Managing Triggers Over the Holidays

While holidays can be joyous occasions, they can be difficult for many people. This year may be especially difficult for some as many will experience more loneliness and grief than before. Some people do not have others to spend time with during the holidays, or their family members engage in substance use or other unhealthy behaviors. Many self-help groups such as Alcoholics Anonymous or Narcotics Anonymous extend their meetings during the holidays to help people going through these experiences.

If you are experiencing distress or having triggers to use, ACCEPTS is an acronym from Dialectical Behavior Therapy that can help in managing this:

Activities Engage in activities that get you thinking and keeps your mind preoccupied. Reading, playing video or board games, and engaging in other hobbies are ideas that can help to think less about distressing things.

Contributing Do something for someone else. Make or buy a special gift for a loved one, send a card or letter, help a family member cook a meal or set up for the holidays, or help someone who is less fortunate.

Comparisons Compare your situation to a more difficult one. It could be thinking about how much more difficult your situation would be if you were not sober or working on your mental health, or when things were worse than they are now. Consider how others may be coping less than you are.

Emotions Do something that brings up positive emotions to replace distressing ones. Watch a funny or uplifting movie if you are sad or anxious, go for a walk if you are angry, or call a loved one if you are lonely.

Pushing Away Use imagination to push out and block negative thoughts that are triggering you to relapse or causing you distress. Think of a “happy place” instead that brings you joy, whether it is a real or fictional place. Imagine putting your thoughts on a leaf and watching them float down a stream.

Thoughts Use grounding techniques to shift your thoughts, such as naming all of the blue things in the room, finding items in the room that start with each letter of the alphabet, or imagining tracing your feet with an invisible pen.

Sensations Engage the five senses to distract you. Some examples are taking a cold shower or holding an ice cube, eating something spicy, smelling candles, listening to music or watching relaxing videos.

If you are wanting more help with tolerating distress and temptations to go back to unhealthy patterns, contact Charmed Counseling to schedule a consultation or appointment at 509-768-6852.

Freedom: Breaking the Cycle of Mental Health Stigma

“My mental illness was disregarded and ignored in my childhood; the family had to keep up appearances so I can’t be having these thoughts, they are not right.” G.B. 2020

What is stigma?
According to an article by the Mayo Clinic, stigma is described as, “ when someone views you in a negative way because you have a distinguishing characteristic or personal trait that’s thought to be, or actually is, a disadvantage (a negative stereotype).” The sad part is, we often stigmatized ourselves as well. This is usually based on those negative stereotypes we hear throughout society, news or family beliefs. According to NAMI, National Alliance on Mental Illness, “Stigma causes people to feel ashamed for something that is out of their control. Worst of all, stigma prevents people from seeking the help they need.” In the article by the Mayo Clinic, they list some of the harmful effects of stigma as:
Lack of understanding by family, friends, co-workers or others
Fewer opportunities for work, school or social activities or trouble finding housing
Bullying, physical violence or harassment
Health insurance that doesn’t adequately cover your mental illness treatment
The belief that you’ll never succeed at certain challenges or that you can’t improve your situation
Reluctance to seek help or treatment
A Personal Story:
G.B. 2020
One definition of freedom is as follows: The state of not being imprisoned or enslaved. I have personally experienced freedom. I have felt that incredible power of being freed, and freed of something I never thought I would be free of. A vast majority of my life I had allowed my mental illness ( bi-polar, anxiety) to enslave me into thinking that I had done something or hadn’t done something to cause my mental illness. My mental illness imprisoned me into thinking that there would never be a way out, that I was stuck in mental illness forever.

I was lucky in my epiphany. It was 100% undeniable, even to my mind: I met my birth parents and family. After spending a bit of time with my birth family I realized a vast majority of my gene pool was suffering from some sort of mental illness. That is when it hit me like a train, I actually remember the exact thought, “Holy crap it’s not just me, I came preloaded with all this.” I realized I did nothing to make myself mentally ill.

When I started seeking help in my recovery, the face of mental illness looked a whole lot different than today. Mental illness was considered a weakness (especially if you were male). I literally can not count how many times I was told to just “snap out of it”. The only reason I ever started counseling was after my first suicide attempt, at this point (1993). There was only one place for mental health counseling I could go to and it was referred to as the “nut house.” Today, not only are there more places to go to seek help it’s also highly encouraged to do so. Also, there is an increased amount of coping skills and resources available now compared to “just take this pill.” The stigma has yet to disappear, however the mark is much lighter and that gives me some hope that someday it will be gone.

What can we do?
So often, this stigma is based on a lack of understanding, but that is no excuse for it to continue. With great organizations like NAMI, through vetted online resources, and people talking to each other and advocating for themselves, stigma can become a thing of the past. Unfortunately, most of the information people find on the internet is not vetted, it is based on harmful, preconceived notions or what is trending at the time. But there is something you can do. NAMI suggests the following to help fight stigma:
Openly talk about mental health
Educate yourself and others
Be conscious of language (“He has schizophrenia” not “He is schizophrenic”)
Encourage equality between physical and mental illness
Show compassion for those with mental illness
Choose empowerment over shame
Be honest about treatment
Let media know when they are being stigmatizing
Don’t harbor self-stigma.
Do something. Anything. Talk to your friends and family about mental illness, seek help, become educated. We all have a choice and we all have the freedom to make a change. For more information on mental illness reach out to the therapists at Charmed Counseling or other therapists in your area, or go to NAMI.org to learn more about how you can help or get support for your or your loved one’s mental illness.

Resources:
Mayo Clinic article:
https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477

NAMI (National Alliance on Mental Illness) https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma

Written by Debra Winter, LMHC, LSWAIC, Clinical Therapist at Charmed Counseling
Debra@charmedcounseling.com, www.charmedcounseling.com

How to overcome Social Anxiety

It is normal for people to have some anxiety when participating in new social situations, such as going on a first date, having a job interview, or giving a speech. Some anxiety can be healthy to motivate us to perform well and try our best. Social anxiety can become more troubling when it is persistent over multiple months, causes significant distress, and when social situations are avoided or confronted with intense fear. When this happens, a person may have Social Anxiety Disorder.

Social Anxiety Disorder, (or Social Phobia) is a mental health condition where a person fears being negatively evaluated by others. Social situations cause significant distress and are often avoided. It is one of the most common anxiety disorders and often begins in childhood or adolescence.

One of the most effective ways to overcome fear is to face it! People with Social Phobia often have core fears of being negatively evaluated by others, being rejected, and/or humiliating themselves. It is inevitable that some people will reject and judge us. To a person with Social Anxiety Disorder, the social costs of these experiences are exaggerated. Experiencing these fears helps a person challenge their beliefs and learn that most people are not judging them, and when they are, the consequences are usually not as severe as a person thinks it will be. The cost of avoiding social interactions is higher than occasional negative evaluations by others.

Exposure-based Cognitive Behavioral Therapy (CBT) empowers a person to gradually expose themselves to feared situations that they avoid. Through repeated exposures, a person’s anxiety decreases as their thoughts and beliefs about the situation changes. While uncomfortable to put oneself in these situations, it is currently the most known effective strategy in overcoming social anxieties.

If you are motivated in overcoming social anxiety and interested in learning more, Taylor Hocking, LMFTA, SUDP utilizes exposure-based CBT in treating Social Phobia. Call 509-768-6852 to schedule a consultation.

Prolonged Exposure Therapy for PTSD

Prolonged Exposure Therapy is a type of psychotherapy that specifically treats Post-Traumatic Stress Disorder. It is evidence-based, meaning that research has shown its effectiveness in treating people with PTSD. Many people who undergo Prolonged Exposure no longer have significant PTSD symptoms after completing treatment, and only 6% of people have a relapse of PTSD in the future. It is considered a first-line treatment for PTSD.

When people have PTSD, they often avoid people, places, and things that remind them of the traumatic event. Avoidance can be a healthy coping mechanism in situations where there is real and actual danger. However, avoiding relatively safe situations, as well as thoughts and feelings related to the trauma, can perpetuate PTSD symptoms. Exposure helps a person to face their fears and learn that they can overcome them and that most situations are not dangerous. It also helps the person to learn that thoughts and feelings are not dangerous as well, even though they are disturbing and uncomfortable to manage.

The main components of Prolonged Exposure are in-vivo exposures and imaginal exposures. In in-vivo exposures, a person puts themselves in safe situations that they have been avoiding. This may include public places, smells, songs and scenes in movies, and other situations. When a person does this, over time, their anxiety reduces and they build confidence that they can handle different situations.

The second main part of Prolonged Exposure is imaginal exposure. In imaginal exposure, a person tells their trauma story throughout the session, and re-hears this story on a daily basis. While intense and scary at first, the story eventually becomes less distressing to talk about. A person may learn new perspectives of the trauma and no longer feel like it is controlling their life. Although difficult, this is a major step towards healing PTSD.

Prolonged Exposure therapy typically lasts 10-15 weeks, with weekly 90 or 60 minute sessions. It is a short-term, intensive therapy that requires daily treatment work between sessions. If you are interested in doing the work to overcome PTSD, schedule a free consultation with Taylor Hocking, LMFTA, SUDP at 509-768-6852.

Common Reactions to Trauma.

After experiencing a traumatic event, it can be difficult to cope with everyday life. A person may begin to think, feel, and behave differently than they used to. Some people have experienced trauma early in life and it can be hard to compare their lives to before the trauma happened. Regardless of how long ago the trauma occurred, these are a list of common experiences those who have experienced trauma have:

Frequent negative emotions, and struggling to experience positive emotions. Common emotions might include: guilt, shame, anxiety, anger, depression
Certain things might remind you of the trauma and may trigger negative thoughts and emotions
Having intrusive thoughts about the trauma such as flashbacks and nightmares. Sometimes, these flashbacks and nightmares can feel very vivid and that the trauma is happening all over again
Becoming easily startled and jumpy
Difficulty concentrating
Feeling out of control or that you are going crazy
Trouble sleeping
Avoiding people, places and things that remind you of the trauma. This could include avoiding thoughts and feelings about the trauma
Forgetting some parts of the trauma
Emotional numbness
Feeling detached from yourself or your surroundings
Believing that the world or other people are dangerous
Having a negative view of self or other people
Crying spells
Thoughts of harming yourself or thoughts of suicide
Feeling angry and aggressive/being snappy with others
Self-destructive behavior, such as reckless driving, drug and alcohol abuse, or other risky behaviors
Relationship difficulties, and struggling to feel emotionally and sexually intimate with others
Loss of interest in sex and physical affection

If you are experiencing some of these symptoms after experiencing a traumatic event, you are not alone. These are common symptoms that many people experience. Fortunately, therapy can help to alleviate these symptoms. There are several effective treatments for trauma-related mental health issues, some of them including Eye-Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure, Cognitive Processing Therapy, Trauma-Focused Cognitive Behavioral Therapy, and others.

If you are interested in learning more about treatment options, there are several counselors at Charmed Counseling who may be able to assist you. Taylor Hocking, LMFTA, SUDP is trained in Prolonged Exposure and EMDR. Contact 509-768-6852 for a free consultation.

References
Foa, E. B., Hembree, E. A., Olasov Rothbaum, B., & Rach, S. A. M. (2019). Prolonged exposure therapy for ptsd (2nd ed.). New York, NY: Oxford University Press.

The Power of Pawsitivity

We’ve all heard about the power of positivity. I know my clients hear me talk about it all the time; “Write down 3 positive things each day” or “What you focus on grows.” In these times of isolation and uncertainty, it is often difficult to stay focused on the positives, but for those of us who own pets, we know how much they can help us from falling deeper into our despair. It has been proven that pets, especially cats and dogs, can reduce stress, anxiety and depression. They encourage us to play, get exercise and can improve our overall health. Children growing up with pets can learn responsibility, empathy and compassion. So let’s take a closer look at the Power of Pawsitivity.

Pets don’t only offer companionship, they add real joy and unconditional love to your life. Studies show that pet ownership can: reduce depression, lower blood pressure in stressful situations, playing with your pet can increase your levels of serotonin and dopamine (happy hormones), lower cholesterol levels, and increase overall exercise. Pets tend to fulfill the basic human need for touch, which is the reason for these therapeutic effects. The companionship of a pet can ease loneliness and dogs especially help with increased exercise which can boost mood and ease depression. Dog parks are a great way to meet new people and provide at least some aspect of socialization not only for your pet but for you as well. The reduction in anxiety is also a great benefit of pet ownership by helping you be more mindful of your present and appreciate the moment, as well as adding structure and routine to your day.
Oh, you say you are allergic to cats and/or dogs? Well there are alternatives to those fur babies. You may think that reptiles seem cold, but studies show that lizards and snakes can grow attached to their owners, recognizing those who care, handle, and feed them. Not your thing? What about a bunny rabbit? They can make exceptional pets, be litterbox trained and have loads of personality. Birds can help encourage social interaction by teaching them to talk or do tricks which promotes healthy cognitive function in the elderly. Even watching those boring fish swim around in their tanks can reduce stress and calm your heart rate.

Did you know that growing up with a pet actually reduces risk of allergies and asthma? They can give children the sense of security and help reduce separation anxiety. They also can help kids build better relationships with others, calm hyperactivity, learn responsibility and build confidence. Children on the Autism spectrum or with other learning difficulties sometimes are able to interact better with pets compared to people. They often rely on nonverbal cues to communicate, just as animals do. This can help them regulate their emotions and calm themselves easier.

For more information on the benefits of pet ownership and other ways of keeping yourself emotionally healthy please visit helpguide.org or reach out to your local pet shelter for information on volunteering or adopting a pet of your own.

Written by Debra Winter, LMHC, LSWAIC, Clinical Therapist at Charmed Counseling
Debra@charmedcounseling.com, www.charmedcounseling.com

What is Post-Traumatic Stress Disorder?

Post-Traumatic Stress Disorder (PTSD) is a mental health disorder that occurs in some people after experiencing a traumatic event. While many people have believed that it is only diagnosed in combat veterans, there are multiple traumatic experiences that can cause PTSD. PTSD is a common diagnosis: about 10% of women and 4% of men in the United States will have PTSD at some point in their lives.

In order to have PTSD, a person must have experienced certain traumatic events. These include actual or threatened death, serious injury, or sexual violence. This can occur by directly experiencing the event, witnessing it happen to other people, or learning about the event happening to a close loved one. Another situation PTSD can develop is in being exposed multiple times to traumatic details or events, such as 911 operators hearing traumatic stories.

Traumatic symptoms are normal within the first couple of months after experiencing a trauma. If these symptoms persist after 1 month of experiencing the trauma, a person may have PTSD. While this is a list of some potential PTSD symptoms, it is not a way to diagnose a person; an assessment must be made by a mental health professional. Some of these symptoms include:

Intrusive symptoms. These include experiences such as nightmares, flashbacks, or unwanted thoughts of the event. These may be in response to things that remind a person of the event, or they can come on randomly.
Avoidance symptoms. This includes avoiding things that remind the person of thoughts, feelings, and memories of the traumatic event. A person may start to withdraw from other people and be less interested in activities that they used to enjoy.
Negative mood. A person might feel detached from others and struggle to experience positive emotions. It is common to experience feelings of sadness, guilt, anger, rage, and shame. It is very common for people to begin to believe that the world and other people are dangerous and cannot be trusted. Many people with PTSD also blame themselves for the event.
Hyperarousal symptoms. A person may begin to feel more on guard, aware of their surroundings, become easily startled, struggle to concentrate, have sleep issues, and anger outbursts.

It is normal to struggle with some of these symptoms after a traumatic event. As time progresses, many people will recover from these symptoms as the brain naturally heals itself. If you are still experiencing PTSD symptoms several months after the traumatic event, it is helpful to get treatment for it. If the traumatic event happened more than a year ago, it is very unlikely that your symptoms will go away on their own. The good news is that there are several treatments that are very effective for PTSD, even multiple years after the event. The most evidenced based treatments for PTSD include Prolonged Exposure, Eye Movement Desensitization and Reprocessing (EMDR), and Cognitive Processing Therapy.

Taylor Hocking, LMFTA, SUDP is trained in Prolonged Exposure and EMDR. If you are interested in learning more, contact 509-768-6852 for a free consultation.

GeneSight Testing: What is it and how it can help

What is it?
GeneSight Psychotropic is a pharmacogenomic test that analyzes clinically important genetic variations in your DNA. The results of the test can info rm your doctor about genes that may impact how you metabolize or respond to certain medications (Genesight.com). This can be a game changer for those of you who have tried various medications for your mental health disorders with little to no success. It can also help find the appropriate medications that can eliminate or greatly reduce the side effects you can often experience from psychotropic medications.

How it works:
The GeneSight Psychotropic test analyzes how your genes may affect your response to medications commonly prescribed to treat depression, anxiety and other psychiatric conditions (Genesight.com). The test results provide information about dosage, which medications are most likely to be effective and decrease the amount of side effects. Proven and peered review studies have shown a 30% response improvement over treatment as usual (TAU), and a 50% improvement of remission rate over TAU.
First-hand story:
For me Genesight testing CHANGED THE GAME. Let me start at the beginning. I have chronic depression and anxiety. The chronic just means it’s not going anywhere, I’m gonna have to put up with it for the rest of my life, which for most of my life seemed very daunting but now I’m very optimistic because of Genesight testing. For most of my life I was put on various medications that helped to manage my depression and anxiety but never really gave me a foothold. My mental health was always either on the edge of falling or already rolling down the hill, and I’ll be honest it was hard, very hard. And then my therapist told me about Genesight testing and I was willing to try anything at that point because I had no other options. I don’t remember how long it took to get the results back because at that point in my life I was under so much stress and so depressed that I had no concept of time. When I got the results back I was shocked, not only was I able to read it myself but it all made sense. It told me the drugs that I have been taking the majority of my life were chemically imbalanced to my body, meaning I was never going to do well on them. So we started some drugs that this little piece of paper told me I would do better on. And something changed, I got better. I was able to return to work, enjoy my life, and just have some hope for a better future. About a year later, I am still on the same meds and I am flourishing in my life. I was able to return full-time to work, something I haven’t done in years, conquer fears, make friends and finish therapy, something I had honestly never thought I’d do. Genesight testing worked for me. It gave me answers. It gave me hope. I hope it does the same for you.
Side note: What this past client of mine is not telling you is when we met 2 years ago she was highly suicidal and had no hope of getting better. I was seeing her 3x week just so we could keep her out of the hospitals. It was one of the most severe cases of depression I have seen. She had minimal trauma in her life and had tried so many counselors and medications with very few results. When I asked her to switch from her PCP to a particular psychiatric ARNP she was skeptical but willing to try. This ARNP followed my suggestion of doing the Genesight testing and it truly was the game changer. Less than a year later I was able to successfully discharge this client and know she was going to be alright.

Therapist’s view:

This is just one client’s experience, but as a therapist I have seen similar experiences time and time again. Why not take the guesswork out of medication management? It is possible to feel better without bouncing from one medication to another. However, sometimes the difficulty lies within your insurance covering it or doctors even believing it is worthwhile. My suggestion is to be proactive and advocate for yourself. Take the research to them and insist on having the testing done, especially if you have tried many other medications to no avail. Check out the Genesight testing website at genesight.com for more information and tips on how to talk to your doctor.

Written by Debra Winter, MSW, LMHC, LSWAIC

Things to Do During the Pandemic

Mental health concerns are increasing during the pandemic due to grief, loss, financial stressors, fear of the virus, and isolation. Since there is a strong connection between the mind and body, all of these issues can negatively impact our mental and physical health.

Research has shown that social isolation and chronic loneliness can increase rates of depression and anxiety, cause cardiovascular issues, impair our cognitive abilities, and create sleep concerns. A recent study has also found that research participants who were quarantined during the pandemic were significantly more likely to suffer from depression and anxiety than those who were not, particularly in areas where there was not a high rate of Coronavirus.

Part of the reason why depression and anxiety is more prevalent while quarantining is due to lack of connection with other people. We are wired to connect with other human beings. Being around friends and family can improve our mental and physical health. Another reason why mental health issues may be increasing during the depression is more down time. While having time for rest and not having a full calendar can be important for self-care, excessive downtime with little to do can increase ruminating thoughts. Ruminating thoughts can result in anxious “what-if” thinking and sad/hopeless thoughts, especially for people prone to anxiety and depression.

Although life looks different for many of us during this time, we can find creative ways to have social and recreational needs met while keeping ourselves and others safe. Planning activities and different types of socialization can help to decrease distress and improve overall mental well-being. Research shows that when our mental health declines and we experience chronic stress, our physical health starts to decline as well. Being purposeful in finding lower risk activities where we build connection with others and stimulate our minds can help to offset some of this stress and bring some feelings of normalcy.

The following are ideas of activities to try in the current and upcoming seasons. These activities can be adjusted to include physical distancing of 6+ feet apart when around other people, wearing masks, and sanitizing/hand-washing.

Online Activities
Teletherapy
Zoom/face-time/Facebook messenger videos
Virtual book club
Virtual religious meetings
Virtual support groups such as AA/NA
Virtual classes
Online game night/virtual Pictionary

Outdoor Activities
Rafting
Kayaking/paddle boarding
Tubing
Boating
Fishing
Golfing
Hiking
Tennis/badminton
Swimming in river
Walking in neighborhood
Historical site seeing
Drive-in movies
Physical distance BBQ (bring your own food, set chairs 6+ feet apart)
Camping with family/housemates
Scenic drives
Riding bikes
Long-boarding/skateboarding
Star gazing
Family picnic
Gardening
Picking fruit and making recipes
Build a snowman/snow angel
Sledding
Berry picking
Pumpkin patch
Fire pit
Slip-n-slide
Water balloons
Soak in a natural hot spring
Physical distance ice skating
Snowmobiling
Snowshoeing
Snowboarding/skiing
Snowball fight
Horseback riding
Fly a kite
Chalk sidewalk
Create an outdoor obstacle course
Paint and hide rocks (Spokane Rocks)
Outdoor yoga/meditation
Earthing

Indoor Activities/Hobbies
Yoga/meditation
Crafting
Study genealogy (ancestry.com)
Cooking meals/baking
Making cider
Board games
Make homemade ice cream
Painting/sculpting/drawing/collaging/etc.
Canning
Sewing
Rent a cabin in the mountains
Make a bird house
Camp out in the family room
Decorate sugar cookies
Puzzles
Create mosaic stones
Paint rocks
Sensory activities: sandbox, water table, play dough, slime

Volunteering
Write thank you/I’m thinking of you cards to people
Send care packages to someone in need
Activity packs for nursing home residents
Donate to a cause
Food banks

References:
Fang, T., Liang, J., Zhang, H. Kelifa, M. M., He, Q., et. al. (2020). Covid-19 related depression and anxiety among quarantined respondents. Psychology & Health. doi:10.1080/08870446.2020.1782410

Novotney, A. (2019). The risks of social isolation. American Psychological Association, 50(5).

Written by Taylor Hocking LMFTA SUDP
Taylor@charmedcounseling.com www.charmedcounseling.com

Charmed Counseling
Establishing connected,
healthy relationships


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