvalue its "drive" parts and underuse "higher thinking" parts. So high-fat, high-salt, high-sugar foods are extra rewarding to a tired brain, AND a tired brain doesn’t have the willpower in reserves to resist the reward.

This is a pattern already seen in ADHD. At the beginning of the day- it's easy to resist that candy bowl on your coworker's desk by 3 pm, though? The will-power supplies are low, and it gets so much harder. If you start the day already depleted then, it can feel next to impossible to resist that powerful therapy drive for pleasure all day long.

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Anxiety Treatment & Anxiety Disorder

Anxiety Disorder

Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.

Signs and Symptoms

Anxiety Treatment Chapel Hill N.C. CBT helps individuals address and treat anxiety, depression, relationship problems, etc. by teaching new skills and ways of coping. For example, someone with social anxiety may work to improve the skill of tolerating being in anxiety-inducing social situations.

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

Generalized anxiety disorder symptoms include:

  • Feeling restless, wound-up, or on-edge
  • Being easily fatigued
  • Having difficulty concentrating; mind going blank
  • Being irritable
  • Having muscle tension
  • Difficulty controlling feelings of worry
  • Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

An anxiety disorder can interfere with your everyday life including work, school, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and phobia-related disorders. There are several types of anxiety treatment boulder. To learn more contact WellTalk. Anxiety Disorder Boulder.

Panic Disorder

People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.

During a panic attack, people may experience:

  • Heart palpitations, a pounding heartbeat, or an accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath, smothering, or choking
  • Feelings of impending doom
  • Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia (see below).

Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

  • May have an irrational or excessive worry about encountering the feared object or situation
  • Take active steps to avoid the feared object or situation
  • Experience immediate intense anxiety upon encountering the feared object or situation
  • Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

  • Flying
  • Heights
  • Specific animals, such as spiders, dogs, or snakes
  • Receiving injections
  • Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Standing in line or being in a crowd
  • Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.

Risk Factors for Anxiety Disorder

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include:

Temperamental traits of shyness or behavioral inhibition in childhood
Exposure to stressful and negative life or environmental events in early childhood or adulthood
A history of anxiety or other mental illnesses in biological relatives
Some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder.

Anxiety Treatment and Therapy

Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety and people should work with their specialist to choose the treatment that is best for them.


Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety treatment. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.

Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.

CBT can be conducted individually or with a group of people who have similar difficulties. Often “homework” is assigned for participants to complete between sessions.

Support Groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others to aid in anxiety treatment. Internet chat rooms might also be useful, but any advice received over the internet should be used with caution, as Internet acquaintances have usually never seen each other and what has helped one person is not necessarily what is best for another. You should always check with your specialist before following any treatment advice found on the internet. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from a health professional.

Stress Management Techniques

Anxiety treatment using stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. Research suggests that aerobic exercise can help some people manage their anxiety; however, exercise should not take the place of standard care and more research is needed.

THE ADHD ADVANTAGE: The 10 greatest benefits of ADHD brains

Is ADHD a gift?



Kinda. Sorta. Maybe. It depends. And everything in between.

ADHD brains are different.

And with difference comes great strength and great struggle. There are some indisputable advantages to ADHD brains- they work in some unique and marvelous ways. But living with a brain that works differently than much of the rest of the world? That’s hard. That brings pain and struggle.

So maybe we don’t need to define ADHD as a gift or a curse. Maybe we don’t need to compare ADHD brains to neurotypical brains.

Maybe we could acknowledge their difference, their unique beauties, and their strengths but also hold onto the truth that ADHD brains lack a privilege that neurotypical brains have- the privilege to operate in a world created for its brain. And whenever you lack privilege, struggle follows.

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The ADHD Advantage:

But the difference and the struggle that make ADHD both a gift and a burden are precisely what creates its advantage.

The Advantage of Struggle:

Any parenting book worth its salt will tell you not to swoop in and save your child every time he/she faces a problem. Why?

Because it’s a struggle that teaches us.

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Pain and struggle push us out of our comfort zone, it shows us what we are capable of, and it proves to us what we can withstand. And besides that? Struggle and pain help us build empathy and compassion for the struggle and pain of the people around us.

The Advantage of Difference:
Seeing the world differently? Having different experiences? Needing to understand your brain to work it to its fullest? That’s hard. But you know what? That is also beautiful. Because all that difference brings new energy, new perspectives, and new possibilities to the table, that without your unique brain may have been boring, bland, and ever so linear.

When you combine these two advantages, you get that special sauce that makes ADHD brains their flavor of awesome.

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Top 10 ADHD Superpowers

Novel Problem Solving
ADHD brains are big picture thinkers. They can zoom out-- way out-- which allows them to see patterns where other people only see chaos. This makes ADHD brains great CEOs, creatives, and team members because they will so often find the novel solution where others feel stuck


The flip side to sensitivity and a history of struggle? The ability to empathize with the pain and struggle of others. ADHD brains see pain, and they don’t just walk on by- they want to help, they feel drawn to give others a hand up, particularly when it’s one they needed themselves at one point.

Sense of Humor

Many ADHDers are the life of the party. But even when they’re not the center of the show, they’re often on the side, bringing light and humor to the group. ADHD brains look at the world differently, they have a keen sense of perception, and they know from experience that perfection is overrated. Roll that all into one, and you get a wicked sense of humor that brings fun to any situation.

ADHD Intuition

The sensitivity of an ADHD brain makes it attune to minor details that other brains may miss. Neurotypical brains filter out extraneous details, but because the ADHD brain takes it all in, it doesn’t miss a thing. This tunes it into the feelings, non-verbals, and subtle cues that people are putting out and makes it almost eerily able to read a situation or person.

ADHD Creativity

ADHD brains are brains without walls. They don’t tend to operate in a lockstep, linear way. And when you don’t function linearly, you’re opened up to more options, possibilities, and solutions. Neurotypical brains are often confined by their own linear process. But ADHD brains see these possibilities and embrace the endless possibility they bring.

Sense of Justice

ADHD brains are often “justice sensitive.” They have a keen sense of what’s right and wrong, and they notice and are activated by injustice around them. I’ve always believed this comes from the ADHD brain’s tendency to see the big picture and not gloss over details. When it takes in a big picture, and there is even one small detail that’s amiss, the ADHD brain has a hard time letting that go.

Unlike others, who may not even notice and almost always look away- ADHD brains see injustice and act in part because seeing that thing that is amiss is too painful to let go.


The ADHD brain’s ability to hyperfocus is a powerful thing. ADHD brains can zone in on something and not let it go even when other things (and people) are calling for its attention. When it’s in hyperfocus, it is incredible the things an ADHD brain can accomplish.

Boundless Energy

One of my favorite things about ADHD brains is their energy. As someone who sometimes struggles to maintain her energy through a day- the energy that an ADHD brain brings is refreshing and inspiring. And the beauty of that energy is that in addition to fueling you- it’s so often contagious.


Can ADHD brains be impulsive? Yes.

Can that impulsivity be used as spontaneity? Double yes!

Inspired ADHD brains can be quick starters, not stuck in the should I/ shouldn’t I that can so often stall a neurotypical brain. That spontaneity brings passion and enthusiasm and can push people out of their comfort zone and into something new and challenging.


You find an above-average number of ADHD brains in ERs, surgery theaters, firehouses, and police stations. Because while the crisis may cause some brains to shut down. ADHD brains are often clarified and activated by a crisis- making them great paramedics, firefighters, ER docs, and professional athletes.

What are your favorite things about your brain?

Choosing to Live Your Life over Anxiety

Remember that anxiety list you keep?

It might not be a literal list, but it is a list somewhere in your psyche. I am referring specifically to that list that gets added to every time you say “no” to your desires. Whether you are aware of the painful “no moment” when it comes up, a little part of you sulks away, head and shoulders down and heart a little broken, when this occurs.

We make choices every day that inform the kind of life we live. Many of these are routine decisions that occur almost on autopilot. Sometimes autopilot keeps us from recognizing the “no moments” that accumulate over time. Every time we choose to spend another half an hour watching television, we are saying “no” to journaling, meditating, dancing, extra sleep, connecting with a friend – you name it. Decompressing with television is not problematic in itself, it is problematic when it replaces life-giving activities that allow us to actually spend time with ourselves.

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Journaling, meditating, taking a bath – these are more routine moments that may or may not live on our list. These are the “I should” self-care tasks. But there is another part of the list that I am talking about that represents a deeper rejection of ourselves. It is the “I wish” portion of our list. The list might be full of items you can plug into this sentence:

I wish I were ____________ enough to _____________.

For me, this happened recently when I was heading out for a solo beach day. I had, among other beachy items, my hula hoop in the back of my vehicle. I tossed it in, not seriously planning to use it. My list item was “I wish I were brave enough to hula hoop on the beach by myself.” On the way to the beach a combination of desire and the right song on my playlist lined up and I teared up as a realization washed over me: “I have to hula hoop on the beach today, I refuse to live my life like this.” And I did. I hula hooped until I was sweaty, sandy, and tired.

This may not seem earth shattering, but it is not really about hula hooping. It is about making fear-based decisions and living small lives because we are afraid of judgment and rejection. When we live our lives like this, for other people, there is a resentment that builds in us. We trade authentic expression of ourselves for approval from others. The thing is, that most people are not thinking about us, and anyone that would criticize you for living a full, vibrant life, is likely just mad at themselves for the length of their list.

Do yourself a favor and dump your list out on paper, then get to it! Whatever is on your list, know that you are worthy enough to dance, sing, wear that outfit, talk to that person, write that book, decorate your house that way, to say “no” to when you do not have a “yes” in you, or whatever else might be residing on your list.

Photo by Clem Onojeghuo on Unsplash

Effective Therapy for Distressed Couples

Emotionally Focused Therapy (EFT) is a short-term (8 - 20 sessions) and structured approach to couples' therapy developed by Drs. Sue Johnson and Les Greenberg in the 1980's. It is grounded in research while focusing on negative communication patterns and love as an attachment bond.

Attachment Theory in Couples Therapy

"Attachment" between people typically provides a safe haven: a retreat from the world and a way to obtain comfort, security and a buffer against stress. Attachment also offers a secure base, allowing you to feel safe while you explore the world and learn new information. Its formation begins in childhood with a primary caretaker, such as a parent. Those early, established patterns carry through to adulthood. An "unavailable caretaker" creates distress in a baby akin to an "unavailable partner" creating distress in an adult. Attachment theory provides the emotionally-focused therapist with a "road map" to the drama of distress, emotions and needs between partners.

Grounded in Science in Couples Therapy

According to the website dedicated to EFT, www.ICEEFT.com, a substantial body of research outlining the effectiveness of this treatment exists. It is now considered one of the most (if not the most) empirically validated forms of couples therapy. Research studies have found that 70-75% of couples undergoing EFT successfully move from distress to recovery, and approximately 90% show significant improvements. This recovery is also quite stable and lasting, with little evidence of relapse back into distress.

Couples Therapy Tribeca
New York City Therapist Carolyn Ehrlich focuses on learning how we share space with each other. In therapy, both parties are given the opportunity to speak, guided by a therapist. And most importantly, both will be heard.

EFT is being used with many different kinds of couples in private practice, university training centers, and hospital clinics. It is also quite useful with various cultural groups throughout the world. The distressed couples who may benefit from EFT include those where one or both partners suffer from depression, addiction, post traumatic stress disorders and chronic illness, among other disorders. EFT has proven to be a powerful approach for couples dealing with infidelity or other more traumatic incidents, both current and past.

Effective Therapy for Distressed Couples

Neuroscience also intersects attachment theory and EFT. More recently produced MRI studies demonstrate the significance of secure attachment. Our attachments are potent, and our brains code them as “safety.” According to an article on EFT in Social Work Today, any perceived distance or separation in our close relationships is interpreted as danger. Losing the connection to a loved one threatens our sense of security. "Primal fear" ensues, and sets off an alarm in part of our brain called the , also known as the fear center. Once the amygdala is activated, it triggers our fight-or-flight response. When incoming information is familiar, the amygdala is calm. However, as soon as the amygdala encounters threatening or unfamiliar information, it increases the brain’s anxiety level and focuses the mind’s attention on the immediate situation. People go into a self-preservation mode, often doing what they did to "survive" or cope in childhood. This is the reason we are triggered as adults in our romantic relationships, in the same repeating (and unhealthy) patterns from our formative years. EFT can help to unwind these automatic, counter-productive reactions.

Fostering Healthy Dependency in Couples Therapy

EFT provides a language for healthy dependency between partners and looks at key moves and moments that define an adult love relationship. The primary goal of the model is to expand and re-organize the emotional responses of the couple. New sequences of bonding interactions occur and replace old, negative patterns such as “pursue-withdraw” or “criticize-defend.” These new, positive cycles then become self-reinforcing and create permanent change. The relationship becomes a haven and a healing environment for both partners.

Creating a Secure Bond between Couples

The process reduces couples’ conflict while creating a more secure emotional bond. Couples learn to express deep, underlying emotions from a place of vulnerability and ask for their needs to be met. Partners begin to view undesirable behaviors (i.e., shutting down or angry escalations) as “protests of disconnection.” Couples learn to be emotionally available, empathic and engaged with each other, strengthening the attachment bond and safe haven between them.

EFT has many strengths as a therapeutic model. First, it is supported by extensive research. Second, it is collaborative and respectful of clients. It shifts blame for the couples' problems to the negative patterns between them, instead of the couples themselves (or the partners). Finally, the change process has been mapped into a clearly defined process consisting of nine steps and three change events that help guide the therapist and track progress. If you are looking for help with a distressed relationship, an EFT trained therapist would be a wise choice.

By Marni Feuerman

Photo: Unsplash

Boca Raton Therapy
Christiane Blanco-Oilar, Ph.D., ABPP is a Board Certified Counseling Psychologist, specializing in Boca Raton Therapy. Dr. Blanco-Oilar has expertise in helping you through life transitions, grief and loss, intimacy issues, relationship difficulties - Couples Therapy Boca Raton - and in supporting your goal to achieve vibrant relationships with yourself and others. Offering therapy in Spanish.

Questioning for Clarity: Online Counseling New Jersey and Nutrition Coach Philadelphia

We have all struggled with uncertainty at one point or another in life, and you may find that the more you search for an answer, the muddier everything becomes. While using our analytical skills is important to help us weigh out the costs and benefits of various options, our analysis only takes us so far. What can you do when you have weighed all the options, and there is still no clear answer?

Manage your mental health symptoms through Online Counseling in New Jersey

Do you want to improve your mental health? Contact me to learn more about working together through online counseling in New Jersey.

Understand Your Motivation

Make a list of your options. Why are you considering these options? What started you on this journey, what led you to this point? Are you making fear-based decisions, or empowered and confident decisions? This process can help us evaluate how we move through our lives in more significant ways, but also in the ways that seem less consequential.

If we are used to moving through our day to day lives motivated by fear rather than feeling empowered, it is likely that this same pattern will be reflected in larger decisions we make. While there is nothing wrong with playing it safe, sometimes playing it safe can mean shrinking. For instance, if you fear judgement from other people, you might choose to keep your thoughts and feelings to yourself to avoid feeling vulnerable. However, there are times when sharing your thoughts and feelings can lead to a greater sense of feeling connected and understood by others. By playing it safe in this way, you avoid discomfort, but you might also be avoiding opportunities for connection.

Decisions on a larger scale are trickier. With any big decision, we often are not lucky enough to have a clear answer presented to us. An example of this might be choosing to move to another city in order to have a more expansive life experience. There are obvious risks in doing this, but also potentially great rewards.

Questions you can ask yourself to explore your motivation include:

  1. What might I be running away from or avoiding if I do make this decision? If I do not?
  2. What feelings do I value in life? Why? (Examples might be feeling adventurous, feeling secure, feeling relaxed, feeling open, feeling engaged)
  3. What feelings come up for me when I consider my options?
  4. What am I afraid will happen if I do make this decision? If I do not?
  5. What am I hopeful will happen if I do make this decision? If I do not?
  6. Why do I want to make this change? Why do I not want to make this change?
  7. Is this the best time for this change? Why or why not?
  8. What will I regret if I do make this change? If I do not?

I am not encouraging anyone to throw caution to the wind and make the more empowered decision if it does not ultimately feel like the right decision. Taking time to reflect on the questions above can help you to sit with and explore your thoughts and feelings in a more intentional way, and hopefully provide you with more insight into what is driving your decision making.

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

I now also offer online counseling in Pennsylvania Nutrition Coach Philadelphia Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

Photo by Jac Alexandru on Unsplash

The Guilt of Not Working More, When We’re Done for the Day

At the end of a day of work, there can be a simple practice of wrapping things up and shutting down for the day.

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Christiane Blanco-Oilar, Ph.D., ABPP is a Board Certified Counseling Psychologist, specializing in Boca Raton Therapy. Dr. Blanco-Oilar has expertise in helping you through life transitions, grief and loss, intimacy issues, relationship difficulties - Couples Therapy Boca Raton - and in supporting your goal to achieve vibrant relationships with yourself and others. Offering therapy in Spanish.

But so many of us feel guilty at simply stopping, and this feeling that we should be doing more … it drives some of us to keep going as long as we can.

This can lead to overwork, burnout, tiredness, and never letting ourselves enjoy a moment of rest.

Do you relate to this guilt of simply stopping and resting?

The thing about this guilt is that it doesn’t have to be rational — it’s simply fear, that we’re not doing enough, that we’re not on top of things, that we’re not going to be OK if we don’t get everything done.

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I know this fear well. I still have it, on a daily basis. It’s not rational, but then fear never is.

This fear will control us if we don’t bring a kind awareness to it, and start to work with us. It will own us, and we’ll always be checking our phones, replying to messages, stuck in perpetual motion. Rest becomes difficult, joy becomes mostly inaccessible.

Here’s how I work with this guilt and fear:

  1. Recognize it when it’s happening. When it’s late in the day, and we could be wrapping things up and closing our work day … notice the urge to do more. Notice the guilt of stopping. Just bring awareness to the fear and guilt, without judging them or needing them to go away.
  2. Breathe, and feel it. Pause, take a few deep breaths, and don’t let yourself buy into the fear. Feel the physical sensation of the fear, but don’t believe it. Give yourself some kindness.
  3. Remind yourself of a bigger truth. The idea that you should be on top of everything and working harder and checking emails and messages … it feels really true in the moment. But it is very rarely true. What’s a bigger truth? That you need rest to be able to serve others. That you are allowed to do other things, to spend time with others, to take care of yourself, to feel joy at spaciousness in your life. And this is a model for how others might live too. Taking rest serves the world. Remind yourself of this truth.
  4. Then take the rest. Feel in your heart how this is worthwhile. And let yourself enjoy the space. You don’t need to fill every moment with more work, more messages, more email.

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How To Experience More Wow

Awe might seem an unobtainable luxury to many but, with the right approach, you can enjoy it daily – no mountain required.

On a crisp, clear day in January about four years ago, my children and I joined a few thousand Rhode Islanders in a protest march against a recent change in law that restricted the number of refugees who could enter the United States. As I held the hand of my four-year-old son, I was overcome with emotion. ‘No hate, no fear, refugees are welcome here,’ the crowd chanted as we marched through the streets, my six-year-old daughter joining in stone-faced. With a tightness in my chest and tears in my eyes, I could barely join along without choking up.

At the time, I didn’t have a word to describe exactly what it was that I was feeling, but now I do: awe.

Since the march, I had a spell working as a research and writing fellow at the Greater Good Science Center based at the University of California, Berkeley, which gave me the opportunity and privilege to delve into the burgeoning science of this emotion. The more I learned about it, the more I came to believe that it’s worth recognising awe and trying to cultivate it in our lives.

For centuries, mystics, religious scholars, philosophers and artists have had differing understandings of what the word ‘awe’ means. It originally connoted fear and dread toward divine beings, but now has a more general meaning encompassing a wide variety of experiences. ‘I define it as the feeling of being in the presence of something vast and mysterious that you don’t understand with your current knowledge,’ says Dacher Keltner, the founder and a faculty director of the Greater Good Science Center, and a leading researcher into the psychology of awe.

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New York City Therapist Carolyn Ehrlich focuses on learning how we share space with each other. In therapy, both parties are given the opportunity to speak, guided by a therapist. And most importantly, both will be heard.

A landmark new scientific conceptualisation of awe by Keltner and his fellow psychologist Jonathan Haidt was published in 2003, based on what had been written about it from the fields of religion, philosophy, sociology and psychology. They proposed that, as varied as awe experiences can be, they all share two features: ‘perceived vastness’ and a ‘need for accommodation’.

According to this framework, while the perceived vastness of dramatic vistas such as canyons and mountains can provoke strong feelings of awe, this aspect of the emotion isn’t limited to literal size. Rather, it encompasses ‘anything that is experienced as being much larger than the self, or the self’s ordinary level of experience’, such as I felt on the Rhode Island march, but other related triggers might be extreme ‘social size’ (fame, prestige or authority), conceptual complexity and even outstanding moral goodness.

The other component of awe, ‘need for accommodation’, refers to the way the emotion forces us to change our understanding of the world. Awe can seem mind-bending in part because it is; it forces us to adjust our mental structures to assimilate new information (recent research scanning people’s brains while they experience awe suggests that this effect manifests at a neural level in decreased activity in the left middle temporal gyrus, a brain area that’s known to be involved Couples Therapy Tribeca in adjusting one’s previous schemas and understandings in light of new events and experiences).

Awe isn’t always experienced as a purely positive emotion. In around a quarter of awe experiences, people also report feeling a layer of fear. Imagine the mix of awe and alarm you might feel if you stumbled upon a grizzly bear on a hike, were stuck in a thunderstorm, or contemplated going to Hell. Early evidence suggests that this kind of threat-based awe might be more prominent outside the Western European and North American populations that have been the source of many awe studies. ‘You find more threat-based awe in hierarchical cultures,’ says Keltner. That said, his work has found that, at least in the Western world, most awe experiences are positive and have positive effects. ‘A quarter of the experiences are threat-based but three-quarters are really about exploration and connection, and have a lot of delight in them,’ says Keltner.

There’s a lot we can gain from those more delightful awe experiences. In the past nearly two decades of research on awe, dozens of studies have unearthed benefits associated with the emotion. ‘On all the major checkboxes of what’s good for you, it does a pretty good job,’ says Keltner.

For starters, there appears to be a connection between experiencing awe and better physical health. In a recent study, Jennifer Stellar, a psychologist at the University of Toronto, found that awe was one of the positive emotions most strongly associated with having lower levels of proinflammatory cytokines – protective proteins that are released when you get injured or ill, but which can have negative effects on health when they’re chronically elevated, including raising the risk of cardiovascular disease, diabetes and depression.

In terms of awe’s psychological benefits, there’s even more compelling evidence, with research linking greater experience of the emotion to more life satisfaction, increased humility, better mood, dampened feelings of materialism, and greater scepticism toward weak arguments.

Awe can make us better social beings, too. In multiple studies, participants who have been asked to write about an awe experience or who experienced awe in an experiment displayed more generous and cooperative behaviour than people who were induced to feel other emotions.

Besides boosting life satisfaction and making you a kinder person, awe experiences often just feel good – and important. ‘People report it being a very profound experience to have awe,’ says Stellar. ‘It also makes people see the world in a different way, and I think that’s valuable in its own right.’

Awe might feel profound in part because it encompasses a number of transcendent phenomena. It can change our perception of time, making it seem more plentiful and expansive, allowing us to savour the here and now. During awe, people also report feeling less significant and smaller relative to their environment – a positive effect that researchers term ‘the small self’.

‘When people feel shame, they feel very small, but they also feel very aware of themselves, which is different than awe where they feel small but not so aware of themselves,’ says Stellar. ‘[Awe] seems to be this very interesting situation where you can feel self-diminishment, but it’s a good and exhilarating feeling.’ At a neural level, brain imaging research suggests that this is reflected in reduced activity in the ‘default mode network’, a network of brain regions that are particularly active when our minds are wandering or we’re thinking about ourselves (similar neural effects are observed during meditation, states of flow and psychedelic trips).

While awe makes us less focused on ourselves, evidence suggests it also makes us feel more connected to other people, more a part of a greater whole and something larger than ourselves. In this way, it creates a bridge between what Keltner calls the ‘default self’ – our drive to do well, meet our goals, protect ourselves, rise in status – and our desire, and indeed need, to be part of society and help others. ‘I’ve got to protect myself, but I’ve got to serve the collective – that’s one of the great tensions in identity and in our evolution,’ says Keltner.

While we can imagine how, in the wrong hands, this bridge can be used as a force for manipulation – think of a charismatic cult leader or suicide bomber – the transformative effects of awe can also be powerfully positive. ‘[I]t seems to be this really important emotion for when we’re confronting things that might be scary and bigger than us and hard to understand, but it’s the positive side of that,’ says Stellar. ‘It’s so embedded into humanity’s goal of trying to understand the world better and really taking on that challenge and those scary, unfamiliar parts, rather than shying away from it.’

All that being said, some of us are clearly more awe-prone than others. Modern life can also make awe feel inaccessible. If your life is packed full of work stress, domestic demands and commercialised spaces, you might feel that experiencing awe in your day-to-day existence is a challenge – or even an unobtainable luxury. I know I’ve felt that way, especially in the middle of a global pandemic when I’ve rarely left my suburban home and found myself in a loop of repetitive routines. Fortunately, there’s research suggesting that we don’t need to step out of our everyday lives to experience more awe, and in this Guide I’m going to show you how.

What to do

To foster more awe in your life, Keltner recommends exploring the ‘eight wonders of life’. Before I share these wonders with you, here are a few broad considerations that might make it more likely that you’ll have an awe experience:

*If possible, limit distractions. Complete the task that has been nagging you. Turn off notifications on your phone (or leave it in another room or at home). Ask your partner, roommate and/or children for some space.

*Treat your awe experience like a contemplative exercise. Begin with some deep breathing, and pay attention to the sound and feeling of your breath as you inhale and exhale.

*Turn your attention outward and be open to inspiration. Notice what catches your mind. Do some of your senses seem heightened? Do you feel goosebumps? Do you feel more curious? Delighted?

*Don’t worry if you’re not feeling awe. Awe is different for everyone, and some days you might just not be feeling it.

The nice thing is, once you start thinking about awe, you might begin to notice all the places it shows up in your everyday life. In other words, you might naturally experience awe more often as you start to pay attention to it, similar to how people often feel more gratitude once they begin a gratitude journal. Of course, not all awe experiences will move you to tears or make you feel at one with the Universe. Just as with other emotions, awe comes in a range of intensities – from the gentle awe you might experience on a walk through the woods to the life-changing awe you might experience at the birth of your child.

Some places I believe I’ve experienced awe include concerts, sporting arenas, movie theatres, the Badlands National Park, the Pacific Coast, in my previous life as a neuroscientist, and as a parent. ‘In our studies around the world, people are feeling it two or three times a week,’ says Keltner. ‘I think you can get a little dose every day.’

Now to Keltner’s Eight Wonders of Life – eight ways to seek out more awe:

1. Witness other people’s moral beauty and courage

The first wonder of life, according to Keltner, is other people’s moral beauty and courage. It’s easy to become awestruck by stories of courageous people such as Harriet Tubman, Martin Luther King, Jr or Greta Thunberg. Similarly, Stellar notes that movements for social change, such as Black Lives Matter and March for Our Lives, can be awe-inspiring for people. Generally speaking, Keltner thinks that we tend to discount the extent to which other people are important for awe. ‘We often think of awe as spiritual or natural – and that’s part of it – but the bigger story is it’s about our fellow human beings… We find that 50 to 60 per cent of awe experiences are just like you’re blown away by other people,’ he says. People can also feel awe when observing someone with incredible skill or talent or unique abilities (think Michael Jordan or a contortionist).

2. Move in unison with others

From ceremonial dances to army marches to tapping your toes in rhythm with a friend, humans have a natural proclivity for synchronised movement. Several studies have found that people are more cooperative and generous after moving in unison with others, and that they feel more bonded to their movement partners. Moving together appears to help strengthen social ties and, says Keltner, it can also elicit awe. To test out this wonder, try participating in a form of shared movement such as dance, exercise, playing music, singing in a choir, cheering on a sports team or even walking with a friend.

3. Get out in nature

Importantly, you don’t need to visit the Grand Canyon or the Great Barrier Reef to get a dose of awe from nature. ‘It can just be a walk through a forest that’s near your house,’ says Stellar. To get more awe out of an everyday hike, Keltner recommends taking time to deepen your thinking about the experience. ‘Start to look for patterns in nature, take a moment to think about what’s vast,’ he says. You might consider making a habit of going for ‘awe walks’. In a recent study, Keltner and his colleagues found that older adults assigned to take weekly 15-minute awe walks reported greater increases in positive emotions and decreases in distress in their day-to-day lives than did those assigned to a control walk condition. The Greater Good Science Center offers step-by-step instructions for getting the most out of an awe walk, including how to breathe and shift your awareness to what’s around you.

4. Listen to or create music

Listening to a symphony, singing in a choir, or playing an instrument can produce feelings of awe. If you’ve ever had goosebumps or what people call ‘the chills’ while listening to a particularly moving song, you were likely also experiencing awe. While listening to any form of music has the potential to elicit awe, songs that are exceptionally beautiful or complex are more likely to produce the emotion. Making music with others – be it in a choir, band or orchestra – might also increase the likelihood of awe because those activities have the added benefit of involving synchronised movement.

5. Take in visual art or film

Visits to art galleries and museums (in person or online), public art and sculpture, and movies with stunning visual elements can all provoke awe. Stellar, who lives in Toronto, says she normally seeks out awe in the city by going to museums and galleries. Visuals that might be more likely to evoke awe are those that are very large – such as Michelangelo’s David or the Taj Mahal – or very detailed, intricate or complex, such as a fractal or an exceptionally lifelike painting. Even the most common elements can produce awe when presented in a unique way. In one study, viewers experienced awe when they watched a slow-motion video of drops of coloured water falling into a bowl of milk.

6. Seek out a spiritual or religious experience

For people of faith, religious gatherings, ritual and prayer can be profound sources of awe. Meditation, Stellar notes, can also inspire awe for some. Even recalling a past spiritual or religious experience can evoke feelings of awe. In a 2017 study, participants who wrote about spiritual experiences reported higher levels of awe and a greater sense of ‘a small self’ than did control participants who wrote about humorous experiences. Both religious and non-religious participants experienced these effects despite recalling different types of memories. Religious people recalled more religious events as well as life-and-death events, whereas non-religious people were more likely to recall experiences with nature, science, yoga or meditation. The message here is that the types of experiences that you personally deem spiritually meaningful are the ones most likely to result in awe.

7. Consider a big idea

‘It gets kind of metaphysical,’ says Keltner. ‘Big ideas give people awe – like Marxism, free markets, evolution.’ You might have already had an experience in school or while reading that filled you with awe. The process of wrapping your mind around a new concept is cognitive accommodation, a key competent of awe. So if you take the time to grapple with a new, big idea for you – say quantum physics – that could bring more awe into your life. Similarly, Keltner says poetry that at first glance can seem difficult to comprehend can evoke awe when the reader discovers what the poem is about.

Another related way to add more awe to your life is to deepen your contemplation and curiosity about the world by posing questions or puzzles to yourself – to turn everyday experiences into a way to think about big ideas. For example, Keltner recommends thinking about clouds and how they work – or waves, or rainbows. This is a way to transform simple wonder into awe and discovery. He points out that the obsessions René Descartes and Isaac Newton had with rainbows led them to figure out the physics of light.

I’ve found that parenting can be a fountain of inspiration for this type of awe, both because I experience awe secondhand when my children understand something for the first time, and because human development (such as witnessing children learn to talk, read and do mathematics) is awe-inspiring.

8. Witnessing life and death

For parents, the miracle of pregnancy or birth can create feelings of awe. Contemplating or witnessing death, too, is often tinged with awe, although confronting this aspect of awe can be psychologically difficult. While you might not want to go out of your way to cultivate these experiences in your personal life for the sake of awe, life and death are prominent themes in many memoirs, novels and other forms of art.

Hopefully, one thing that comes across from Keltner’s Eight Wonders of Life is that awe can be found in many corners of our everyday lives. ‘We talk about it as if it’s a once-in-a-lifetime thing, but in fact it’s everywhere,’ says Keltner. That said, research suggests that some people – whether by personality and/or life circumstance – are more naturally prone to experiencing awe. If you’ve tried some of these activities and haven’t experienced awe, don’t despair. Keep seeking out new experiences that interest and excite you. Who knows? You might just discover a ninth wonder.

‘My big advice is that some people aren’t that into music or nature or whatever, but everybody can find something that makes them feel awe,’ says Stellar. ‘Awe is an amazing emotion and there are so many different ways people can experience it. Find that thing that does it for you and keep doing that.’

A note about psychedelics

An elephant in this awe-filled room is psychedelic use. According to Keltner, there is some theorising that the psychedelic experience is essentially the experience of awe. In a 2018 article, Peter Hendricks, a clinical psychologist at the University of Alabama at Birmingham, lays out the case for how ‘mystical experiences elicited by classic psychedelics appear to exemplify awe’.

Indeed, people who use psychedelics report feeling a sense of connectedness with humanity and oneness with the Universe, as well as a changing awareness of the self. In the scientific study of psychedelics, this is known as ‘ego dissolution’, which could be conceptualised as an extreme example of the small-self phenomenon common in awe experiences. Intriguingly, Hendricks also proposes that awe might be the mechanism that underlies the positive effects caused by psychedelic-assisted psychotherapy. While I can’t personally attest to or vouch for or against psychedelic use, this branch of awe research will likely continue to develop as a growing number of municipalities in the US – and the entire state of Oregon – have decriminalised use of the hallucinogen psilocybin. If you’d like to explore further, a previous Psyche Guide covered the basics of how to have a safe psychedelic trip.

Couples Therapy Tribeca Key points

*Awe is a complex emotion that tends to arise when you’re in the presence of something vast that you don’t already understand. It heightens your sense of time, makes everyday concerns fall from view, shifts your perspective, and makes you feel more connected with the world and part of a greater whole.

*Awe is usually, but not always, perceived as positive, and experiencing it more often is associated with a range of physical and psychological benefits including reduced inflammation, greater life satisfaction and humility.

*The vastness that provokes awe doesn’t necessarily have to mean physical size. Any type of stimulus that goes beyond your ordinary experience of the world could qualify, including objects or concepts that are especially complex or people who are exceptionally famous, prestigious or morally good.

*Awe is more common than you might think. People experience awe on average 2.5 times a week. You don’t need to summit a mountain to experience awe. It can be found in your own backyard, in a book or on the internet.

*Adopting the right mindset can increase your chances of experiencing awe, including deepening your breathing and turning your attention outward.

*Look to Keltner’s Eight Wonders of Life for experiences that can make you feel awe: moral beauty and courage, moving with others, nature, music, visual art and film, spiritual and religious experiences, big ideas, life and death.

*Awe experiences are different for everyone. What elicits awe in one person might not have the same effect on you. It’s worth trying a variety of experiences.

Learn more

Our notions about awe – what the emotion is like and what experiences are likely to inspire it – have changed over time. Nowadays, awe has mostly positive connotations, particularly in the Western world, but this wasn’t always the case. Even today, the Merriam-Webster dictionary defines awe as: 1) ‘an emotion variously combining dread, veneration, and wonder that is inspired by authority or by the sacred or sublime’, and 2) ‘[archaic] a: dread, terror; b: the power to inspire dread’.

To chart the meaning of awe over the centuries, Stellar teamed up with a linguist in her university’s computer science department to analyse how the usage of the word ‘awe’ has changed over time in Google’s corpus of texts. ‘There is evidence that it has changed to become more positive,’ says Stellar. ‘It looks like the time period in which it’s changing has to do with transcendentalism and Romanticism as philosophical movements that prioritise beauty in nature and spirituality.’ In other words, rather than being tied to scary gods and fearful experiences, awe began to be tied to beauty in nature, art and music.

This change in the cultural meaning of awe might mirror the changing relationship between people and nature. The American environmental historian William Cronon articulates this change in his essay ‘The Trouble with Wilderness; or, Getting Back to the Wrong Nature’ (1995):

Go back 250 years in American and European history, and you do not find nearly so many people wandering around remote corners of the planet looking for what today we would call ‘the wilderness experience’.

Whereas people today seek solace and awe on mountains and in canyons, this would probably have seemed strange to people in the 18th century or earlier, at which time Cronon says we were much more likely to associate being in wilderness with ‘bewilderment’ or ‘terror’ (and thus closer to the historic darker notions of awe).

One need only look at the Bible, says Cronon, in which the wilderness was a place where people found themselves in ‘moral confusion and despair’ – where Moses wandered for 40 years, and Christ struggled with the Devil, and where Adam and Eve were ousted to from Eden. ‘Wilderness, in short, was a place to which one came only against one’s will, and always in fear and trembling,’ writes Cronon.

This began to change with the spread of Romanticism. The Romantics had the idea that it is in sublime landscapes that people are most likely to experience the sacred and, in Cronon’s words, ‘glimpse the face of God’. Cronon adds: ‘He [God] would most often be found in those vast, powerful landscapes where one could not help feeling insignificant and being reminded of one’s own mortality … God was in the mountaintop, in the chasm, in the waterfall, in the thundercloud, in the rainbow, in the sunset.’

It’s true that early Romantic writers found these kind of nature experiences terrifying. Consider a poem by William Wordsworth about his visit to the Alps where his encounter with the divine evoked a decidedly terror-tinged sense of awe, with ‘Winds thwarting winds bewildered and forlorn’. But a century later, there are signs of this fearful attitude changing. Here’s the Scottish-American naturalist John Muir in 1911 describing Yosemite’s North Dome:

No pain here, no dull empty hours, no fear of the past, no fear of the future. These blessed mountains are so compactly filled with God’s beauty, no petty personal hope or experience has room to be. Drinking this champagne water is pure pleasure, so is breathing the living air, and every movement of limbs is pleasure, while the body seems to feel beauty when exposed to it as it feels the campfire or sunshine, entering not by the eyes alone, but equally through all one’s flesh like radiant heat, making a passionate ecstatic pleasure glow not explainable.

It’s clear that Muir is describing an awe experience here, complete with a changing perspective of time and diminishment of the self, in tune with the contemporary psychological definition of the emotion. This broader cultural shift also meant that by the late 1800s people were beginning to seek out experiences in nature. Natural sites in the US, such as Niagara Falls, the Catskills, Yosemite and Yellowstone, started to become tourist destinations. Wilderness was no longer a place to avoid out of terror or temptation, but rather a place to seek out beauty, the sacred, wonder and awe.

‘The Romantic legacy means that wilderness is more a state of mind than a fact of nature, and the state of mind that today most defines wilderness is wonder,’ writes Cronon in his 1995 essay, although he could just as easily have defined it as awe, wonder’s more magnificent cousin. ‘The striking power of the wild is that wonder in the face of it requires no act of will, but forces itself upon us – as an expression of the nonhuman world experienced through the lens of our cultural history – as proof that ours is not the only presence in the Universe.’

Links & books

My 2018 white paper for the Greater Good Science Center delves into dozens of studies about the science of awe. It includes a discussion about how to define awe, who is most (and least) likely to experience awe, why a feeling such as awe might have evolved, what experiences tend to elicit awe, and what’s known about the physical and psychological effects of awe.

The psychologist and awe researcher Dacher Keltner recommends checking out the Greater Good Science Center’s series of step-by-step awe exercises and this guided awe walk meditation through Muir Woods in California that he did for Mindful.org.

Keltner also recommends Alan Cowen’s Mapping Emotion website. By exploring these maps, you can see what sounds, videos and facial expressions correspond to awe and other emotions. In particular, he recommends the ‘Emotional Experiences Evoked by Video’ map that shows which emotions were most commonly evoked by 2,185 different short video segments. A research study about these findings was published in the Proceedings of the National Academy of Sciences.

The psychologist and awe researcher Jennifer Stellar recommends watching clips from the BBC Earth channel on YouTube, attending virtual or in-person concerts by a symphony orchestra, or visiting a photography exhibit hosted by a museum.

The ultimate awe experience might come from seeing Earth from space. A 2016 paper by the psychologist David Yaden includes several quotes from astronauts discussing this experience, sometimes called the ‘overview effect’. While most of us will never be able to truly experience this first-hand, you can still get a dose of awe from viewing the International Space Station’s live feed of Earth. In a similar vein, I use Chrome’s Earth View from Google Earth browser extension, which displays an image from across the globe each time I open a new tab.

Yaden founded the Varieties Corpus, a website where people can share and learn about self-transcendent and awe-inspiring experiences.

Perhaps surprising to some, Couples Therapy Tribeca social media can be a great place to encounter strange moments of awe. Some recent awe-inspiring posts I’ve seen on Twitter include a giant xylophone in the woods of Japan that plays Bach and a video of the surface of Venus.

Books that touch on personal awe experiences include Mountains of the Mind: Adventures in Reaching the Summit (2004) by Robert Macfarlane, A Private History of Awe (2006) by Scott Russell Sanders, and How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (2018) by Michael Pollan.

Summer Allenis a freelance science writer and former neuroscientist. She served as a research and writing fellow for the Greater Good Science Center at the University of California, Berkeley. Her work has appeared in The Washington Post, Mindful magazine, and other outlets. She lives in Portland, Oregon.

Photo: Pexels

Active Listening – Online Counseling New Jersey

When communicating in counseling

It can be easy to focus more on what we are saying than how we are listening. If we are not truly hearing what someone is saying to us, then communication is not successful and misunderstandings occur.

While listening may seem straight forward, there are many ways to practice poor listening skills that you may not recognize are barriers to really understanding someone. Some examples of poor listening habits include when you are distracted while someone is speaking, planning your response in your head before someone finishes what they are saying, or responding judgmentally to what someone has shared. Being mindful of the lens you view the world through can increase your awareness of any bias informing how you interpret and respond to information.


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If you have had poor listening habits, no need to worry. Active listening is a skill you can build with practice and commitment. Here are some tips on how to practice active listening2:

  1. Be aware of your nonverbal cues. Even when we aren’t verbally contributing to a conversation, we are contributing through our body language or subtle sounds we might make to indicate our engagement.
  2. As I mentioned above, judgment gets in the way of understanding someone. When you want to make someone feel heard, drop the judgment and know that you do not need to take a stance by agreeing or disagreeing with what’s being said.
  3. Focus on the present moment by devoting your attention to the speaker rather than distractions. It’s easy to get lost in thought if we aren’t making an effort to be present. There is so much information we can absorb when we are really hearing someone, such as changes in their tone of voice or body language.
  4. Reflect back what you are hearing to make sure you are understanding. This shows someone that you are following what they are saying, and if you reflect back inaccurately, it provides an opportunity for clarification.
  5. Dive deeper by asking questions about their experience. This shows that you have not only been following what someone is saying, but that you are interested in learning more about their perspective.

There are many reasons to cultivate active listening skills. It will likely improve your relationships and it will help you understand others. Active listening has been found to be significantly associated with empathy.2

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides online counseling in Pennsylvania, contact her to learn more.


  1. https://positivepsychology.com/active-listening/
  2. https://www.sciencedirect.com/science/article/pii/S2352900816300231
  3. Photo by Bewakoof.com Official on Unsplash

Menstrual Cycle and Mood

The menstrual cycle is composed of four different phases, which vary in duration from woman to woman, and may fluctuate in length. The phases are menstrual, follicular, ovulation, and luteal. While the length of a menstrual cycle varies from woman to woman, many experience a cycle that lasts 28 days. During the fluctuations of a cycle, key hormones - testosterone, progesterone, and estrogen -  increase and decrease in a pattern that influences how we feel.

Nutrition Coach Philadelphia
Sarah Tronco, CMHIMP, is a 
Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

Menstrual Phase

The beginning of your menstrual phase happens when your period arrives and, on average, spans five days. The uterus is shedding its lining through the vagina during this time.  This marks the lowest level of estrogen during our cycle. You may be feeling more solitary at the beginning of this phase. As estrogen increases during this week, often we experience increases in energy, improved mood, and more of a desire to be around others.

Follicular Phase (aka the Proliferative Phase)

The follicular phase overlaps with the menstrual phase, since it begins at the start of your period and spans until ovulation. The purpose of this stage is to prepare an egg to be released, which it does by producing follicle stimulating hormone, or FSH. FSH sends a message to the ovaries letting them know to ready an egg to be released from the ovary, known as ovulation. Fluid filled sacs called follicles are contained in the ovaries, and the largest, dominant follicle produces estrogen during growth and is released during ovulation. The average length of the follicular phase is 10-22 days.1 This stage is also known at the proliferative phase because increasing estrogen levels result in the proliferation of the endometrial lining of the uterus.2 Your mood may feel more calm as estrogen has continued to increase during this stage of your cycle.


Beginning around two weeks into your menstrual cycle, luteinizing hormone levels increase due to high levels of estrogen and cause ovulation when the dominant follicle bursts and releases a mature egg into a fallopian tube.3 The phase generally takes place about 14 days before the beginning of the next menstrual phase. Estrogen and testosterone are highest at this point in your cycle, which cause you to feel more aroused as your body tries to get pregnant.

Luteal Phase

The fourth and final stage of your menstrual cycle is the luteal phase, which spans the latter half of your menstrual cycle and lasts approximately 14 days. During this time, the released egg is making its way through the fallopian tubes toward the uterus. You experience a spike in progesterone and estrogen during this phase. Pregnancy will occur if your egg is fertilized by a sperm. However, if this doesn’t happen, then estrogen and progesterone decrease and your body sheds the endometrial lining of your uterus during your next period. During this stage, you may feel increasingly more lethargic or have difficulty focusing. Some women experience negative mood symptoms, such as sadness or irritability. During the luteal phase, you experience a drop in serotonin, which may contribute to feeling of sadness prior to menstruation.4

Nutrition Coach Philadelphia Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.




  1. https://helloclue.com/articles/cycle-a-z/the-menstrual-cycle-more-than-just-the-period
  2. https://progyny.com/education/fertility-101/follicular-phase/
  3. https://www.verywellhealth.com/the-menstrual-cycle-3520919
  4. https://www.blackmores.com.au/womens-health/how-your-menstrual-cycle-affects-your-mood
  5. Photo by Andrés Gómez on Unsplash

Cortisol, Stress, and Overall Nutritional Health

Cortisol is our body’s primary stress hormone. Our levels of cortisol fluctuate throughout the day, with morning typically being when we have our highest levels of cortisol with a decrease throughout the rest of the day. The changes in our cortisol levels throughout the day is known as diurnal cortisol slopes.1

What is the function of cortisol in the body?

In the context of mental health, we often associate cortisol with stress, however, it plays a role in many essential bodily processes, such as our immune response, regulating blood sugar, metabolism, and decreasing inflammation. Cortisol belongs to a group of steroid hormones, known as the glucocorticoids, and is produced from the two adrenal glands found on top of each kidney.2 Throughout your body, almost every cell has cortisol receptors, so cortisol’s function varies depending on the type of cell receiving it.3


Nutrition Coach Philadelphia
Sarah Tronco, CMHIMP, is a 
Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.


When cortisol levels are too high…

When we face a stressful situation, our body experiences a hormonal response, including the release of cortisol in the body. The function of cortisol release is to help the body prepare for fight or flight response (check out my post Soothing the Stressed Amygdala). However, when our lives are full of stressors that don’t necessarily warrant a fight or flight reaction, the frequent release of cortisol can cause issues over time, including gastrointestinal problems, cardiovascular disease, immune system suppression, fertility issues, weight gain and obesity, and blood sugar imbalance and diabetes.2

Managing stress

Certain lifestyle changes, such as incorporating meditation, having a social support network, and exercising, are important for managing stress levels. Being mindful about food choices is another essential tool for caring for yourself, reducing stress, and regulating cortisol. For instance, making sure you are hydrated, choosing black or green tea instead of other caffeinated beverages, incorporating probiotics and prebiotics, dark chocolate, and avoiding excess sugar are all ways to support a healthy stress response.4


Nutrition Coach Philadelphia Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568897/
  2. https://www.todaysdietitian.com/newarchives/111609p38.shtml
  3. https://www.yourhormones.info/hormones/cortisol/
  4. https://www.healthline.com/nutrition/ways-to-lower-cortisol#TOC_TITLE_HDR_13
  5. Photo by Marcus Dall Col on Unsplash

Staying at the Edge of Uncertainty & Anxiety

When we get into a situation that feels uncertain, most of us will immediately try to get to a place of certainty.

Instead of writing a blog post, I’ll find myself wanting to check emails or my favorite websites.

Instead of having a difficult conversation, we’ll stay in a crappy situation for longer than we need to.

Instead of putting our art out into the world, we’ll hide it in the safety of obscurity.

When things feel chaotic and overwhelming, we look for a system that will feel ordered and simple.

All of us do this in most areas of our lives. Sometimes, we are able to voluntarily stay in uncertainty, but those times are relatively rare, and usually we don’t like it so much.

Here’s the thing: the edge of uncertainty and chaos is where we learn, grow, create, lead, make incredible art and new inventions.

The edge of uncertainty is where we explore, go on adventures, get curious, and reinvent ourselves.

The edge of uncertainty is where we can find unexpected beauty, love, intimacy, vulnerability, meaning.

Everything we truly crave is at the edge of uncertainty, but we run from it.

The trick is to stay in it.

An anxiety disorder can interfere with your everyday life including work, school, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and phobia-related disorders. There are several types of anxiety treatment boulder. To learn more contact WellTalk. Anxiety Disorder Boulder.

The Edge of Anxiety, Not Deep in the Pit

I say the “edge of uncertainty” because most of us are unprepared to be fully in uncertainty without some kind of ground under our feet. We need some certainty, some safety. Without it, we feel like we’re spinning out of control.

When our lives become untethered, we need some kind of ground to stand on. When we’re lost in depression or trauma, we need to feel the ground of our basic goodness, of knowing that there are others here with us.

So I don’t recommend letting go of all certainty. Let your life be mostly stable.

But once you have a little stability, let yourself get to the edge of uncertainty.

It’s the place where you’re learning, but not completely lost. Where you are exploring, but not freefalling. Where you’re creating something new, but not without some grasp of what came before you.

Stay at the edge, and then let yourself rest in some kind of comfort. Go to the edge, then come back and take a breather.

How to Train at the Edge

If you’d like to get good at staying in uncertainty, I highly recommend daily training.

And no, it’s not enough to say, “My life is all uncertainty, I’m already doing it!” I mean, that’s probably true, but it’s not deliberate practice. It’s what’s happening to you, but you’re not deliberately training to stay at your edge.

So I recommend daily deliberate practice:

  1. Set aside a time. It’s not usually helpful to say that you’ll do it sometime. You already have enough of those things in your life, adding one more won’t be helpful. So pick a time and set multiple reminders.
  2. Pick something you’re avoiding or feel overwhelmed/afraid of. Writing that book or report, marketing, giving honest feedback, dealing with new technology, making calls, recording videos, etc. It should make you feel somewhere around a 7 out of 10 resistance. Have a good reason to do this task, not just because it’s hard. Are you doing it for something meaningful to you? For someone you care about?
  3. Do it for a short time. Just 10 minutes is fine, or 15. Work up to 30 minutes a day. You just need to stay there a little while, not forever.
  4. Learn to embrace the uncertainty. Notice how you feel like doing something else. Let yourself feel the uncertainty, as a physical sensation in your body. Let yourself stay there, but bring curiosity instead of complaint to the uncertainty. See if there can be any kind of openness, gratitude, even joy in the middle of the uncertainty.
  5. Be kind to yourself. Notice if you’re beating yourself up about not doing more or doing better, and let go of some of that. Be kind. If you’re trying to force yourself to do something you hate, give yourself encouragement. Cultivate a friendly attitude toward yourself in this training.

It also helps to have accountability, or to do it with others (on a video call, for example).

An anxiety disorder can interfere with your everyday life including work, school, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and phobia-related disorders. There are several types of anxiety treatment boulder. To learn more contact WellTalk. Anxiety Disorder Boulder.

12 Ideas for Establishing a Calming Routine

One of the most rewarding changes in your life can be finding peace with a morning routine.

I’ve made it a habit to wake before most of the world, at about 4:30 a.m., and just enjoy the quiet and solitude.

It has made all the difference in the world.

I sit quietly with a cup of coffee, and enjoy the silence. I go for a morning run, which relieves stress and is perfect for contemplation. I use the quiet time before my family awakes to write something each morning. I read, as a good novel is one of my favorite companions.

Now, not everyone is a morning person, of course. But that doesn’t mean you can’t create your own routine, one that incorporates something that gives you solitude, quiet, or stress release. While morning is an ideal time for such a routine, other ideal times are after work and before bed — and really, any time that works for you is good.

I recommend that if you haven’t yet, you create your own calming routine.

Give it a couple of weeks to become a habit, focusing on doing it every day, and soon, you will not want to miss it.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

Here are just a few ideas to get you started:

  1. Morning coffee. If you’re not a coffee person, tea or cocoa work great as well. Sit and enjoy the silence as you wake up, and even better, watch the sun rise. It’s the perfect way to greet the day.
  2. Exercise. I like to go on an easy run. It relieves stress, and gives me time to myself to think, and enjoy nature. Evening runs are great too, especially as the sun goes down. If you’re not into running, walking, cycling, swimming, or really any exercise works well. Just take it easy in the beginning, and try to do a little every day. Don’t overdo it.
  3. Meditation or yoga. I haven’t been meditating on a regular basis, but when I do, it’s so calming, and so centering. You don’t need to do anything formal — simply focusing on your breathing, as it goes in and out, is a good meditation. While I’ve never been into yoga, I know a lot of people who swear by it, and I would recommend you give it a try if it sounds appealing to you.
  4. Gratitude session. This is one of my favorite rituals: every day, take a couple of minutes to think about everything and everybody you are grateful for in your life. This may sound corny, but it is an amazing ritual. Try it right now — it only takes a minute. Who are you grateful for? What are you grateful for? I’ve found that this little ritual has so much power that it makes me happier and more compassionate. Btw, every time I do it, I thank the people who donated and helped me become a giant step closer to my dream (that’s you guys!).
  5. Goal mantra. This is another one of my absolute favorites. I got the idea from Guy Kawasaki, who tells us that corporate mission statements are basically useless, and recommends you create a corporate mantra instead of three or four words (tops). So instead of creating a corporate mantra, I created a personal mantra to remind myself of why I do everything I’ve been doing this year (with the blog, all my writing, and some new projects that are coming up, including an e-book). Here it is: Liberate Yourself. And I just make sure to repeat this mantra at least once a day (if not several times). It helps me stay focused. I suggest you do the same for your personal mission.
  6. Evening review. I think this would be an especially fruitful routine for anyone. Basically, it’s a routine that Ben Franklin did himself: he would spend some time at the end of each day to review how he did with his goal, and reflect on how his day went. It only needs to take a few minutes, but just go over your day, think about your goal (your mantra), what you did to further that goal, what you did right and what you did wrong today, what you can improve, what you need to do in the future. If you want to journal this, it would be even better!
  7. Bath time. My home doesn’t have a bath tub, but I truly cherish a long hot bath. If you have the time to do this, it can be extremely relaxing.
  8. After work unwinding. Long day at work? Stressed out? Take 30 minutes to unwind. Some great ideas for that: a 20-30 minute nap, snuggling with your kids, deep breathing, stretching, self-massage, or really anything that relaxes you.
  9. Pre-bed ritual. Another ideal time for a calming routine is just before you go to bed. You can do any of the calming things mentioned in the other items, or just develop a routine: get clothes ready, get lunches ready, clean up, brush teeth, decide on your three Most Important Tasks (MITs) for tomorrow, etc.
  10. Journaling or writing. A morning writing ritual is a good thing, but you can do a writing ritual at any time that works for you. Or instead of writing, try journaling. It can be very productive and relaxing.
  11. Conversation. Try this: every night for an hour, just sit and talk to your spouse. Share the highlights and lowlights of your day, talk about your goals, your finances, your relationship, movies, music, books. This can, of course, be adapted for conversation with your children.
  12. Reading time. Ah, one of my favorites. Take time each day to spend with a good book. Or a trashy novel. It doesn’t matter. I actually like to take time in the morning and evening, but whatever time is convenient for you will work.

How to Do the Thing You’re Avoiding

Most of us have something on our task list we’re avoiding or a project we’ve been putting off.

Think for a moment: what’s the task or project you’ve been avoiding lately?

Some possibilities:

  • That report you don’t want to write
  • Your book or blog you’ve been meaning to write
  • The business you’ve been wanting to create for years
  • Your garage you’ve been meaning to declutter
  • That email that’s been sitting in your inbox for a month
  • Going for a run

So what is it you’ve been avoiding? Identify it now before you move on.

In this article, we’ll look at why you’re avoiding it, and how to actually do the thing.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

Why We Avoid the Thing

We often spend our days doing everything but the hard thing we don’t want to do.

We’ll research something to death instead of actually just doing the thing. We’ll talk about it, read about it, buy all the equipment for it, but not actually do the thing. We’ll do our email, messages, small tasks, and check social media or the news — just real quick! — instead of doing the thing.

Why? We’re protecting ourselves from uncertainty. We don’t want to feel like we don’t know what we’re doing. We don’t want to look stupid. We don’t want to feel overwhelmed, we don’t want to feel like we’re not good enough, we don’t want to feel like a failure or disappointment.

We’re protecting ourselves from feeling that. So we do everything else, out of protection.

And of course, it doesn’t work. Avoiding doing the thing actually just makes us feel more overwhelmed, more like a failure or disappointment, more stupid or not good enough.

Avoidance doesn’t actually work.

So how can we stop avoiding, and actually do the thing?

How to Actually Do the Thing

We do the thing by deciding to do the thing. Like, deciding decisively to do it.

We have to pause for a moment and actually consider that we’re avoiding something – which is what I asked you to do at the beginning. Did you do it then? We usually don’t want to face that fact, so it can help to have someone else to talk to about it, to report to, to commit to. Every day, tell someone what hard thing you’re going to do, and by when. Then report to them the next day, right before you tell them what you’re going to do that day.

Decide to do it, and then don’t waver. Don’t let yourself argue about it. When you decide to do it, just commit and do it.

Do it at a certain time: tell your accountability buddy you’re going to do it at 10am, or whatever works best. Set a reminder. Do it when the reminder goes off.

Psyche yourself up, if it helps. Play some pump-up music, get some tea, clear distractions, and then pour yourself into it. Do a countdown: 5-4-3-2-1 and then do it!

Do it with someone else. Meet someone for a focus session on a video call at a certain time, and tell them what you’re going to do for the next hour, while they tell you when they’re going to do. Set a timer, don’t talk, just work. When the timer goes off, report to each other how it went. Repeat daily. Save these focus sessions for the thing you’re avoiding.

Get into the action habit. The habit of recognizing what you’re avoiding, turning towards it (instead of away from it), and then just starting.

Get small victories. Small victories are incredibly powerful. Avoiding doing a big task? Do 5 minutes of it. Do 10 minutes. Eventually, doing an hour of it will be much easier, but do the smallest possible chunk, and get a victory. Celebrate it! Do a dance, acknowledge yourself. Then get another victory.

With practice, the habit of doing the thing you’re avoiding can become so much easier. Use these techniques to get there.

Healing from Narcissistic Abuse

If you’ve decided to read this article, it’s perhaps because you, or someone you know, is trying to heal in the aftermath of a toxic relationship. Or maybe you have been wondering how to leave a toxic relationship and how you will be able to heal.

Whatever drew you to read this article, I want you to know that you are not alone, and that healing from being with someone abusive, is possible.

Let’s start by defining what narcissistic abuse means.

It’s a new term in our colloquial language, and it’s been used more and more to describe people who show a pattern of self-absorption, emotional superficiality, lack of empathy or concern for the needs of others, a high sense of self-Importance, a strong need to be admired and adored, and strong abilities to manipulate others in order to get their needs met. Sound familiar?

Boca Raton Therapy
Christiane Blanco-Oilar, Ph.D., ABPP is a Board Certified Counseling Psychologist, specializing in Boca Raton Therapy. Dr. Blanco-Oilar has expertise in helping you through life transitions, grief and loss, intimacy issues, relationship difficulties and in supporting your goal to achieve vibrant relationships with yourself and others. She also provides therapy in Spanish.

Partners or children of those who fit the narcissistic spectrum often have a chronic feeling of not being good enough, they also suffer from self-doubt and spend large amounts of time and energy trying to device ways to change who they are because they feel if they change for their partner, then they will receive love and respect they yearn for. The thing is, that after years of being with a partner or a parent with narcissistic tendencies, we are starved; starved of the experience of feeling lovable and worthy. Because with a narcissist what we do will never be enough, years of being criticized, undermined, minimized, insulted and rejected will chip away at our self-esteem and sense of worth. The result: we become a shell of who we used to be (in the case of years with a narcissistic partner), or if we grew up with a narcissistic parent we simply never were given a chance to develop a sense of self-worth or self-esteem in the first place.

Victims of narcissistic abuse often come to therapy feeling chronically depressed, unable to leave their partner even though they realize the relationship causes them great pain. Or, they come to therapy deeply depressed and/or anxious, riddled with insecurities and engaging in ample self-sabotaging in their lives, in the case of having been raised by a narcissistic parent. All too often victims will blame themselves, will wonder what they can do to change who they are as they believe what they’ve been told for years: that they’re not good enough.

Healing is a process of shifting our perspective.

When we are raised by a narcissistic parent, or after years of being with a narcissistic partner, our entire focus is on our relationship with the narcissist. We are worried almost exclusively about how to please them, how to make them happy, and how to become good enough based on their definitions of what good enough means (which often changes) imposed on us. As such, in order to heal, we have to shift our focus from the narcissist, to ourselves. We all have a relationship with ourselves, similar to the relationships we have with others. When we are in a narcissistic bond, we abandon ourselves completely. We ignore our needs, we abandon our likes, our desires, our preferences, and absorb the narcissist, as this is the only way that a narcissist will last in a relationship: they have to be the center of that relationship. The healing process, thus, will involve a look at the one and only thing we can change in the situation: ourselves. But this time, the change is not about pleasing the narcissist…the change is an internal change veered towards your own needs, your own goals in life, your own Self. This is the hardest because after years of abandoning yourself, you may not know where to even begin. You may have lost sight of, or never had a chance to even find out, your true Self.

It is time to reflect.

What are your values? What are your likes and dislikes? What makes you feel passionate? What are you interested in? What is unique about you? What are you really good at? What inspires you and makes you motivated in life? In those answers, lie the answers to who you are, that no one can take away from you.

Working with your individual therapist can help you find ways to reconnect with yourself, and ways to empower yourself to make decisions in your life that are in line with your values, your preferences, and your own sense of what makes you happy. Therapy can also help you gain insights as to how it is you found yourself in a toxic relationship so you can have more compassion for yourself, and also a better sense of the red flags to look out for your future relationships. Finally, individual therapy can help you establish a healthy relationship with yourself, which will ensure that in the future you will only accept mutually nurturing and healthy relationships with others.

Trauma Therapy, how does it work?

A therapeutic approach in treatment planning has focused on the initial healing of individuals who have survived Post-Traumatic injury. A consultation, and comprehensive assessment of the client can direct that individual to an improved and motivated quality of life journey.

Though the integration of theory, intervention, insight and to multi-cultural awareness, my goal emphasis has been on clients who are dually diagnosed, complex developmental trauma and psychological effects such as secondary trauma, emotional conflicts, self-medication, substance use to recovery and wanting life back.

Claire Vines, PsyD. is Doctor of Psychology, DAPA practicing in Rancho Mirage, CA in the greater Palm Springs area. She specializes in Couples Therapy Virtual Counseling Counseling Rancho Mirage. Contact her today to schedule an appointment.

I apply strategic attachment trauma, TF-CBT, Psychodynamic, EBP, groups and combination approaches to an emotional directed model towards the discovery. Self validation and externalization through forms of creative expression are also applied.Initial consultations identify the presenting issues. Following sessions focus on the deeper pathway to coping, healing and nurturing the authentic self.

Emotional regulation, balance, self-awareness of internal conflicts between thoughts and feelings, can begin to reduce symptoms of acute distress, uncomplicated post traumatic and other factors surrounding anxiety, panic & depression, developed personality disorders such as Borderline, Depersonalization, mood disorders and dissociation.

While we can't remove traumatic events, we can work together to better manage the reflections of injurious memories. "When you remember a past event, you're actually remembering the last time you remembered it, not the event itself".

Trauma-focused cognitive behavioral therapy (TF-CBT)

TF-CBT is a components-based treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques. TF-CBT has proven to be effective in addressing Post-traumatic Stress distress, depression, anxiety, panic, startled responses, externalizing behaviors, sexualized behaviors, feelings of shame, rage, fear and mistrust.

Attachment-Trauma Therapy

Attachment-Trauma Therapy, will treat developmental injuries and complex developmental trauma, formed or maintained negative interpersonal relationships, personality disorders such as Borderline personality, moods dysfunctions such as dissociation, self medication and other paths of destruction related to loss, traumatic events or the witnessing of violence. Self-medication and other paths of destructive self-behavior related to loss, traumatic events or the witnessing of violence.

Trauma Therapy

Trauma Therapy is composed of multidimensional interventions, while the focus is on post-traumatic stress, panic, startled responses, depression and manufactured emotions such as, guilt, embarrassment or shame related to abusive emotional associations of reminders to trauma, distortion of events and a negative view of the self, others and the world.

Claire Vines, PsyD. is Doctor of Psychology, DAPA practicing in Rancho Mirage, CA in the greater Palm Springs area. She specializes in Couples Therapy Virtual Counseling Counseling Rancho Mirage. Contact her today to schedule an appointment.

Author: Claire Vines, PsyD. - Doctor of Psychology, DAPA
Photo: Pexels

What is a website builder?

Looking for a therapist website builder?

Website builders are tools that typically allow the construction of websites without manual code editing. They fall into two categories:

  • online proprietary tools provided by web hosting companies. These are typically intended for users to build their private site. Some companies allow the site owner to install alternative tools (commercial or open-source) — the more complex of these may also be described as content management systems.
  • offline software that runs on a computer, creating pages and which can then publish these pages on any host. (These are often considered to be "website design software", rather than "website builder".)

Online website builders

typically require customers to sign up with the web hosting company. Some companies provide examples of fully functional websites made with their website builder. The range of services varies anywhere between creating basic personal web pages or social network content to making complete business and e-commerce websites, either template based or, on the more flexible platforms, totally design free.

The main advantage of an online website builder is that it is quick and easy to use, and often does not require prior experience. Often, a website can be built and be up and running live on the Internet quickly. Technical support is usually provided, as are how-to video and help files.

HTML tools are divided into those that allow editing of the source code and those that only have a WYSIWYG mode.

Offline web builders cater to professional web designers who need to create pages for more than one client or web host. Modern offline web builders are usually both WYSIWYG and allow direct editing of source code and cascading style sheets (CSS) styling. They generally require at least a basic understanding of HTML and CSS. Although they are more flexible than online builders, many proprietary offline website builder software can be expensive, however, there are also many open-source website builders.

The first websites were created in the early 1990s. These sites were manually written in HTML.

Over time, software was created to help design web pages: e.g. Microsoft released FrontPage in November 1995.

By 1998, Dreamweaver had been established as the industry leader; however, some have criticized the quality of the code produced by such software as being overblown and reliant on tables. As the industry moved towards W3C standards, Dreamweaver and others were criticized for not being compliant. Compliance has improved over time, but many professionals still prefer to write optimized markup by hand.

Open source tools were typically developed to the standards and made fewer exceptions for the then-dominant Internet Explorer's deviations from the standards.

The W3C started Amaya in 1996 to showcase Web technologies in a fully featured Web client. This was to provide a framework that integrated many W3C technologies in a single, consistent environment. Amaya started as an HTML and CSS editor and now supports XML, XHTML, MathML, and SVG.

GeoCities was one of the first more modern site builders that didn't require any technical skills. Five years after its launch in 1994 Yahoo! purchased it for $3.6 billion. After becoming obsolescent, it was shut down in April 2009.

Looking for a complete and fully supported therapist website builder?

Unstuck: Create a New Path for Yourself

Sometimes it can feel like we’re stuck in life, doing the same things we’re unhappy with, over and over again.

Maybe you’ve been procrastinating on your meaningful work, or getting stuck in indecision or perfectionism. Maybe you’ve been putting off exercise or meditation, getting your finances in good shape, or making some other important change in your life.

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Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

We get stuck.

I’ve been stuck many times — and it turns out there’s always a way through the stuckness. It’s not turning away from the stuckness, but turning towards it. Going through it. Embracing the stuckness, and letting it unstick itself.

I’m going to talk about a few principles of getting unstuck, and creating a new path for yourself. And then talk about recommendations for changing your habits this year, or getting good at doing your meaningful work.

Ways to Get Unstuck

There’s no one way to do this, but I’ve found some things are incredibly helpful:

Turn towards the difficulty. If you’ve been avoiding thinking about a difficult project, or your messy finances or messy clutter, or your exercise or diet or other health issues … not much will change until you turn towards it and face it. A willingness to turn towards the difficulty and work with it is one of the most important requirements to change.

Make a decision & set an intention. If we want something different to happen, we have to decide to make a change. It’s as simple as that, and yet what happens is we get stuck in an in-between state, where we want to change but we haven’t made a clear decision to do so. A clear decision means we let go of all of the “should I do this or maybe not?” kind of self-talk, and just commit to the decision fully. And then we set an intention: what would we like to do?

Be compassionate with yourself.

When we keep doing the same things over and over again, we can get really down on ourselves. We get disappointed, discouraged, frustrated, and form a negative self-image. Trust me, I know this well! And yet, none of that helps us get unstuck — it only adds to the stuckness. So what would it be like to be kind to ourselves instead? That doesn’t mean we don’t try to change … it just means we stop adding self-discouragement to our list of challenges. Or at least, if we do, we start adding encouragement and compassion.

Do it with others. Most people try to get unstuck and make a change by themselves. This feels safer. But it means you’re doing something tough on your own — which can work sometimes, but often doesn’t work. I’ve found it incredibly powerful and effective to do it with others. Find a group, do a challenge, get accountability, find a wolf pack to run with. You will find that it helps to not be alone, and to get support when you feel like giving up.

Set a time to practice with it, and keep up the practice. It’s funny how often we say we’re going to do something, but then don’t commit to a time. Make a date with yourself to do it. Or make a date with someone else to do it with them! Keep practicing with it, daily if possible, and you’ll see gradual change.

Small victories, slow change, amazing progress. Focus on small victories at first. I told myself I just had to lace up my shoes and get out the door. I increase very gradually. In a year, I went from not being able to run 10 minutes, to running my first marathon. Gradual change equals huge progress over time.

Progress, not perfection. You’re not trying to be perfect at this. You’re trying to trend in the right direction. Missed 4 days of meditation last week? Focus on the 3 days you did do! Keep making progress, and let go of small misses.

These are some of the most helpful things you can bring to any changes you want to make. Now let’s talk about two ways to change your life I’m offering.

Change Your Habits This Year

I’m committed to helping people get good at changing habits this year. If you get good at the skills of changing habits, you can eventually change your entire life.

We’re spending this year practicing habit skills and changing a range of different habits.

Get Good at Doing Meaningful Work

If you’ve been wanting to get good at doing your meaningful work, but feel stuck … I offer a training in getting unstuck and actually taking action.

The Effect of Oxidative Stress on Mental Health

Understanding oxidative stress is important because we are exposed to many environmental and dietary stressors that can contribute to an imbalance in our body that impacts overall health. Oxidative stress is defined as “a disturbance in the balance between the production of reactive oxygen species (free radicals) and antioxidant defenses.” 1 Oxidative stress occurs when your body has an imbalance of antioxidants and free radicals. Free radicals, or reactive oxygen species (ROS), are molecules that contain oxygen and have an uneven electron number, making them highly reactive with other molecules and able to cause large chain chemical reactions. When these reactions occur, they can be either harmful or beneficial.2

Free radicals are created endogenously during the metabolic process. Exogenous causes of free radicals occur from exposure to toxins such as pollutants in the environment, certain drugs, heavy metals, cigarette smoke, certain styles of cooking, radiation, alcohol, and chemical solvents.3 When ROS are formed excessively, it can cause oxidative stress which leads to cell damage and, eventually, cell death. In response to this, cells have a network of antioxidants that scavenge the excess ROS.4

Nutrition Coach Philadelphia
Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

Does Oxidative Stress Affect Mental Health?

The link between oxidative stress and mental health is still being explored, though we know that when the brain has oxidative damage, it causes impairment to the nervous system. Oxidative stress appears to play a role in anxiety disorders, high levels of anxiety, and depression. 5 Animal studies have helped to demonstrate the role of oxidative stress in anxiety-like behaviors. 6 In addition to anxiety and depression, oxidative stress is implicated in mental health issues like schizophrenia and bipolar. 7

Nutrition and Oxidative Stress

Research suggests that diets high in carbohydrates and animal proteins, as well as excessive fat consumption, produces ROS, which subsequently leads to oxidative stress.8 Many healthy foods can help to protect your body from damaging effects of ROS. Incorporating antioxidant rich fruits and vegetables can protect you from cancer as well as reduce mortality, so find ways to incorporate foods rich in vitamin C, beta carotene and vitamin E can help to support your overall health.9

Photo by Yoann Boyer on Unsplash

Anxiety treatment NYC: How To Help A Child Struggling With Anxiety

Childhood anxiety treatment is one of the most important mental health challenges of our time. One in five children will experience some kind of clinical-level anxiety by the time they reach adolescence, according to Danny Pine, a child and adolescent psychiatrist at the National Institute of Mental Health and one of the world's top anxiety researchers. Pine says that for most kids, these feelings of worry won't last, but for some, they will — especially if those children don't get help.

Anxiety Treatment NYC

Carolyn Ehrlich, LCSW specializes in treatment for anxiety. Anxiety is best described as the unhelpful thinking patterns we experience when our mind fixates on threat, uncertainty and negativity. I can provide the tools to help you build resilience during difficult times.

Here are six takeaways that all parents, caregivers and teachers can add to their anxiety toolkits, including information on how anxiety works, how parents can spot it and how to know when it's time to get professional help.

1. Anxiety is a fear of the future and all its unpredictability.

"The main thing to know about anxiety is that it involves some level of perception about danger," says Pine, and it thrives on unpredictability. The mind of an anxious child is often on the lookout for some future threat, locked in a state of exhausting vigilance.

We all have some of this hard-wired worry, because we need it. Pine says it's one of the reasons we humans have managed to survive as long as we have. "Young children are naturally afraid of strangers. That's an adaptive thing. They're afraid of separation."

Full-blown anxiety happens when these common fears get amplified — as if someone turned up the volume — and they last longer than they're supposed to. Pine says separation anxiety is quite common at age 3, 4 or 5, but it can be a sign of anxiety if it strikes at age 8 or 9. According to research, 11 is the median age for the onset of all anxiety disorders.

A bundle of factors contributes to a child's likelihood of developing anxiety. Roughly a third to half of the risk is genetic. But environmental factors also play a big part. Exposure to stress, including discord at home, poverty and neighborhood violence, can all lead to anxiety. Research has shown that women are much more likely than men to be diagnosed with an anxiety disorder over their lifetime and that anxiety, as common as it is, appears to be vastly underdiagnosed and undertreated.

That's why it's important for parents, caregivers and teachers to spot it early. Be on the lookout for how long anxious feelings last. A few weeks, Pine says, usually isn't a cause for concern. "It's really when it goes into the one- to two-month range — that's where parents should really start ... worrying about it."

Here's another red flag: "Are there things that the child really wants to do or needs to be doing, and they can't do those things?" asks Krystal Lewis, a colleague of Pine's and a clinical researcher at the National Institute of Mental Health who provides therapy to anxious children. "If you feel you're hitting a wall in terms of trying to get the child to do those things, that might be another indicator that potentially, you know, we should get some help."

2. Be on the lookout for the physical signs of anxiety.

The worried feelings that come with anxiety can seem hidden to everyone but the child trapped in the turbulence. That's why it's especially important for grown-ups to pay close attention to a child's behavior and to look for the telltale signs of anxiety in children.

Anna, of Brampton, England, remembers when her 7-year-old son started having trouble at school. (We aren't using parents' full names to protect their children's privacy.)

"He was just coming home and saying his stomach hurt. He was very sick," Anna says. When she followed up with him to try to get to the root of his stomachache, she says, "he did tell me he was worried about school, and he told me specifically it was a teacher that he was worried about."

A stomachache, headache or vomiting can all signal anxious feelings, especially as a child gets closer to the source of the anxiety.

"You'll see that they'll have a rapid heartbeat. They'll get clammy, you know, because their heart is racing," says Rosemarie Truglio, the head of curriculum and content at Sesame Workshop. "They'll become tearful. That's another sign. ... Anxiety is about what's going to be happening in the future. So there's a lot of spinning in their head, which they're not able to articulate."

It's near this point of panic that Pine says a child's anxiety is most visible: "So you can see it in their face. There is a certain way the eyes might look. You can see it in behavior in general. People tend to either freeze, be inhibited not to do things when they're anxious, or they can get quite upset. They can pace. They might run away."

Rachel, of Belgrade, Mont., says her 6-year-old son really doesn't want to swim or go to their local splash park.

"He just says there's too many kids in there. And he cries, and I've tried to go early in the morning when there's no one there. I mean, I've lost count of how many times we've driven by just to see if I could get him out of the car and he won't. And I'm not going to drag him."

We heard this from so many parents: My child is terrified to do something that I know won't hurt them, that they might actually enjoy. What do I do?

3. Before you try to reason with a panicked child, help the child relax.

"You're not going to be able to move forward until you get them to calm down," says Sesame's Truglio. "Because if you can't calm them down, you can't even reach them. They're not listening to your words because they can't. Their body is taking over, so talking and shouting and saying, 'You're going to do this!' is not very helpful."

How do you break through this kind of panic? We recommend the Swiss Army knife in the mental health toolkit: deep belly breathing.

Now that you've managed to calm down your child, it's time for some anxiety treatment.

4. Validate your child's anxiety.

We heard from lots of parents who say they really struggle to know how to respond when their kids worry about unlikely things — especially if the fear is getting in the way of a busy daily routine, maybe a fun family outing or sleep.

"She comes down. It's 2 a.m. And she wakes me up," says Amber, of Huntsville, Ala., about her 8-year-old daughter. "And she said, 'I don't want to go away to college. I want to live at home for college.' And it's 2 a.m. ... That's when I really have to filter and not say, 'That is ridiculous. This is not a big deal!' "

Amber's filtered response was exactly right, says Truglio. Never dismiss a child's worries, no matter how irrational they may seem. A parent's priority, she says, should be "validating your child's feelings and not saying, 'Oh, you know, buck up. You can do this!' That's not helpful."

Lewis, of the National Institute of Mental Health, has language for parents who in the moment may feel frustrated by a child's behavior:

" 'I know that you're feeling uncomfortable right now. I know these are scary feelings.' You want to personify the anxiety, and so you can almost say, 'You know what, we know that this is our worry brain.' "

Lewis says it's crucial that children feel heard and respected. Even if you're pretty certain aliens aren't going to take over the planet tomorrow, if your child is worried about it, you need to let your child know that you respect that fear.

5. Help your child face their anxiety.

This is the fine line every parent, caregiver and teacher must walk with a child struggling with anxiety. You must respect the child's fear, but that does not mean giving in to the fear.

"I think our initial reaction when we see an anxious child is to help them and protect them and not to push them or encourage them to do the things that they're afraid of," Pine says. But, he adds, one of the things researchers have learned from years of studying anxiety in children is "how important it is to face your fears."

This might be hard for some parents to hear, but we heard it from every expert we interviewed. As to why it's important to face your fears, Lewis says, "the more that you avoid or don't do certain things, it's almost implicitly teaching the child that there is a reason to be anxious or afraid if we're not doing the things that are difficult. It's sending this message that, 'Oh well, there is potentially a dangerous component to this.' "

So it's important, Lewis says, "that children understand that things are gonna be difficult in life. Things can be scary. We can do them. ... I tell some of my patients, 'You can feel scared. That's OK. We're gonna do it anyway.' "

And Truglio agrees. While we do have to validate our kids' feeling of fearfulness, she says, "we can't always give in to this feeling. ... You need to push them a little bit. And there's this fine line: You can't push so far, because that's going to break them, right? They're going to fall apart even more."

How do we grown-ups find that fine line?

6. Build confidence with a baby-step plan.

Helping kids come up with a plan to face their fears is Lewis' job. It's called cognitive behavioral therapy, and a big part of that is exposure therapy.

Lewis says she once worked with an 8-year-old who was terrified of vomiting.

"We did a lot of practice, which included buying vomit spray off Amazon and vomit-flavored jelly beans," she recalls. "We listened to all types of fun vomit sounds using YouTube video. We did a lot of practicing up to the point where we created fake vomit, and we were in the bathroom and just pretending to vomit."

And Lewis says that baby step after baby step, the girl made important progress.

"One of her peers had vomited in the classroom. And she comes into session, and she was just like, 'Someone vomited in my class, and I ran to the corner of the classroom' and was just like, 'I didn't leave the classroom!' ... She was very proud of the progress she was making. In the past, she would have run out of the classroom to the counselor's office and then missed school for, like, the next week."

Lewis says parents can use rewards to celebrate their kids when they make progress — think small but meaningful rewards like letting your child pick dinner that night or the movie for family movie night.


IMAGE BY Lindsey Balbierz

A Guide to the Basic Anxiety and Depression of Life

Underlying much of what we do is an uncertainty, an anxiety, a fear, doubts, dissatisfaction, and ultimately depression.

And we react to these anxieties, dissatisfaction and uncertainty in so many unhelpful ways: we seek distraction, we eat unhealthy food, we procrastinate, we get caught in a cycle of anxiety and unhappiness, we lash out at others, we dwell in our loneliness, and then we get in denial about it all and become depressed.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

If we could learn to deal with the basic anxiety of life, we would have much more ease and less struggle.

The Anxiety Underneath Our Problems

On Twitter, I asked people to share a problem they’d like me to write about, the problems were all very difficult, but the basic anxiety of life was the undercurrent to all of them.

Each one has an external problem, with the undercurrent of anxiety, fears or uncertainty underneath the external problem. Let’s take a look at a few:

Feeling of being left out, lack of belonging: We can all relate to this feeling of not belonging. Externally, the problem is not finding people you connect with, not having that connection in your daily life. But on top of that, we add the anxiety/dissatisfaction of feeling like we’re left out and don’t belong. This is normal, but it’s good to notice.

Finding your passion, optimizing potential: The external problem is that you are in a job you’re not passionate about. On top of that is the anxiety/dissatisfaction of not finding that passion, of feeling like we’re not optimizing our potential. We can all relate to this too!

The phase of anxiety before big changes occur: The external issue is that we’re facing a big change, and then because it’s a situation filled with great uncertainty, we feel anxiety about it.

Beginning/purchasing self improvement books/classes/plans and not using them: The external problem is not finding the time or energy to use materials you’ve bought, but we add to that an anxiety about ourselves not living up to our potential, not taking advantage of opportunities, not doing what we hoped we’d do. I think we can all relate to this.

Addiction to social media, videos and cell phone: The external problem is the distractions that keep pulling our attention. But the anxiety is that we feel addicted and feel something is wrong with us for not being less distracted. In addition, the addiction is probably a coping mechanism for dissatisfaction with the moment in front of us, or anxieties in other parts of life.

PTSD — Post Trump Stress Disorder: A lot of people are coping from dissatisfaction with the political scene right now, no matter what your views on the president might be. There’s the external situation of what’s going on, and then we add our dissatisfaction, anxieties about uncertainty, frustration and anger.

Depression - Sometimes feel helpless & empty for a reason I can’t identify. Only time makes that go away but I feel that time was wasted: There’s probably an external situation that’s causing a feeling of uncertainty, anxiety, dissatisfaction and/or helplessness. But the real problem is the feelings about it all, the uncertainty and anxiety about it all, and the anxiety about wasting the time it takes to get over it.

Getting over breakups: The external problem (end of a relationship) is overshadowed by the pain, dissatisfaction, anxiety that follow the breakup. We might have frustration and anxiety about wanting it not to have ended, about not wanting to be alone, about how we feel about ourselves after being dumped, about how the other person acted.
I think we can all relate to these problems, to not only the external situation but the reactions that we have.

There’s a fundamental anxiety and dissatisfaction that runs through the human condition, about whatever we’re experiencing in life, about other people and about ourselves.

So how do we deal with it all?

Where Does Basic Anxiety Come From?
It’s good to start by recognizing why we have this basic anxiety. It’s caused by:

Uncertainty about life, about the current situation, about people
Wanting certainty, stability when life isn’t stable or certain
Dissatisfaction with the above facts — which is also dissatisfaction with our situation, ourselves, and others.

If you sit right now for 5-10 minutes and just pay attention to your breath, you’ll likely notice the fundamental anxiety, it results in wanting to stop paying attention to the breath, wanting the meditation to be over, wanting to get on with the tasks of life, wanting distraction, thinking that the exercise is stupid, wanting to think about problems you have.

But instead of running from this anxiety, instead of getting away from it into thinking about problems or getting out of the meditation, what if we just stayed with it and paid attention to it?

If we can get in touch with this fundamental anxiety that we suffer through in life, we can start to work with it.

Learning to Deal with Basic Anxiety and Depression

Instead of running from the anxiety and depression, instead of trying to cope by using distractions, food, shopping, alcohol, drugs, we’re going to find the courage to face it, with a smile.

Here’s how to work with it:

Face the physical feeling. Drop out of the story that’s spinning around in your head, that’s causing the anxiety. Instead, just be mindful of how your body feels. What does the anxiety feel like, and where in your body is it located?

Stay with it & be curious about it. Don’t run, just stay with the physical feeling. Instead of rejecting it and wanting it to stop, just open up to it and see it with curiosity. What does it feel like? Does it change? What kind of reaction does your mind have to the feeling?

Smile at it. Develop a feeling of friendliness towards the physical sensation of this anxiety. See it as one of the fundamental realities of your existence, and learn to be friends with it. See this as a chance to work with something that will be with you for your entire life, an opportunity to get comfortable with this discomfort. If you can do that, you’ll need your coping mechanisms a lot less.

Open to a bigger space. Our normal way of relating to this feeling is wanting to reject it, because we’re stuck in a small-minded, self-centered way of seeing it (I say this without judgment, it’s just something we do). Instead, we can start to touch the wide-open space of our minds, like a big blue sky, not a small space but expansive. In this open space, we can hold the anxiety like a cloud against the backdrop of the blue sky, but not be lost in the cloud. We can see the anxiety but also see that like a cloud, it’s temporary, it’s not that solid, it’s not all-encompassing, and it’s just floating by. This wide-open space of our mind is always available to us.

It’s that simple, and yet it’s not always easy. Sometimes the anxiety we feel is small, just a bit of tightness in our chest once we investigate it. But sometimes it’s quite big, a looming depression or a manic energy that we just can’t tolerate. So face it in small doses, just for a minute, just for a moment. Then let yourself run. Continue to work with it in small, tolerable doses until you start to trust that you’ll be OK if you face it and smile at it.

Once we start to touch on this anxiety and depression, face it with courage, stay with it like a good friend would, we start to realize it’s not so bad. It’s just something that comes up, like a ripple in a pond, like a breeze in a field, and it will go away. We don’t need to panic, we don’t need to run, we can relax, invite it to tea, and see that nothing else is required. Instead, we stay, we give it love, and see that this place of uncertainty we’re in is absolutely perfect as it is.

Are You Sabotaging Your Relationships?

Warning signs that you might be sabotaging a good thing

You meet someone new and happily date for a little while. The connection is great, there is chemistry, and sex is fun. You start spending more and more time together and begin considering becoming a couple. But then, you stop replying to their texts right away. You cancel dates. You avoid talking about taking things to the next level. Your partner expresses frustration, disappointment, or even anger about your behavior. Not long after, the partner breaks up the relationship.

Does this sound like something that happens to you? If so, you might be self-sabotaging your relationships.

Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and Couples Therapy Boca Raton. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders. My goal is to help you recognize, understand and have compassion for how you may have developed less-than-ideal ways of dealing with specific areas of your life.

Why We Self-Sabotage

The specific reasons why someone may self-sabotage relationships are context-specific. Every person has had a different past: parenting, childhood, teenage years and first serious relationships all have an effect on how we act right now.

One of the main reasons why people sabotage their relationships is fear of intimacy. People are afraid of intimacy when they fear emotional or physical closeness with other people.

Everyone wants and needs intimacy, but in people with certain experiences, intimacy may be linked to negative rather than positive experiences, leading to a "push-and-pull"-type behavior that leads to a relationship breakup or avoidance.

Fear of intimacy typically comes from difficult or abusive parental relationships and childhood trauma (physical, sexual, emotional). The deep, embedded belief in people who fear intimacy is: "people who I am close to cannot be trusted".

Because early trusting relationships with parents or caregivers were broken by abuse, people who fear intimacy believe that people who love them will inevitably hurt them. As children, they could not extricate themselves from these relationships; however, as adults, they have the power to end or leave them, even when they are not inherently abusive.

This fear appears in two types: fear of abandonment and fear of engulfment. In the first, people are worried that those they love will leave them when they are most vulnerable; in the second, people are worried that they will lose their identity or ability to make decisions for themselves. These two fears often exist together, leading to the "push-and-pull" behavior so typical of those with deep fears of intimacy.

Signs Of Self-Sabotage In Relationships

There are many signs that you might have a tendency to self-sabotage even the best of relationships. Here are some of the most common.

You always have an eye on the exit

You avoid anything that leads to bigger commitment: meeting parents, moving in together, etc. You're always wondering: "if it goes wrong, how can I extricate myself easily from this relationship?" Because commitment reduces your ability to leave a relationship without financial or emotional consequences, you tend to avoid it.

You gaslight your partner

Gaslighting is a form of emotional abuse whose aim is to deny the other person's reality or experiences. For example, if your partner says: "I'm really upset that you canceled our date", you respond with something like: "You're not really upset, it's your fault I canceled and you're just trying to blame me for it." Gaslighting is a sign that you don't really believe your partners' feelings are valid or real (even though they are).

You are known as a "serial dater"

Your friends often ask you why you break up with potential partners so often or lament the fact that you never seem to "settle down" with anyone. You break up with partners on the slightest of issues, only to start dating another person right away and repeat the cycle. You don't want to be seen as a "player" but you can't seem to find someone who you can commit to.

You are paranoid or extremely jealous

You always worry that your partner might be seeing someone else behind your back. You demand control over every aspect of their life and require constant contact. When they spend time with other people without you, you fret, text constantly, experience jealousy, and ask for proof that they're being faithful. They break up with you because they find you controlling.

You criticize everything they do

You constantly look for perfection in a partner, even though you know perfection is impossible. You find fault with every little thing they do, from the way they cook to the clothes they wear. You are impossible to please, and your partner eventually gives up trying and breaks up with you.

You avoid facing problems

You spend a lot of time trying to convince yourself that the relationship is perfect, even when it's not. When your partner wants to address a problem, you avoid the topic or simply say: "I don't think we're having an issue; it's going to go away." Your partner grows resentful of your inability to face problems together and leaves.

You have sex with other people

While in some cases having sex with other people is okay when both people agree to non-monogamy, in general, going from affair to affair can be a sign of self-sabotage. You're doing one of the most hurtful things you can do to a romantic partner in the hopes that they'll find out and leave you.

You always tear yourself down

You always talk about yourself in self-deprecating ways: "I'm not as smart as you", "I'm just an idiot, why are you with me?", "You're just with me because you pity me", etc. This is a sign of low self-esteem, and most people do not enjoy being told that they love someone who is worthless. When, despite their constant reassurance that you are a good person, you keep tearing yourself down, they give up and break up.

These are just a few examples of how people with a fear of intimacy might sabotage their relationships. Note that many of them are abusive: things like gaslighting, paranoia and control can damage the other person. People with these patterns have childhood trauma and don't know how else to act.

Ending Self-Sabotage

To end self-sabotage, you first need to take a good, hard look at yourself and your behavior patterns. Unless you are willing to be honest with yourself and face all the ways you may have abused or hurt other people because of your fear of intimacy, you are doomed to repeat it.

Therapy is the first step many take to end their self-sabotaging patterns. A professional can help you identify your behaviors, dig to the root of your issues, and find new, healthier ways to behave.

In general, a few things are important to uncover when ending self-sabotage.

What is your attachment style?

Attachment theory is a framework that explains patterns of behavior with intimate others. The ideal type of attachment is "secure": this is when people feel like they can trust others and remain a distinct individual, even in close relationships.

However, childhood experiences can lead to anxious, avoidant, or disordered attachment styles: these are the ones that cause issues in adults trying to develop strong relationships and families. The good news: you can work with a therapist on developing a more secure style by facing your fears and removing false beliefs about relationships.

What are your triggers?

Fear of intimacy and self-sabotage can remain dormant until a trigger wakes them up. It might be words, actions or even places. Knowing what triggers your fears will help you either avoid them or work on them so they don't trigger you anymore.

Do you confuse the past with the present?

One of the main problems of self-sabotaging is that we behave in the present as if the current situation was the same as one in the past. It can be childhood or past adult relationships. Learning to say: "that was then, this is now" can help you make decisions that are based on the present, rather than reacting blindly based on what happened to you in the past.

Can you talk about these issues?

One of the hallmarks of self-sabotage and fear of intimacy is the inability to talk about your feelings and your problems. You avoid talking about these things because talking means feeling, and you want to avoid feeling these things at all costs. Expressing your emotions, your fears and your needs will not only help you identify the problems but will also help others understand you better.

Get The Help You Need

Remember that it's okay to get help. Seeking therapy, or simply a kind and friendly ear is the first step towards freeing yourself from self-sabotaging behaviors in relationships. Be kind to yourself and accept that everyone needs help once in a while.

By Anabelle Bernard Fournier

Finding Mindfulness in an Age of Depression & Anxiety - Depression Treatment Raleigh

Depression Treatment Raleigh

We live in uncertain times.

Actually, things have always felt uncertain to the people who live in those times, but these days it might feel even more heightened, with the hyperconnectivity of the internet, social media and constant messaging, comparing ourselves to everyone else, and a very tense, divisive political situation (not just in the U.S., but in many countries).

It’s enough to drive anxiety through the roof for many people and depression seems to be a huge problem for many people we work with. Anxiety & depression seem to be on the rise, or at least it can feel that way to many.

So what can we do to deal with this anxiety & depression?

There isn’t one simple solution, but there are some habits we can form to help us cope — even thrive — in the middle of chaos and uncertainty.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

The Causes of Anxiety

In short, our anxiety is caused by uncertainty. It’s a feeling of alarm, of stress, of fear or even slight panic, when things feel unsettled, constantly shifting, out of control.

We feel this kind of "out-of-control", all the time at some level which can lead to hopelessness and depression. There are times when this feeling is heightened:

  • We lose our job or feel like our job is unstable
  • We get into deep debt or feel like our finances are out of control
  • Someone we love has a crisis (like health crisis)
  • We get sick
  • There’s a death in the family
  • Someone we can’t stand gets elected to the leadership of our country (this has happened in multiple countries, I’m not talking about anyone in particular)
  • You move to a new home in a new city


You get the idea — they’re all times of heightened uncertainty, and so the feeling of anxiety starts to increase.

The thing is, if you go through just one of these things, it’ll increase stress and maybe anxiety, but then if things calm down, you have a chance to recover. But if you’re constantly going through these kinds of things, it doesn’t give you a chance to recover. You’re constantly in a fragile state, and everything becomes more stressful.

The key is not to eliminate uncertainty and stress in your life, but instead to increase your resilience by allowing yourself to feel grounded even in the middle of a stressful, uncertain event. Then things become not such a big deal. They might stress you out a bit, but they won’t be the end of the world.

Six Habits that Lead to Mindfulness

The basic habits that lead to this kind of resiliency, and a feeling of groundedness, are things you can practice every single day:

Let ourselves feel it.

When we’re feeling uncertainty, instead of rushing to solve it … or to distracting ourselves or comforting ourselves with food or shopping … we can let ourselves feel the uncertainty. I’m not talking about engaging in a narrative about what the uncertainty is like and why it’s so bad — but instead feeling it physically in your body. Where is the feeling located in your body? Can you give it some attention and curiosity? Can you stay with it for a few moments? This habit of letting ourselves feel the uncertainty and stress is transformative — every bit of anxiety becomes a place to practice, an opportunity to be present with ourselves. It becomes a chance to create a new relationship with our experience.

Learn that it’s OK to feel groundlessness.

You are feeling anxiety & depression because of the uncertainty of your situation. But that’s because uncertainty becomes a reason to freak out. What if, instead, we learned that this groundless, uncertain feeling is actually just fine? It might not be completely pleasant, but it’s nothing to panic about. In fact, it can be an opportunity to find joy and appreciation in the groundlessness — what is there to appreciate in this feeling of complete openness? Start to shift how you see and react to this groundlessness, embracing it rather than panicking about it.

Give ourselves love.

In the middle of stress and uncertainty, instead of engaging in our old habits of shutting down or avoiding, of worrying and fretting, can we try a new habit of giving ourselves love? This is a way of being compassionate and friendly with ourselves, no matter what we’re doing. It’s like giving love to a child who is in pain — the compassion and love pour out of our hearts. Can we practice this for ourselves?

Simplify by being fully present with one thing.

We have so much going on that it can all be overwhelming. Can you simplify by focusing on just one thing right now? Trust that you’ll take care of the other things when it’s needed. Instead, be fully present with this single task. It can be something important, like working on that writing that you’ve been putting off for days. Or it can be something small, like washing this one dish, or drinking this one cup of tea. Be fully with it, and savor the experience fully. This leads to a feeling of groundedness, and helps us to not feel as frazzled.

Find the joy in being fully present and savoring.

The item above, of simplifying by doing one thing, can feel like quite a shift for many of us. It might feel like sacrifice, not constantly switching tasks and being on social media and checking phones. But it can be a way of opening up to the moment, treating yourself with a little focus, joyfully savoring whatever you’ve chosen to do with this moment of your life.

Learn to love being resilient.

Resilience is a matter of saying “No Big Deal” to any kind of uncertainty that arises, of savoring and being present, of giving ourselves love and being present with whatever uncertainty is coming up for us. Resilience is not blowing everything up to End of the World level, just because it’s not under control. Resilience is feeling grounded in the middle of chaos (even if there’s stress present), and finding a joy in being in that uncertainty. Resilience is taking a breath and then savoring that breath. It can be a wonderful thing, if you learn to love it.

For Men Only – Men’s Mental Health

At A New Day Family Counseling, we understand the challenges men face today to improve their mental health.

Men typically engage in fewer health-promoting behaviors, have fewer social supports, possess less effective behavioral responses to stress, and use fewer health care services than women. Men are 4 times more likely than females to die from suicide attempts (Centers for Disease Control and Prevention, 2010). Men with depression are more likely to turn to alcohol and drugs. Men are also more likely to allow anger to be expressed freely without acknowledging other’s feelings and are not likely to ask for help in managing anger. Finally, young men engage in more risky behaviors and are increasingly likely to engage in those behaviors over time (Mahalik et al., 2013).

Untreated mental health problems tend to get worse over time and can lead to serious consequences including addiction, incarceration, destroyed relationships and damage to physical health. Fortunately, with the right treatment most mental health problems are resolved within a relatively short period of time and result in an increased ability to cope with future challenges, improve relationships and improve contentment in life.

Beginning the therapy process is a sign of strength and takes courage.

As E.E. Cummings penned, “It takes courage to grow up and become who you really are.” In recent years, I have had the experience of seeing many more men access mental health services. My heart is touched by these men, who recognize their need for help and allow themselves to take a risk to open up emotionally and be vulnerable in ways that they may never have been before. These men have accessed services for a variety of reasons including divorce or a separation, relationship problems, illness or injury, or for help with addiction, anger, trauma or anxiety and depression. Additionally, fathers have sought help with understanding their children’s needs as they develop or to adapt to the challenging task of parenting. I have also had the experience of seeing young men challenge traditional gender roles and try out new behaviors that would have been shamed or made fun of many years ago. As a result, old gender roles thankfully are changing. The new world demands equality between the sexes in the workplace, in relationships and in child rearing. I believe that these changes are helping men become more satisfied with their relationships and themselves.

A New Day Family Counseling Plainfield, IL  believes in healing not only individuals but attends to the healing of the whole family.  After all, our family relationships are the most important human connection we will have and have the power to hurt or heal us.   We take a collaborative, family-centered approach and use brief, solution-focused and evidence-based treatment methods.  Our therapists listen deeply, empathically and non-judgmentally and seek to understand your feelings and beliefs to help create a new and empowering story about who you are. We will teach you how to identify old, limiting beliefs that interfere with your relationships, your sense of purpose, and inner peace. We will work on healing that unhealthy relationship with yourself so that you may embrace a new one that is whole, genuine, and resilient.  And, we will work on restoring your family relationships with authentic, safe and healing communication, teaching the art of compromise, and restore bonding and attachment that has been challenged by difficult times, loss, trauma, emotional injuries, addiction and mental health issues.

We offer individual counseling for adults, teens and children, family counseling, couple/marital counseling.  We also offer Telehealth services.  We treat anxiety, depression, bi-polar disorder, chronic anger, personality disorders, women's issues, trauma, grief and loss or coping with stress or inevitable changes in life that challenge us in so many ways. We will assist your family with blending, parenting, step-parenting, and coping with and addressing behavioral and emotional issues and disorders including ADHD, autism, developmental disorders, and mood disorders. We provide help to couples and families suffering from relationship problems, intimacy issues, divorce, physical and mental illness,  loss, or trauma.

We provide counseling services to Plainfield, Romeoville, Shorewood, Joliet, Oswego, Naperville, Yorkville, Bolingbrook, and Aurora and the surrounding areas in Will County, IL. Gwen Ginski, MEd, LCSW

While I have been fortunate to observe these exciting changes in men, it is still true that many men hold on to old, rigid and restrictive stereotypes. These stereotypes have a negative impact on men’s mental and physical health and can be very destructive in family relationships. Men often believe that they must handle problems by themselves and fear that they may seem weak or that others will find out that they are struggling. Boys often socialized from a very early age by their parents, peers, and teachers to “toughen up” and not cry. These norms are further shaped and reinforced by the work force, where emotions are not recognized or denied and men are expected to fulfill a variety of roles that may endanger their emotional well-being.

Some men become so enthralled in the pursuit of a “masculinity ideal” that requires that they have to continuously prove their power, strength and vitality.

These men continually practice norms in the pursuit of wealth, dominance, success, power, status and superiority. On the other end of this spectrum are the men who do not have the access to resources to prove this so-called masculinity and turn to anti-social behaviors in pursuit of this same ideal. This can lead to “Toxic Masculinity” which results in macho behavior, promiscuity, workaholism, authoritarianism and even violence. Toxic Masculinity ultimately results in a loss of internal strength, confidence and stability and leads to interpersonal and emotional problems, and even legal problems.

Men sometimes believe that the best way to handle emotions is to avoid them or bottle them up.

If a man experiences a crisis, which undoubtedly happen in life, whether it be a loss, a divorce, or another difficulty in life, he may not have the ability to process through the intense emotions that go along with these life experiences. As a man, you deserve to be happy and have satisfying healthy relationships. Seeking help for yourself is a sign of great strength. It is much easier to deny and avoid facing problems than it is to take an active step towards improving yourself and your mental health. Reach out and find a therapist that fits your needs and circumstances. Most therapists will provide a free consultation to see if they are a good fit for you. In the meantime, take care of your physical health and don’t compare yourself to others. Remember that everyone copes differently and your coping is not a reflection on your worth as a man. Allow family and friends to support you and ask for that support. Some family members or friends may not be able to be there for you, but some will. Try not to take this personally. Seek out people who can support you! Contact A New Day Family Counseling

Gwen Ginski, MEd, LCSW

Resources for Men

Headsupguys – A self-check to help men determine if they are experiencing symptoms of depression headsupguys.org/mens-depression/self-check/
Alcohol Use Disorders Identification Test (AUDIT) - A self-check tool to screen for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder www.audit.org
Anxiety Screening Tool - psychologytoday.tests.psychtests.com/
ManTherapy - A public office campaign that offers information about mental health to reduce the stigma www.mantherapy.org

Understanding Alcoholic Neuropathy - Addiction Counseling Westwood New Jersey

Alcoholic neuropathy is one of the most common and least recognizable consequences of heavy alcohol use. People with a long history of alcohol misuse might experience pain, tingling, weakness, numbness, or loss of balance as a result of alcoholic neuropathy.

Signs and Symptoms of Alcoholic Neuropathy

Signs and symptoms of alcoholic neuropathy can progress gradually, and they are usually subtle at first. Often, a person who drinks heavily might not recognize that the symptoms are related to alcohol or to neuropathy. For addiction counseling Westwood New Jersey. Signs and symptoms include any combination of the following:

*Deceased sensation of the toes, feet, legs, fingers, hands or arms

*Pain, tingling or other unusual feelings in the toes, feet, legs, fingers, hands or arms

*Weakness in the feet or hands

*Lack of coordination of the feet or hands

*Loss of balance/unsteadiness when walking

*Bruises, cuts, sores or skin infections on the toes, feet, or fingers

*Decreased pain from injuries, especially on the feet or hands

*Dizziness, particularly when standing with eyes closed

*Trouble walking a straight line, even without recent alcohol use

*Constipation or diarrhea

*Urinary incontinence

*Sexual dysfunction

Effects of Alcoholic Neuropathy

Alcoholic neuropathy is a nerve disease caused by excessive alcohol consumption over a long period of time. The effects of alcoholic neuropathy are caused by nerve damage and fall into four main categories; decreased sensation, pain/hypersensitivity, muscle weakness, and autonomic.

Decreased Sensation

Alcoholic neuropathy damages sensory nerves, resulting in decreased sensation of the hands and feet. This may not sound like a terrible problem, but diminished sensation actually causes very serious consequences.

Pain and Hypersensitivity

Another prominent effect of alcoholic neuropathy involves painful and uncomfortable sensations. Alcoholic neuropathy can result in hypersensitivity to touch and/or resting pain. Light touch can feel exaggerated and painful, particularly in the fingers and toes.

Constant pain in the hands or feet is one of the most bothersome aspects of alcoholic neuropathy. The pain can feel like burning, throbbing, or sharp pins and needles. As the condition progresses, the pain may vary in intensity, sometimes diminishing for months at a time before worsening again.

Muscle Weakness

For addiction counseling Westwood New Jersey, severe alcoholic neuropathy may cause motor weakness due to nerve damage. Our muscles need to receive a message from nearby nerves in order to function. When this message is interrupted due to damaged nerves, the muscles cannot function as they normally would. This most often manifests with weakness of the hands and feet.

Autonomic Neuropathy

Autonomic nerves control functions of the organs of the body, such as the bladder, stomach, and intestines.2

Alcoholic neuropathy can weaken the autonomic nerves, causing impairment of bowel and bladder function and sexual dysfunction.

Dr. Gerald Opthof has been providing addiction counseling Westwood New Jersey for individuals, couples and families for over 20 years. His practice is built on connection, relating to his clients as whole people and not just the problems they are facing. He offers strategies built on his professional knowledge, experience, and the perspective that he has gained from his own life challenges. Also specializing in Marital counseling Westwood New Jersey.


In general, it takes years for alcoholic neuropathy to develop, so a long-standing history of heavy alcohol use is typical. Some heavy alcohol users experience a faster onset and progression of alcoholic neuropathy than others. It is not completely clear why some people are more prone to this complication than others.

Alcoholic neuropathy is caused by nutritional deficiency, as well as toxins that build up in the body. Alcohol decreases absorption of nutrients, such as protein and vitamin B12, causing significant deficits that affect many areas of the body, including the nerves. Alcohol also alters the function of the stomach, liver, and kidneys in ways that prevent the body from properly detoxifying waste material, which then builds up and harms many regions of the body, including the nerves.

Nerve damage typically affects the axons, which are the projections that send electrical signals from one nerve to another, as well as the myelin, which is the fatty coating that protects the nerves. Nerves do not have a resilient ability to regenerate if they are severely damaged. The nerve damage of alcoholic neuropathy may be permanent if the damage has been taking place for a long period of time or if it persists.

Diagnosis of Alcoholic Neuropathy

The diagnosis of alcoholic neuropathy involves a combination of medical history, physical examination, and possibly blood tests or nerve tests such as electromyography (EMG) and nerve conduction studies (NCV).

Physical examination: A complete physical and neurological examination tests reflexes, muscle strength, sensation (including light touch, pinprick, vibration and position sense), and coordination. Usually, people with alcoholic neuropathy have diminished reflexes and diminished sensation. In very advanced disease, weakness may be present too.

Electromyography (EMG) and nerve conduction studies (NCV): These tests examine nerve function in detail. Characteristic patterns, such as decreased function in the hands and feet, low amplitude of nerve waves, and slowing of nerve function, are suggestive of alcoholic neuropathy. The nerve tests do not identify the cause of neuropathy, only the extent of nerve damage.

Nerve biopsy: In rare instances, a doctor may suggest a nerve biopsy, which can show a pattern of nerve damage consistent with alcoholic neuropathy.

Other tests: Additional assessments might include blood tests, urine tests, or imaging studies of the brain or spinal cord to rule out other causes of neuropathy symptoms.

Treatment of Alcoholic Neuropathy

There are several medical treatments that can be used to manage the pain of alcoholic neuropathy. These include pain medications and antidepressants. While not specifically approved for the treatment of alcoholic neuropathy, antidepressants are often prescribed to help control the pain. Similarly, anti-seizure medications: As with antidepressants are sometimes prescribed as a way to manage pain.

Since nutritional deficiencies are partly to blame for alcoholic neuropathy, supplementation with vitamin B12, folate, vitamin E, and thiamine may be recommended.

There are no medications that can help improve loss of sensation, strengthen the muscle weakness, or aid the coordination and balance problems caused by alcoholic neuropathy. However, some people notice an improvement in symptoms a few months after discontinuing alcohol intake for addiction counseling Westwood New Jersey

Sometimes alcohol causes such severe damage to the body that a liver transplant may be necessary. In that case, there may be some improvement in the symptoms of alcoholic neuropathy after the liver transplant,4 but often, the neuropathy is so advanced that there may be little, if any, improvement, even after a transplant.

Alcohol use disorder is a challenging condition. The medical community has recognized that addiction is a disease and that some individuals are born with a tendency to become addicted to substances. Thus, it is usually necessary to get medical help to managing alcohol use disorder.

Some of the symptoms of alcoholic neuropathy can be partially reversed, but if the neuropathy becomes advanced, it might not be reversible. Medication can help in reducing some of the symptoms of alcoholic neuropathy. The most important strategy against alcoholic neuropathy lies in preventing the symptoms from getting worse by decreasing alcohol consumption as soon as possible.

By Heidi Moawad, MD, and medically reviewed by Huma Sheikh, MD

Photo: Pexels

What America Can Learn from Couples Therapy

The principles of good communication for Couples Therapy Palo Alto could also apply to divided Americans.

At family gatherings, in bars and restaurants, relatives and friends are shouting at each other instead of engaging in what used to be called political discussions. These high-volume, emotionally charged exchanges are also increasingly the norm in venues ranging from local governments to national ruling bodies across the world.

These shout-fests might remind you of a bad marriage—and we think there is some truth in that. We are clinical psychologists who are couples therapists and researchers who evaluate the benefits of interventions with couples. We do not have answers to urgent questions about how to bridge political and cultural chasms, but we do know a thing or two about how to help two people reduce the conflict in their relationship. What are the principles backed up by both research and clinical experience of working with couples who have unresolved differences? How have they been useful in helping Couples Therapy Palo Alto communicate more effectively about issues on which they disagree? And can these insights be applied to healing political divisions?

We do not assume that Democrats and Republicans—or politicians attempting to negotiate Britain’s exit from the European Union, or Russians debating the power of Vladimir Putin—will suddenly pay attention to these principles. Rather, we offer these ideas with modesty, in hopes that individual readers may find them useful in de-escalating tensions with family and friends with different political and social ideas. While you can’t control what other people believe or how they behave, there are steps you can take to make your conversations more productive.

1. Try to understand their perspective
Before meeting up with someone we expect to disagree with, most of us either think about how to avoid the topic, or we act like lawyers preparing for a trial. We give a great deal of thought to presenting our point of view in a convincing way and to considering the weaknesses and absurdities in the other person’s arguments. While some of this preparation is adaptive, studies suggest that we might find such conversations less troubling and more effective if we took the time to try to understand the perspective of the other person. If the person is someone you know, you can try to reconstruct their side of an argument as best you can. If the person comes from a group with an identifiable point of view, you can examine written material or information from social media that presents the other’s point of view effectively.

Why does all this work? If you can demonstrate that you can understand accurately what the other person is saying, and if you can find some areas of agreement, the other person is more likely to feel heard. And feeling heard tends to reduce the repetition, frustration, and rise in volume that occurs when the other person concludes that you are not listening, you have misunderstood what they have been trying to say, or you are just not very clever!

A more general approach to preparing for a discussion that may get heated is to practice staying in the moment—what is now often called mindfulness. Research suggests that we can reduce the biases that often fuel disagreements by building moment-to-moment awareness of our thoughts, feelings, and surroundings through practices like meditation. Mindfulness can make us more cognizant of the mental shortcuts we take when judging others and help us react less intensely when we feel threatened or upset.

2. Try to confide, not attack or avoid
Dan Wile, a nationally known couples therapist, has pointed out that when we disagree or are upset with each other, there are typically three stances that each person can take: We can avoid, attack, or confide.

Most often when we anticipate a conflict, we tend to engage in avoidance—not raising the issue at all, or stating only a small part of the issue. This may keep the temperature from rising, but it does nothing to resolve disagreements, reduce simmering tension, or formulate actions to solve problems collaboratively.

When one person is on the attack, the most likely response from the other is to fight back or withdraw. This is understandable, but, like avoidance, it does little, if anything, to convince the other to entertain a new idea.

Robert Levenson and John Gottman have been pioneers in studying conflict between opposite-sex and same-sex partners while both are hooked up to equipment that measures their physiological arousal and distress. One of the important findings of this research is that as the disagreement escalates, both partners show sharp increases in physiological arousal, but that for one partner (more often the female), the arousal quickly returns to baseline, while for the other, arousal and distress remain high (more often the male).

This discrepancy tends to result in escalating conflict in which the high-arousal partner attempts to hide the feeling (stonewalling) while the lower-arousal partner is engaged in attempting to solve the problem. When this happens, the problem is that the stonewaller is still upset and their partner is frustrated at the lack of verbal response. Gottman further describes what he considers to be the “four horsemen of the apocalypse.” In addition to stonewalling, he points to criticism, contempt, and defensiveness as emotional nightriders that come along to destroy intimate relationships.

Wile suggests that a more productive strategy is for each person to confide rather than attack or avoid. Confiding involves letting the other person know that you are worried about raising this issue, or that you can see some of the weaknesses in your own arguments or some strengths or at least reasonableness in the other person’s point of view. This confiding style enables people to disagree while maintaining a more collaborative conversation.

For more information about Couples Therapy Palo Alto, please go to my therapist website & contact me.

3. Make it safe for people to confide in you
OK. It’s easy for us to say that a collaborative strategy will be more productive for both people than an avoidant or attacking stance. But how can we achieve this ideal when we feel passionately about our personal or political beliefs?

There are positive communication strategies we can use to encourage disclosure and collaboration and result in both parties feeling they are being heard. Some of the points we list come from the research on the “Speaker Listener Technique” by Scott Stanley, Howard Markman, and Galena Rhoades, who have shown how couples who take turns at being speaker and listener—not interrupting to get a new point across—and who follow some of the suggestions below show improvement in their relationship over time. They coach Couples Therapy Palo Alto to:

Make short statements. Arguments get out of hand when a large number of ideas are presented all at once before allowing a response.

Slow the conversation down. Especially as we get upset, we tend to talk faster and rush past points when we feel that little blip in the gut that signals hurt, anger, or anxiety.

Take time to make sure we understand what the other person is saying. We often assume that we know what the other person means and that what they are saying is either misinformed, wrong, or intentionally hurtful. Instead of walking away or attempting to contradict what sound like errors or even lies, we recommend what may be a counterintuitive step—interviewing the other person carefully to ask more about what they mean.
Use “I” statements that describe what you feel and believe, not “you” statements that characterize the other person’s intentions. (A sentence such as “I feel that you are hostile” is not an “I” statement.)

4. If conversation gets hot, take a break
No matter how well we prepare for an argument or follow good communication guidelines, sometimes our feelings or the other person’s emotions are triggered to the point where one of the four horsemen enters the scene. One or both become critical, defensive, or contemptuous—or go silent while continuing the conversation but not expressing upset. Under these circumstances, it becomes impossible to consider the other’s point of view. We want to underline the seemingly obvious point that people rarely modify their point of view when they are being criticized, shouted at, dismissed, or ignored.

Very often, one of the participants in a heated discussion wants to continue, hoping that in the end the other will see the logic of their point of view. Often the other person tries to get away by leaving the room psychologically or physically. Most couples therapists suggest that their clients agree to a “time out,” which gives both partners a chance to cool off.

But this won’t work unless both people agree on a time to resume the discussion in order to have a “recovery conversation” that is not derailed by feelings of helplessness and anger. That is, a recovery conversation can help to shift from a battle between two warriors, to an exchange between two people working together to address a difference or problem that concerns them both.

5. Don’t slide; decide
Some difficult conversations start because couples need to make an important decision. Stanley, Rhoades, and Markman report that many partners have reservations about what the other proposes, but choose not to express them. Or both partners simply slide into an option rather than struggle together toward a decision, even on important issues like moving in together, or having a baby, or basic values. It seems easier to agree to move in together rather than find two separate places after graduation. One partner may go along with the other’s desire to have a child rather than have a prolonged and difficult fight. Both may choose to keep quiet rather than discuss a serious disagreement about values or politics.

The problem is that down the road, sliders have a much harder time in their relationship than deciders do. Moving in together saves money, but may be premature in terms of the state of the relationship. The reluctant parent, having avoided a pre-baby argument, may now experience heightened levels of individual and relationship stress. Undiscussed value or political issues can lead to increased polarization and emotional distance.

Especially in facing big issues, we recommend that you take advantage of the strategies in steps one to four, rather than skirting around issues in order to avoid a stressful conversation. If you are able to tolerate listening respectfully to each other and slow things down before coming to any final conclusions, you may actually be able to discuss both of your points of view more directly. To lower the tension at the start of a discussion, we often suggest that partners take the tack that “this is a discussion, not a decision.” This often works in Couples Therapy Palo Alto and it might work for you when discussing a political issue on Facebook or at the dinner table. Who knows? Nationally, it might even help politicians and activists on opposite sides have more productive discussions with each other.

Can these steps help America talk again?
Imagine Republicans and Democrats on the floor of the United States House of Representatives or Senate arguing about a proposed new law—but this time our legislators are applying insights about how to resolve conflict between couples. A Republican speaker might address the assembled legislators this way:

I want to express my support for this bill, but I also want to acknowledge that my Democratic colleagues have some concerns about how the new law would operate. My understanding of their chief concern is that it will be difficult to enforce. Have I got it right?

Almost right. What’s missing is a specification of the administrative office that will administer enforcement. I know that my Republican colleagues are leery of creating bigger government, so how can we work together to address the enforcement problem?

And so on, toward compromise and resolution. It’s a nice thought experiment, though this is not how the current United States Congress operates. Getting members of Congress to adopt those guidelines might seem far-fetched—but we believe it is completely possible for ordinary people to follow them. The next time you find yourself disagreeing with an uncle or a neighbor about strongly held ideas and values, try taking some of these steps. You might not win the argument, but you can avoid some antagonism—while keeping your relationships strong.


Photo: https://www.pexels.com/photo/human-hands-and-us-flag-2240293/

Online Counseling for Work Stress New York City

Online Counseling for Work Stress New York City

What does your reflection reveal?

There are times when we see parts of our character we don’t like. The moments are often fleeting, yet can be haunting.

Did I snap too harshly on the person again?

Was I too passive in the meeting as usual?

Am I too smothering to my child as my parents were to me?

Was it only about me yet again?

We worry, obsess, can’t sleep, or have dreams about this, and can even feel the part of us is right under the surface.

The symptoms are stress, anxiety, work burnout, isolation or depression. We then have to deny, rationalize or escape.

But we can change.

There needs to be a look into character, to study our contradictions, and to minimize balms of the day such as shopping, substances, tv, eating, or social media.

The combination of understanding intellectually and also acting and behaving and experiencing is what makes a person better. You study the self, identify distractions, and challenge the given.

It is a dual process: intellect plus experience.

Without it, we continue to be haunted. With a study of the self, we gain actionable insights, build real changes, and make a more fulfilling life.

When seeing your reflections, what do you do?

Not sure why parts of your character hold you back in your work? For Stress Counseling, Kearns Group helps individuals study the gap between goals and their achievement. Through a contextual counseling we reveal the stress that gets in the way and design strategies to better reach their achievement. Conveniently located in Greenwich Village near Union Square.

Telehealth Stress Counseling: Can it help you too?

Is your stress leading to poor sleep or irritability?

Do you occasionally get down or short tempered?

Realize things about yourself you want to change but find hard to do?

If you don’t get ahead of your mental health care, anxiety can creep up and turn into a bigger deal. It can then easily become a strained life of distraction, hiding, or escaping.

With Telehealth Stress Counseling, there is now a more dynamic and effective approach for change.

As a Mental Health Counselor for working professionals, I am amazed at the accessibility and efficiency of Telehealth Counseling.

People are able to identify work and personal issues more immediately, stay ahead of their stresses more flexibly, and strategically make better choices and build lasting results.

If you are a...

banker who feels even greater pressure to perform

startup employee whose company has pivoted yet again

See unwanted patterns in your relationships again

Or feel more isolated than ever during COVID

it’s time to stop going at it alone.

Get something that sparks you, or someone you care about, in a different way. A mental health approach that is convenient, effective, and helping more and more.

Reach out and connect to Telehealth online Stress Counseling you might like the way you feel.

Can Stress Counseling work for you?

We need to find something that sparks us in a different way to fight our stress. Work on the new recipe, write in the journal, or talk with an old friend.

The spark away from the stress is an assist in helping us get through the rough patch. Finding a new interest away from the anxiety helps us remember we’re going to get through it, even when the skies are grey.

And as you work through the stress, don’t make too big a deal of the situation. If you make it too big of a deal, you don’t go near it. And if you worry all the time, it doesn’t mean you are going to approach it any better. The idea is, how bad can it be? In going through it you usually find out its not the end of the world.

As a mental health professional, Stress Counseling is a big part of my role these days. To help people feel better I emphasize the importance of a spark. I also point out responses to stresses don’t have to be perfect. The idea is to make it good but also recognize you are learning to be better. The process is really about learning to make better choices and learning to work through things.

Put the bat on the ball, return the shot, and treasure the basics. Even spell it out to yourself: is this worth that.

Further, in fighting our stresses, set limits. Limit is all. Somebody pays the piper if you don’t. Have to give attention to your well-being and by setting limits you help yourself.

So find the spark that makes you feel different, try to not make the stress too big, and your response does not have to be perfect but something where we are making better choices.

Online Counseling in Texas

The Pros of Online Therapy

Are you considering Online Counseling in Texas? The internet has opened up new avenues for mental health treatment, but there are some pros and cons you should consider before you decide if e-therapy, also known as teletherapy,1 is right for you. In the face of the social distancing measures required in our COVID-19 crisis, many in-person psychotherapies are becoming online out of necessity.

Pros of Online Therapy
Let’s explore some of the biggest advantages of online therapy.2

Good Option for Remote Areas
Online therapy offers access to mental health information and treatment to people in rural or remote areas. Those who live in such areas simply might not have access to any other form of mental health treatment because there are limited or no mental health practices in their geographic area.

Having to drive long distances and take significant time out of a busy schedule to seek therapy can be a burden on many people in need of help. If you have reliable internet access, online therapy gives you relatively quick and easy access to treatment that might not have been readily available to you otherwise.3

Accessibility for People With Physical Limitations
Online therapy provides accessibility to individuals who are disabled or housebound. Mobility can be a big issue when it comes to accessing mental health care. A therapist practicing out of their own home, for example, may not be set up to accommodate all potential clients.

Individuals who are unable to leave their home for various reasons, such as physical or mental illness, may find online therapy a useful alternative to traditional psychotherapy settings.

Convenience and Affordability of Online Counseling in Texas
Online therapy is usually fairly affordable and convenient. Since you will be attending therapy sessions online in the comfort of your own home, you can often schedule your therapy sessions for times that are the most convenient for you.

Today, many states require insurance providers to cover online therapy just as they would traditional therapy sessions. Contact your insurance company to learn more about how e-therapy treatments will be covered by your policy.

Therapists who only treat patients online likely have fewer overhead costs such as renting office space. Online therapists, therefore, can often offer affordable treatment options for those who are not covered by health insurance.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth
Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Does Health Insurance Cover Online Counseling in Texas?

Treatment Is More Accessible
The Internet makes mental health treatment more accessible.4 People may feel comfortable talking to friends and family about physical health care issues but may not feel the same discussing mental health concerns that are just as important. Online access makes it easier to overcome the stigma that has historically been attached to mental health issues.

Teletherapy can be an important tool to help people learn more about psychological health. Even if you feel like your mental well-being is strong, online therapy can help you become psychologically stronger.5 You can learn more about health behaviors and coping strategies that will lead to better psychological health.

You don't need to have a clinically diagnosed condition to benefit from talking to a professional, and online therapy can provide an easy avenue for getting started.

Overlooks Body Language
In many cases, online therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of your feelings, thoughts, moods, and behaviors.

Some delivery methods such as voice-over-Internet technology and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions possess.

Some people may feel more comfortable undergoing Online Counseling in Texas in a digital setting, especially younger people who are more intimately familiar with such methods of communication, but others—therapists and patients alike—may get more out of therapy that utilizes more direct human contact.

Ethical and Legal Concerns
Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult.8 Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. It is important to understand your therapist's qualifications and experience before you begin the treatment process.

Article: https://www.verywellmind.com/advantages-and-disadvantages-of-online-therapy-2795225

Photo: https://www.pexels.com/photo/apartment-architecture-building-contemporary-380330/

Online therapy in Texas

online therapy Texas

Online counseling is the provision of professional mental health counseling services through the Internet.

Services are typically offered via email, real-time chat, and video conferencing. Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling, and a growing number of clients are using online counseling as a replacement for office visits.

While some form of tele-psychology has been available for over 35 years, the advent of internet video chat systems and the increasing penetration of broadband has resulted in the continuing growth of online therapy. Some clients are using videoconferencing, live chat and email with professional psychologists in place of or in addition to face-to-face meetings. There is also a growing trend with online recovery coaches who can now conduct face-to-face consults with clients online.


In 1972, computers from Stanford and UCLA simulated a psychotherapy session that was considered the very beginning of online counseling. At the time the internet went public,[further explanation needed] this launch went hand in hand with the development of the first self-help groups on the internet who were, in that time, very popular.[citation needed] In 1995, Martha Ainsworth began searching for a competent therapist because she had some psychological complaints. Her travel requirements made it difficult for her to consult a face-to-face therapist, and she therefore searched for an effective alternative online, but only found a dozen webpages that offered online treatment for psychological complaints. Afterwards, Martha Ainsworth wanted to reach the general public with her experiences and founded a sort of clearinghouse for mental health websites, named Metanoia. This database seemed to be a very efficient store-room and by the year 2000, this clearinghouse contained over 250 websites of private practices, and more than 700 online clinics where a therapist could be contacted.

According to metanoia.org, the first service to offer online mental healthcare was "Ask Uncle Ezra", created by staff of Cornell University in 1986 for students. By mid-1995 several fee-based online services offering mental health advice had appeared.

Between 1994 and 2002, a group of trained volunteer crisis counselors called "Samaritans", began providing suicide prevention services via email.


online therapy Texas is filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents, people with disabilities and expats, along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities.

Online counseling has been shown to be effective for clients who may have difficulty reaching appointments during normal business hours, while decreasing the number of missed appointments for in-person therapy.

Kathryn McNeer, LPC provides online therapy Texas specializing in couples counseling at the McNeer Group.

Medical uses and effectiveness

Although there is some preliminary support for the possibility that online counseling may help populations that otherwise underutilize traditional in-office counseling, the question of the effectiveness and appropriateness of online therapy Texas has not been resolved.

Mental health

Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level. J. Suler suggests that people functioning at a particularly high level, and who are well-educated and are artistically inclined, may benefit the most from using text-based online counseling to as a complement to ongoing psychotherapy. Severe situations, such as suicidal ideation or a psychotic episode, might be better served by traditional face-to-face methods, although further research may prove otherwise.

Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition. Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.

ref: https://en.wikipedia.org/wiki/Online_counseling
photo: pexels

Online Counseling

Welcome back to our newsletter series addressing the question we’ve been hearing from our community of clients: Is my response to the abnormality, normal? Last time, we focused on your own thoughts and feelings. In this 3rd installment, we are focusing on what our community is noticing in their relationships with others.

Relating in Isolation

As depicted in the graphic above, our community is noticing that we are still very committed to our relationships, but there are shifts in our roles, or we may play multiple roles at once. You may also find yourself having to navigate how to absorb the reactions of others. As isolating as this situation is, our emotions are still occurring in relation to others. This can affect the entire system’s mood and mindset.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

Therapist near me

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Our Personal Reflections

Last week, my 4 year-old son planted “magic beans” to take us to Giant Land, where he was pretty sure “the virus isn’t going around.” He watched the magic beans (we’re not allowed to just call them beans) vigilantly, watered them 27 times a day, packed for himself and his brother, including a pillow, and waited so we could climb the thing and get out of here. When that didn’t work (shocking, I know), this week he decided to build a spaceship with a seat for each of us so we can finally get off of this blasted planet. A life-size space ship. With plywood, screws, and Styrofoam. As a play therapist, I’m seeing a lot of themes in his play, or as he would call it “work.” However, I’m sure I don’t have to explain the meaning of it to you. We all want an escape plan and are fantasizing in one way or another of an alternate life. It’s been a good reminder that kids are dealing with the same stress as adults. Their symptoms are often the same, but the way it plays out (pun intended) is different. It’s been a reminder for me to appreciate his ingenuity and be compassionate about his struggles - and to do the same for myself and others.

I’ve noticed the different needs my family members have based on their developmental stages. The toddler seems to be okay with his blissful ignorance to what’s going on. The older kids have been dealing with it based on their developmental abilities, but their personality differences also come through. My kindergartner seems satisfied socially, but needs to be held, physically and emotionally, in her moments of rage that come through. My elementary schooler has engaged in magical thinking. He has this idea about turning the light switch off and COVID turns off too. He imagines everything we will do as soon as it ends, such as vacations and time off of school (because somehow he needs even more time off). I’ve found it’s been helpful to meet them in the moment through - whether it’s imagining or holding space until they can regulate. I’ve noticed the parallel as an adult. We have these same emotions and need space for them as well.

Couples Therapy Tribeca
New York City Therapist Carolyn Ehrlich focuses on learning how we share space with each other. In therapy, both parties are given the opportunity to speak, guided by a therapist. And most importantly, both will be heard.

56 Leonard Street, Apt 17AE, New York, NY 10013

Turning Relationships into Community

The sentiment of being in this together while distancing from each other is strange. But part of what’s helping us all survive right now is how we are consciously engaging with our community. Alicia Bailey, a KCC clinician, recognizes that we are experiencing an “intensified version of the pressure we feel every day as parents, which is forming these human beings, but we have nowhere to outsource.” Not to mention managing their mental health along with our own. And meanwhile, our partnerships might either be falling by the wayside so we can function, or riddled with tension at the moment. However, she notes that this situation is increasing our collective resiliency, because we have to get creative on how to outsource, such as enlisting grandparents or neighbors for childcare.

​It’s amazing for us to see the resourceful ideas that many come up with to connect with others, such as creating “COVID families,” weekly video calls with friends and family, drive-by birthday wishes, sustaining the local economy, and normalizing the struggle so that your loved ones will not feel alone.

We are grateful to continue to be a part of your community. If someone you care about could use some help, please forward this on to them, or pass along our information.

Your support around the corner, or wherever there's WiFi,

Psychologist Chapel Hill N.C. - Telehealth

Recent developments in the COVID-19 pandemic have motivated me to transition to an entirely virtual practice. I believe firmly that social distancing is the safest and most ethical way to ensure the well-being for everyone and protect my clients.

I use a HIPAA-compliant platform that can be accessed by phone, iPad, or computer. No set-up needed; you simply click a link sent to you prior to the session.
While the same rules of confidentiality for in-person sessions apply to virtual or phone sessions, there are some unique aspects to consider:
- Use a private Wi-Fi connection with high speed internet.
- Make sure you are in a private space so that you can ensure your privacy.
- Please be present and ready by your device at the scheduled appointment time.

Research has shown that teletherapy is equivalent in effectiveness to in-person therapy. Thanks to recent technology improvements, the differences between the experience of a video session and a face-to-face session are negligible.

Psychologist Chapel Hill N.C. - Telehealth

If you are committed to improving, you will do well regardless of whether the sessions with your therapist are held in person or remotely.

Most individuals report that they find teletherapy to be as effective as an in-person office visit. Added benefits include that you will not have to spend time commuting to my office and the lack of school and available child-care will not prevent being able to attend regular therapy sessions.

Psychologist Chapel Hill N.C. - Telehealth is an excellent option to ensure you get the help you need even during a pandemic where we need to socially distance to maintain safety. Too often, putting off treatment creates more problems. Fortunately, teletherapy is now widely available.

I am a doctoral-level licensed psychologist in North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

Dr. Sara Michelson
Licensed Psychologist Chapel Hill N.C.

I am a psychologist trained in evidence-based treatments.

I have particular expertise in treating psychological trauma and PTSD. I have been certified by the National Center for PTSD as a provider for Prolonged Exposure Therapy (PE) and Cognitive-Processing Therapy (CPT), both evidenced-based treatments to help reduce the symptoms of PTSD.

I also treat insomnia and sleep problems, anxiety disorders, panic attacks, mood disorders, relationship problems, anger, and other stressful life transitions. I have completed specialized training in cognitive behavioral therapy for insomnia (CBT-I), mindfulness, anger therapy, and behavioral activation for depression (BA).

I graduated with a B.A. in psychology and comparative literature from the University of Copenhagen and a Psy.D. in clinical psychology from Roosevelt University in Chicago, IL. I have received training in cognitive behavioral therapies at Northwestern University and the University of Chicago. My doctoral research focused on the effects of childhood trauma on later personality development. I completed my predoctoral internship at the VA Hudson Valley Health Care System and a post-doctoral fellowship at Yale University where I specialized in working with veterans with post-traumatic stress disorder. Since completing my graduate training, I have worked in private practice, VA hospitals, the Center for Deployment Psychology, and with public safety and law enforcement agencies in Illinois and Psychologist Chapel Hill N.C. where I have conducted pre-employment screenings, crisis evaluations, and fitness for duty evaluations.

CBT typically helps individuals address anxiety, depression, relationship problems, etc. by teaching new skills and ways of coping. For example, someone with social anxiety may work to improve the skill of tolerating being in anxiety-inducing social situations. Someone who is prone to extreme worry may work on the skill of talking themselves through their anxiety. Someone with depression may try to improve their ability to engage in behavioral activation. Research has shown that improvements of these skills, can help to alleviate significantly psychological distress.

What are some of the strategies used in CBT?

In CBT, the focus is on thoughts and behavior. Some of the strategies used include:
• Identifying problematic thoughts and thought patterns that are keeping you stuck
• Changing your relationship to the problematic thoughts by accepting their presence and challenging their accuracy
• Developing balanced alternative views to initial interpretations of events
• Learning new problem-solving and emotion regulation skills
• Building motivation and ability to engage in productive and meaningful behavior through exercises

Social Media and Suicide Among Teens

Digital media, including social media, became a centerpiece of day to day life at a seemingly exponential rate. Before I graduated high school in 2006, I remember many evenings spent on ICQ (used to chat with friends), making simple websites with shout outs to my friends which included obnoxious lists of inside jokes, and playing The Sims Online. I whiled away the hours without much consequence – at that time it was  project to upload a picture to the internet (you had to have a digital camera or a scanner), and in order to sign up for Facebook, you needed to have a college email address. These were simpler times.

Fast forward to now, and we are a world of quasi-cyborgs with our phones in our hands and our head in the Cloud. Technology is immensely helpful to us in innumerable ways – it helps us connect with others, provides us with apps that support our well-being, productivity, work, supports us to make healthier lifestyle choices, and so on. However, if this resource is not used intentionally, it may cause irreversible damage. I’m talking about the approximately 60% increase in suicide rates among individuals ages 10-24 between the year 2007 and 2018.1 While we cannot explicitly say that this increase in suicide among young people is mostly due to the growth in use of social media, there seems to be a pretty obvious connection.


Build your self-care skills through Online Counseling in New Jersey

Do you want to improve your self-care skills? Contact me to learn more about working together through online counseling in New Jersey.

I now also offer Online Counseling in Pennsylvania, contact me to learn more.


Take, for instance, the 2017 death of Sadie Riggs from Pennsylvania. Her peers were merciless with their bullying, targeting her in the hallways at school but also through social media, and telling her to kill herself. Her parents, once they discovered what was happening, went to the police and to her school – neither did anything, and they eventually took their daughter’s phone. Unfortunately, it was too late and Sadie completed suicide about a week after her phone was taken.2 Cyberbullying is a type of bullying that extends beyond the boundaries of school; it follows kids home and can infiltrate their life as often as they choose to check their phone, which is at least a couple hours a day for most teens.

What are some of the ways that social media is influencing the increase in suicide among young people? Prosuicidal behavior may be cultivated online in some of the following ways:

  1. Cyberbullying. This refers to when someone is targeted online and repeatedly tormented and harassed. It’s bullying, but online. A study found that victims of cyberbullying were twice as likely to attempt suicide, and the individuals perpetrating the bullying were 1.5 times as likely to have attempted suicide.3
  2. Media Contagion Effect. This refers to the increase in a particular activity that occurs when the media covers it, for instance: mass shootings. One study found that, out of 719 people between the ages of 14-24 years old, almost 60% reported being exposed to suicide related content through internet sources.3; There is also a growing trend of posting suicide notes online, which may influence the decisions of vulnerable individuals.3
  3. Normalizing/disinhibiting suicide or self-harm. Through sharing online, anyone has access to content that may normalize suicide or non-suicidal self harming behavior. Vulnerable individuals who may find extreme chat rooms where others idolize or encourage suicide.3

While there are dangers lurking on the internet, there is also help. If you or someone you know is struggling with suicidal ideation or self harming behaviors, make sure you reach out for help immediately. Here are some resources:

The National Suicide Prevention Lifeline: 800-273-8255

Crisis Text Line: http://www.crisistextline.org/

Society for the Prevention of Teen Suicide: http://www.sptsusa.org/teens/

The Trevor Project, a resource for LGBTQ individuals: http://www.thetrevorproject.org/

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides Online Counseling in Pennsylvania, contact her to learn more.



  1. https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-11-508.pdf
  2. https://www.nbcnews.com/news/us-news/social-media-contributing-rising-teen-suicide-rate-n812426
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477910/

Photo by Danilo Rios on Unsplash

Couples Therapy Palo Alto: Relationships in the Tech World.

Being a Marriage and Family Therapist in the Bay Area specializing in Couples Therapy Palo Alto, means I have the privilege to meet clients from very diverse backgrounds. One of them is the Silicon Valley background which is a culture in and of itself. Clients and couples with this background share some distinct characteristics: high achieving, hard working, intelligent, ambitious, and long working hours. Some people work so hard and long that they don't even dare to get into any intimate relationship. While a small number of people are content with life without being in a significant relationship, many of us have the innate desire to want to connect with a partner. Because of the demand from work for time, it often creates a lot of challenges for those who work in the Silicon Valley culture to have successful and fulfilling relationships.

Palo Alto, being the heart of Silicon Valley, is one of those cities in which many couples struggle to have a healthy work life balance. Over the years of working with couples from that region, I’ve identified a few helpful ways to create and maintain a fulfilling and loving relationship in the long term.

1: Be Honest and Realistic with Yourself and Your Partner.
More often than not, working in Silicon Valley is a long term and heavy commitment. That’s true for the people working in the industry, as well as for the significant others. So it’s critical that couples be realistic about what they’re committing to professionally and how that will have a direct impact on their personal and relationship life. Otherwise, resentment and bitterness often become the natural by product.

2: Know Your End Game.
I’ve had clients complain about how “cut throat” and brutal the lifestyle working in Silicon Valley is. Working 80 hour weeks often is the norm rather than exception. Naturally it’s not a sustainable lifestyle, especially for those that are more family oriented. So if your goal is to experience that culture and get that on your resume, be concrete about your timeline. On the other hand, if your goal is to take companies public, then you must recognize that you need a partner that believes in your vision as well as is willing to make the necessary sacrifices. In the meantime, you also need to be work extra hard on the relationship to maintain a healthy and happy balance.

For more information about Couples Therapy Palo Alto, please go to my therapist website & contact me.

3: Communication (DUH...)
Literally 100% of the couples that I work with have some level of communication issues. For relationships to thrive in the Silicon Valley culture, having great communication is part of the successful equation. That’s because when time is the scarce commodity, it is crucial that the couple knows how to be effective and efficient in their communication to avoid tension, misunderstanding, and resentment building. One tip that I often give to couples is to over communicate. The reason being that I believe 95% of the time, conflicts arise from misunderstanding. And the best antidote to misunderstanding is over communication.

4: Define a Balanced Relationship with Your Partner.
When you’re unable to fully provide the essential currency in a relationship, TIME, you need to understand how you can still meet your partner’s needs in a straight forward manner. Talk with your partner about how you’d like to define and create a healthy relationship with them despite having less than the ideal amount of time. When there’s a genuine gesture to improve and the desire care for your partner, it tends to create a positive chain reaction in the relationship.

Kin Leung, MFT - Individual and Couples Therapy Palo Alto

Photo: Pexels.com

Family Stress Test

Family Stress Test

Stress is a natural and normal “by-product” of every family’s life. In fact, family stress can bring out the best of us: as we stretch to meet the challenges we face, we become better parents, our children blossom and our families grow. But too much stress can spiral our families in the other direction. Take this Thriving test to see how your family fares.

Set 1

1. There is a lot of bickering in our house. Someone is always angry at someone else.

2. There’s never enough time to sit down together, either to talk or to eat. There’s always too much to do.

3. My spouse and I argue a lot about how to raise the children.

4. It’s like pulling teeth to get the kids to help around the house.

5. Our family has experienced a lot of significant change recently (divorce, death, blending family, job loss, illness, other trauma).

6. Money is very tight. My partner and I have constant conflicts about how to spend it.

7. My child has been having behavioral problems at school.

8. The children get upset when they hear us arguing.

9. I work too much, and it’s really getting to me.

10. We don’t really talk about hard issues; we just try to hold our breath, wait and let them go away.

Counseling Plainfield Illinois, my goal as a therapist offering, is to find solutions that work for you on an individual basis, helping you to discover the true potential of your life, so everyday can be a celebration, and feel like a real ‘breath of fresh air.’ There may be no magic button or quick-fix solution when it comes to changing things from the past that have been difficult, but what we can do is work together to find comfort and resolve in the difficult areas of your life, and the challenges you have to face. Read more about Gwen Ginski, MEd, LCSW.

Set 2

1. We acknowledge feelings, encourage their expression and allow time for dealing with the issues these feelings raise.

2. We plan time for family activities. And we eat together at least once every day.

3. If a blended family, we maintain and nurture original parent-child relationships and let new relationships develop in their own time.

4. I feel confident in my role as parent.

5. Our family easily maintains a sense of humor and playfulness.

6. Family priorities take precedence over work.

7. I know what’s important to my kids.

8. When issues arise that we get stuck on, we ask for help from other family members, support groups, community-based programs, clergy and/or a therapist.

9. We have enough money for the important things.

10. Everyone in the family has responsibilities around the house and does them without being nagged.

If you answered true more often in the first set than in the second set, you may want to seek help lowering the stress level of your family. Families that communicate about problems, who face issues as they arise, who support one another and seek help when it is needed, can build strong bonds among themselves, nurture a healthy and loving family and have a lot more fun doing it!

Author’s content used  under license, © 2008 Claire Communications
Photo: Pexels.com

Disorganized Attachment

Mary Ainsworth’s work on attachment identified three attachment categories (secure, insecure avoidant, and insecure ambivalent/resistant). The development of the disorganized/disoriented classification evolved as a part of Mary Main’s doctoral research in which she noticed that approximately 10% of infants in Ainsworth’s Strange Situation Procedure were difficult to classify.1 Disorganized attachment is an additional attachment category that was identified in 1986 by Mary Main and Judith Solomon at the University of California, Berkeley.


Explore your attachment style through Online Counseling in New Jersey

Are you curious about your attachment style and how it may be impacting the quality of your life and relationships? Contact me to learn more about working together through online counseling in New Jersey.

I now also offer online counseling in Pennsylvaniacontact me to learn more.


The three attachment styles identified by Ainsworth are considered organized because they present behaviors that are consistent.2 In the Strange Situation Procedure, behaviors that were classified as disorganized/disoriented include:

-Obvious displays of fear of the caregiver
-Sequential or simultaneous behaviors or affects that are contradictory
-Movements that are asymmetric, misdirected, stereotypic, or jerky
-Apparent dissociation or freezing 1

These behaviors would typically happen for a moment until an infant’s behaviors returned to those that could more easily be classified into one of Ainsworth’s categories. Disorganized attachment can be seen as coexisting among the other three categories instead of being a replacement category, as disorganized infants were always coded into a second organized category.2

Caregiver Behaviors Associated with Disorganized Attachment

The following parental behaviors have been associated with disorganized/disoriented behavior in infants studied in the Strange Situation Procedure:

-Frightened or frightening parental behavior
-Dissociative, withdrawing, or helpless behavior
-Experiencing a persistent anxiety disorder
-Social and economic disadvantage
-Lack of regulation of the caregiving environment 1

Additional behaviors that can cause disorganized attachment behavior in infants, identified by Main and Hesse, include threatening gestures or expressions from the caregiver toward the infant, submissive behavior of a caregiver, sexual or romantic behavior toward the infant, mocking or teasing the infant, role confusion, and withdrawing (being silent during interaction). 2

The Impact of Disorganized Attachment

Disorganized attachment in infancy can impact the development of the amygdala. Components of maternal and infant disorganized attachment are linked to a larger left amygdala volume in adulthood, which is associated with limbic irritability and dissociation.3 Limbic irritability can result in aggression, violence directed at the self or others, and dysphoria.4 Unresolved trauma contributes to disorganized attachment in adults, with unresolved loss being easier to resolve than abuse that is unresolved.5

Check out my previous post to get a general overview of the different attachment styles.


Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides online counseling in Pennsylvaniacontact her to learn more.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321742/#c36
  2. https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-28099-8_2021
  3. https://www.sciencedirect.com/science/article/pii/S0166432816301905
  4. https://www.dana.org/article/wounds-that-time-wont-heal/
  5. https://www.sciencedirect.com/science/article/pii/S2352250X18301052
  6. Photo by Allef Vinicius on Unsplash

Researching Marijuana for Therapeutic Purposes

The Potential Promise of Cannabidiol (CBD)

Three weeks ago I had the opportunity to testify before the Senate on cannabidiol, or CBD—one of the main active ingredients in the marijuana plant, and a compound around which there is a growing amount of interest from the public as well as the scientific and medical communities. The intent of the hearing was to explore ways we can reduce obstacles to research on CBD, given that all chemicals in the marijuana plant are currently in the most restricted category of the Drug Enforcement Administration’s schedule of controlled substances—schedule I. This category is reserved for substances that have a high potential for abuse and no scientifically supported medical use. Medical research can and is being done with schedule I substances; however, there are strict regulations and administrative hurdles associated with this status.

The chemical in marijuana that causes the high (and many of its other effects) is delta-9 tetrahydrocannabinol, or THC. But there are over 100 other cannabinoid chemicals in the plant; CBD is one of those. Different cannabinoids can have very different biological effects; CBD, for example, does not make people high and is not intoxicating. And, there is reason to believe it may have a range of uses in medicine, including in the treatment of seizures and other neurological disorders. In the impassioned, often emotional debates these days over medical marijuana, CBD is often cited as one of the main reasons restrictions on marijuana should be loosened.

A basic understanding of the way cannabinoids affect the body and the brain is helpful to making sense of some of the confusing and contradictory claims made by partisans on either side of those debates. Most cannabinoids (including THC) interact with specific targets on cells in the body, the CB1 and CB2 receptors. CB1 receptors are found mainly in the brain and are important for learning, coordination, sleep, pain, brain development, and other functions; CB2 receptors are found mostly in the immune system. The fact that chemicals in marijuana can speak the body’s chemical language (and cause both beneficial and harmful effects) is not surprising and does not make marijuana special. Many plants, including the opium poppy, tobacco, and coca are similar in that regard. Extracting and amplifying the medicinal benefits of such plants and minimizing their potential harms can lead the way to effective medications, but are also a major scientific challenge.

In marijuana’s case, future medicinal uses will most likely lie in drugs based on cannabinoid chemicals or extracts with defined concentrations that can be reliably produced. There are very few precedents for a whole plant being approved as a drug (only two ”botanical drugs” are currently approved in the U.S.). This is because creating a standardized plant medicine poses major difficulties—especially in a case like marijuana where there are countless, widely varying strains and large numbers of chemical components about which little is yet known. Marijuana has over 500 chemicals in total, including the 100 or so cannabinoids, so we will still be learning about this plant for years to come. However, we are quickly learning a lot about THC and CBD, and because of its unique properties, CBD, especially, may be poised to make great inroads into our pharmacopoeia.

CBD has very little effect on CB1 and CB2 receptors. This is probably why it does not make people high and is not mind-altering; in fact it may even blunt some of THC’s psychotropic effects. Most marijuana grown for recreational use is very low in CBD content (and high in THC). CBD’s actions in the body are not well understood, but they appear to involve several signaling systems besides the CB receptors, including a serotonin receptor.

Although CBD first rose to public prominence two years ago as a result of a CNN piece on medical marijuana, CBD has been considered as a potential therapeutic agent since the 1970s, when its anti-seizure properties were first examined in animal studies. A few very small randomized clinical trials were also conducted in adults with epilepsy, some showing positive results. But what has generated the renewed interest and excitement are the anecdotal reports that some children with otherwise untreatable severe epilepsies respond well to CBD extracts and oils. A followup to the CNN piece depicted the struggles of parents of children with a seizure condition called Dravet syndrome, who moved their families to Colorado in order to get CBD-rich marijuana legally. Several drug companies have recently developed CBD-based medications, and one of these, called Epidiolex, is now being tested in clinical trials. Epidiolex was developed by GW Pharmaceuticals and has been given to more than 400 children under the FDA’s expanded access (“compassionate use”) program.

While the existing data show promise, it is still too soon to tell whether and for whom CBD will be effective. Like most medical treatments, it doesn’t seem to work for everyone. Much more research needs to be done, but it should be done quickly. Parents can’t wait—their children are growing; their children’s brains are actively developing; and the repeated seizures may be damaging this growth. Parents currently must navigate states’ medical marijuana laws or defy the law to obtain CBD extracts—which, in the current unregulated market, may be of questionable quality and content.

Besides the trials of Epidiolex, there are already many studies of CBD for other disorders being conducted, including at NIH. Studies related to its possible use in the treatment of substance use disorders are being funded by NIDA, while other NIH Institutes are funding work on the potential of CBD and other cannabinoids in treating neurological and psychiatric disorders, disorders of the immune system and metabolism, and cancer.

In short, CBD appears to be a safe drug with no addictive effects, and the preliminary data suggest that it may have therapeutic value for a number of medical conditions. Addressing barriers that slow clinical research with CBD would accelerate progress. NIDA will do what we can to address such barriers and expedite the study of this potentially valuable compound, as well as other components of the marijuana plant.

By The National Institute on Drug Abuse

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Medical Marijuana is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.

Ketamine for Depression

Ketamine for Depression is it a Miracle Drug?

A team of researchers funded by the National Institutes of Health (NIH) recently discovered why the drug ketamine may act as a rapid antidepressant.

Ketamine is best known as an illicit, psychedelic club drug. Often referred to as “Special K” or a “horse tranquilizer” by the media, it has been around since the 1960s and is a staple anesthetic in emergency rooms and burn centers. In the last 10 years, studies have shown that it can reverse — sometimes within hours or even minutes — the kind of severe, suicidal depression that traditional antidepressants can’t treat.

Researchers writing in the August 2010 issue of Archives of General Psychiatry reported that people in a small study who had treatment-resistant bipolar disorder experienced relief from depression symptoms in as little as 40 minutes after getting an intravenous dose of ketamine. Eighteen of these people had previously been unsuccessfully treated with at least one antidepressant medication and a mood stabilizer; the average number of medications they had tried unsuccessfully was seven. Within 40 minutes, 9 of 16 (56 percent) of the participants receiving ketamine had at least a 50 percent reduction in symptoms, and 2 of 16 (13 percent) had full remission and became symptom-free. The response lasted an average of about a week.

In a small 2006 NIMH study, one of the first to look at ketamine for depression, 18 treatment-resistant, depressed (unipolar) patients were randomly selected to receive either a single intravenous dose of ketamine or a placebo. Depression symptoms improved within one day in 71 percent of those who were given ketamine, and 29 percent of the patients became nearly symptom-free in a day. Thirty-five percent of patients who received ketamine still showed benefits seven days later.

In the most recent study published online in the journal Nature in May 2016, researchers discovered that a chemical byproduct, or metabolite, is created as the body breaks down ketamine. The metabolite reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine.

“This discovery fundamentally changes our understanding of how this rapid antidepressant mechanism works, and holds promise for development of more robust and safer treatments,” said Carlos Zarate, MD, of the National Institute of Mental Health (NIMH), and a study coauthor and pioneer of research using ketamine to treat depression. “By using a team approach, researchers were able to reverse-engineer ketamine’s workings from the clinic to the lab to pinpoint what makes it so unique.”

In response to the Nature report, Sara Solovitch of The Washington Post wrote that “experts are calling [ketamine] the most significant advance in mental health in more than half a century.” She reported that many academic medical centers, including Yale University, the University of California in San Diego, the Mayo Clinic, and the Cleveland Clinic, have all begun offering ketamine treatments off-label for severe depression.

Therese Borchard, Associate Editor Psych Central. She is the founder of Project Hope & Beyond, an online community for persons with treatment-resistant depression and other chronic mood disorders. She blogs for Everyday Health and is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes.

NYC psychiatrist Dr. Jeffrey Ditzell provides treatment such as Ketamine for Depression using ketamine infusion therapy, Dr. Ditzell also specializes in adult ADHD, Psychiatric Consultations. New York City Psychiatrist.

About Marijuana’s Medicinal Benefits

Obtaining a prescription for medical cannabis can be the first step toward relief for consumers suffering from debilitating symptoms, but many are challenged to navigate the sometimes-unfamiliar terrain of dispensaries and then find the best product to suit their needs.

Now nursing organizations are stepping in to help them serve as educators and advocates for patients who seek to integrate cannabis into their medical treatment.

The San Diego-based Cannabis Nurses Network formed in 2015 as a professional development organization that offers its domestic and international members access to education, networking, professional recognition, and legal and medical advocacy.

According to Heather Manus, a nurse and founding member of the network, the group educates nurses on the science behind medical cannabis and supports them in their careers

Group members appear at various cannabis conferences and will be staging its fourth annual Cannabis Nurses Network Conference from Feb. 28 to March 2, 2019, in San Diego. Manus said conference participants will learn about the latest science, research, and clinical applications relating to the human endocannabinoid system and cannabinoid therapeutics.

The organization’s website also lists educational resources and a member directory to help locate trained cannabis nurses.
A Washington, D.C. Group with Similar Aims

A similar group, the American Cannabis Nursing Association (ACNA), formed on the East Coast in 2012. Denise Foster, a nurse for more than 30 years in Chesapeake, Va., is director of the ACNA in Washington, D.C. The organization develops nursing standards, credentials, and certifications in an effort to reduce the stigma and knowledge gap surrounding cannabis.

Foster and the ACNA are working to train nurses in the safe use of cannabis products.

“Patients are using cannabis as medicine, and it’s important for nurses to be educated on the medical risks and legal implications of cannabis use,” Foster told Marijuana.com. “In addition, it’s important for nurses to know about the scientific evidence related to cannabis and symptom management.”

Foster said the ACNA ultimately hopes to see trained cannabis nurses employed in hospitals, doctor’s offices and dispensaries across the U.S. In these roles, nurses can counsel patients and help them determine the right cannabis product and dosage to manage their health condition.

“Depending on the state in which a patient resides, they may be able to choose from a number of different routes of cannabis administration,” said Sarah Cohen, a cannabis nurse in Chicago and secretary for the ACNA. “Each route has a different duration and time to efficacy. The type of symptom a patient is trying to control – chronic pain versus breakthrough pain, for example – can also help determine the optimal route.”

Cohen worked as a nurse for two years at a medical cannabis dispensary in Illinois. During that time, she saw patients with numerous conditions, including cancer, multiple sclerosis, fibromyalgia, and Crohn’s disease, who found relief from pain, spasms, and insomnia.

“I twice heard from patients whose opioid use was spiraling out of control, that cannabis saved their life,” Cohen said. “In general, consumers are starved for information so, as a nurse, my primary role was education about the different types of cannabis routes of administration.”

Currently, Foster said many patients receive prescriptions for Medical Marijuana from their health-care provider, but are then left with questions such as where to go, what to ask for and how to use the herb.

Foster said she remembers “one woman who was given an inappropriate dosage of medical cannabis and experienced some unwanted side effects,” which can include anxiety, shortness of breath and increased heart rate. “The experience left her nervous about giving cannabis a second chance.”

Cohen said nurses and other clinicians also should receive education about the endocannabinoid system (ECS), a network of receptors that affect appetite, mood, memory, pain, and other physiological functions. Since its discovery, the ECS’s role isn’t adequately covered in most clinical education curricula.

“Cannabis plant material can be smoked, vaped, ingested raw, and incorporated into food and beverages,” Cohen said. “Extracted cannabis oils can be vaped, applied under the tongue, ingested directly, applied topically, and incorporated into food and beverages. Cannabinoids can also be delivered through transdermal patches and gels and via suppositories.”
Preparing Nurses to Meet Needs of Patients

Regardless of whether a state is legal for medical or adult-use cannabis, Cohen said data shows that patients are using cannabis as medicine.

“This means that nurses and healthcare providers in all states, should have a working knowledge of cannabis therapeutics,” she said. “Only with accurate information can we best serve patients.”

Currently, the ACNA is the only professional nursing organization working toward having cannabis nursing recognized by the American Nurses Association (ANA) as a certified nursing sub-specialty. In conjunction with the Medical Cannabis Institute, ACNA offers an online course for nurses, as well as resources for nurses who want to learn more about how medical cannabis and how it can be safely and effectively used to manage a patient’s health condition. While becoming certified as a cannabis nurse is something the ACNA hopes to offer in the future, nurses who pass the ACNA’s Core Curriculum class and pass the subsequent test receive a certificate of competency in cannabis nursing from ACNA.

“While having cannabis nursing recognized as a sub-specialty is still a work in progress, we’re encouraged by a recent announcement from the National Council on State Boards of Nursing (NCSBN) that calls for all nurses to be educated about the mammalian endocannabinoid system and the scientific evidence base related to cannabis and symptom management,” Cohen said. “Additionally, nurses will be required to understand their states’ cannabis policies and how these may impact patient care and well-being.”


What health conditions qualify for medical cannabis in New York?

Only a handful of “severe, debilitating or life threatening” health conditions are currently eligible for medical marijuana treatment in New York.

You are potentially eligible for Medical Marijuana if you have been diagnosed with a specific severe, debilitating or life threatening condition that is accompanied by an associated or complicating condition. By law, those conditions are: cancer, HIV infection or AIDS, amyotrophic lateral sclerosis (ALS), Parkinson's disease, multiple sclerosis, spinal cord injury with spasticity, epilepsy, inflammatory bowel disease, neuropathy, and Huntington's disease. The associated or complicating conditions are cachexia or wasting syndrome, severe or chronic pain, severe nausea, seizures, or severe or persistent muscle spasms.

In January 2016, Health Commissioner Dr. Howard Zucker announced that he would not allow patients with Post Traumatic Stress Disorder, Alzheimer’s disease, muscular dystrophy, dystonia, and rheumatoid arthritis to participate in the medical marijuana program because he does not believe there is enough scientific evidence to prove that cannabis can be an effective treatment for these conditions.

In accordance with state law, the New York Health Department was given a year and a half to consider the five proposed qualified conditions and make a determination as to whether patients with these ailments should be given access to medical marijuana. Officials reportedly pulled in a legion of health and science experts to examine several pieces of research pertaining to marijuana as a viable treatment option, but ultimately they concluded that more evidence was needed before they would be willing to move forward.

The New York Times recently reported that only 51 patients were currently registered to participate in the medical marijuana program, mostly because there are only about 150 physicians in the entire state that have been certified to provide their patients with medical marijuana recommendations. Furthermore, the Times indicates that dispensaries located in highly populated New York City have only seen “a trickle of patients” since opening their doors last week, indicating that dispensaries servicing other parts of the state likely aren’t seeing much action.

Keith Stroup, the founder of the National Organization for the Reform of Marijuana Laws, recently told Vice News that changes to New York’s medical marijuana program will take some time because lawmakers are still suspicious that patients are simply searching for a way to get stoned without legal ramifications. Unfortunately, due to the New York’s impact on national policy, Stroup thinks more states will follow in its footsteps when it comes time to create their respective medical marijuana programs – providing patients with no raw cannabis, no edibles, and no fun.

High Times

Medical Marijuana NYC Psychiatrist Jeff Ditzell Medical Cannabis.

Dr. Ditzell has the training and expertise to certify patients for medical marijuana (medical cannabis) to help guide cases and manage this treatment modality NYC Psychiatrist Jeff Ditzell.

Why is it so hard to find a medical marijuana doctor in New York?

New York doctors are signing up to recommend medical marijuana more quickly than some had anticipated. As of Jan. 28, 306 physicians had registered with the state, and they had helped 465 patients get certified for the program.

But cannabis medicine remains out of reach for many who are eligible, including those with epilepsy, cancer and the handful of other serious conditions approved for treatment.

Read more on Crain's.

There are also some handy fringe benefits to keeping your card current, like the tax-exempt status of medical marijuana. Under Prop 64, recreational cannabis retailers will be taxed by the state, and that’s before considering local city or county taxes that could drive prices up further. Recreational consumers are poised to pay more than Medical Marijuana patients, with the possibility of even higher taxes down the line.

About Marijuana

According to Norml.org, Marijuana is the third most popular recreational drug in America (behind only alcohol and tobacco), and has been used by nearly 100 million Americans. According to government surveys, some 25 million Americans have smoked marijuana in the past year, and more than 14 million do so regularly despite harsh laws against its use. Our public policies should reflect this reality, not deny it.

Marijuana is far less dangerous than alcohol or tobacco. Around 50,000 people die each year from alcohol poisoning. Similarly, more than 400,000 deaths each year are attributed to tobacco smoking. By comparison, marijuana is nontoxic and cannot cause death by overdose.

Recreational Legalization Won’t Make Medical Marijuana Cards Obsolete. Despite the continuing evolution of adult-use laws across the United States, a medical marijuana card can still come in handy and ensure your access to cannabis for any qualifying condition. That’s important, because the wheels of legislation turn slowly.