Couples Therapy

What is Couples Therapy?

Couples therapy is a form of psychotherapy designed to work with partners at the same time, in the same space. In couples therapy, both parties attend weekly or biweekly sessions with a trained therapist in an effort to improve or maintain their relationship. A therapist will work with both partners to help express their feelings, discuss issues, and resolve conflicts. This can be beneficial for couples having relationship difficulties ranging from feelings of disconnection to issues related to sex, an affair, or conflicts due to external stressors. However, couples therapy can also be beneficial for partners simply looking to strengthen their connection and help increase respect, affection, and intimacy. 

Common Topics Addressed in Couples Therapy:

• Communication

• Emotional intimacy 

• Goal setting

• Conflict resolution

• Love languages

• Beliefs 

• Values

• Finances

• Roles and responsibilities

• Infidelity 

• Time spent together

• Parenting Techniques 

• Familial relationships

• Sex and intimacy 

• External stressors

• Health concerns 

• And so much more!

Types of Couples Therapy

• The Gottman Method: This is one of the most popular forms of couples therapy utilized today. It is based on the research of patterns of behavior in successful and unsuccessful relationships. This method involves focusing on the destructive behaviors of criticism, contempt, defensiveness, and stonewalling and how to equip the couple with healthier problem-solving skills, effective communication, and ways to get each partner’s needs met. 

• Cognitive Behavioral Couples Therapy: This therapy modality targets identifying maladaptive thought patterns that negatively influence the behavior of each partner and challenging these thought patterns to help improve relationship quality and communication, as well as reduce frequent misunderstandings and misinterpretations.

• Psychodynamic Couples Therapy: Psychodynamic therapy explores the connection between the couple’s past experiences and their current mentalities and how their mindsets affect their relationship.

• Behavioral Couples Therapy: Behavioral therapy is designed to shape the couple’s behavior by reinforcing positive behaviors that nurture stability and discouraging behaviors that foster negativity. 

• Emotionally Focused Therapy: This therapy aims to improve a couple’s relationship by improving the attachment, emotional bond, and physical bond within the partnership. This method will help the couple understand their feelings of disconnection and how to alter the patterns that led to them. 

Benefits of Couples Therapy

As mentioned, couples therapy can address a multitude of topics. However, the most common benefits seen within couples therapy is improving communication skills, further understanding one another, identifying relationship concerns, resolving conflicts, strengthening attachment, reducing dysfunctional behavior, improving relationship satisfaction, and learning skills. If you believe that your relationship would benefit from couples therapy, first discuss it with your partner and see if they are receptive to the idea and explain why it is important to you. If this is something both you and your partner are interested in, seek out a licensed mental health practitioner to begin!

Obsessive-Compulsive Disorder

What is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a mental health condition that involves unwanted thoughts, urges, fears, and images (obsessions), leading to repetitive behaviors (compulsions). For example, someone with OCD might experience a pattern of unwanted thoughts, which drives them to complete compulsive acts to reduce their distress or anxiety. It is important to note that these upsetting thoughts are persistent, even if you try to ignore them. This disorder is characterized by these obsessions and compulsions causing significant distress and impacting one’s daily activities, however, the severity of OCD can vary from mild to disabling. 

Symptoms of OCD

While many people picture OCD as people who are “obsessive cleaners” or “germaphobes,” in actuality the symptoms of OCD vary greatly as there are many types and forms of OCD. Some of these subtypes will be listed below, however, some commonalities between all forms of OCD include:

• Obsessions: Recurrent and persistent unwanted thoughts, urges, or images that cause distress or anxiety.

• One is unable to ignore or suppress these thoughts, despite making attempts to. 

• Compulsions: Repetitive behaviors or mental acts that the person feels driven to complete in order to ease the anxiety and distress from their obsessions. 

• These behaviors or mental acts are often not connected to the obsession in a realistic way or are clearly excessive 

Most Common Obsessive-Compulsive Subtypes

• Contamination OCD

• Contamination OCD may be characterized by an individual having an intense fear of contracting an illness or spreading germs and attempting to relieve that fear by engaging in compulsive behaviors. 

• Possible obsessions include:

• Fear of becoming ill or sick

• Fear of developing cancer

• Fear of contracting an STI

• Fear of bodily fluids

• Fear of germs, dirt, or toxins

• Fear of getting their loved ones sick by spreading germs

• Possible compulsions include:

• Excessive and repetitive hand washing, showering, or cleaning

• Throwing away items the person feels are contaminated

• Repeatedly changing clothes

• Spending lots of time looking at research on illnesses

• Separating items the person deems dirty versus clean

• Checking OCD

• Checking OCD is characterized by checking-based compulsions, often as a fear of something bad happening if they do not continuously perform their checking rituals. 

• Possible obsessions include:

• Fears about being responsible for making errors

• Fears about being responsible for any form of threat to one’s life or property (house break-in, fire, flood, etc.)

• Fears of bad behavior

• Possible compulsions include:

• Repeatedly checking if one’s door is locked

• Repeatedly checking if the stove is turned off

• Repeatedly checking if they remembered an item before leaving the house

• Avoiding behaviors that could increase anxiety about their obsessions (i.e. not ever using the stove)

• Seeking reassurance to ensure they have done the correct thing

• Replaying events in one’s mind to ensure they did not forget something or do something inappropriate

• Repeatedly doing mental checks of certain actions related to their obsessions 

• Counting OCD

• Counting OCD can be characterized by obsessively thinking that something bad will occur if one does not engage in a counting-based compulsion. 

• Possible obsessions include:

• Fear of if one does not count or tap a certain number of times, they, or someone they love, will get hurt

• Possible compulsions include:

• Completing actions in a predetermined series based on a particular number (i.e. sets of three)

• Counting to a specific number repeatedly

• Preferring even or odd numbers

• Repeating behaviors a certain number of times to avoid “bad” numbers 

• Harm OCD

• Harm OCD can be characterized by intrusive thoughts of harming other people, followed by a compulsion used to relieve one’s distress about these thoughts. These thoughts are unwanted and do not align with the person’s beliefs, values, or character. 

• Possible obsessions include:

• Thoughts or images of hitting someone with your car

• Thoughts of being responsible for harming someone and forgetting about it

• Thoughts of losing control and harming a loved one

• Sudden urges to harm yourself or others

• Possible compulsions include:

• Mentally checking repeatedly what you did the past week to ensure you did not cause harm

• Repeatedly praying to not harm someone

• Repeatedly seeking reassurance that you are not dangerous 

OCD Treatment 

Obsessive-compulsive disorder is primarily treated by medication and/or psychotherapy. In regard to psychotherapy, exposure and response prevention (ERP) is a commonly used therapy modality for treating OCD. ERP is a type of cognitive behavioral therapy (CBT) that focuses on confronting the unwanted thoughts, urges, and images that someone might experience and performing compulsions in order to reduce their anxiety. After addressing these intrusive thoughts and obsessions, the response prevention part of the treatment works on choosing to not complete a compulsive behavior once the obsessions are present. While this often leads to an initial increase in anxiety, treatment helps someone recognize the thoughts cannot hurt them or someone else, and stops the cycle of obsessions and compulsions. This process is certainly challenging, but has been proven to be extremely effective.

If you find that OCD is affecting your quality of life, reach out to a licensed mental health professional to address these concerns.

Disordered Eating

Whether it be for yourself, your child, your partner, a friend, etc., understanding eating disorders and disordered eating could make an important difference in your/their healing journey. Some of you might be well versed in the topic, while others might not have ever heard the term “disordered eating.” Regardless of your current level of expertise on the topic, here is a general starting point for grasping the concept of disordered eating. 

Living in the world of “diet culture” and “fad diets,” we are constantly surrounded by talk of “good” foods, “bad” foods, a range of expectations and myths around food and weight, and a moral hierarchy of body shapes and sizes. Typically, we are taught from a very young age that thin is ideal, weight loss is always good, and thin equals healthy. This mindset and persuasive set of cultural beliefs has created a pathway to glorifying disordered eating, which makes you wonder, when does someone’s focus on calories, food, and weight become a health concern?

First, what is disordered eating?

Disordered eating is a term used to describe a broad spectrum of irregular eating behaviors. These behaviors may or may not warrant a clinical diagnosis of an eating disorder. These behaviors may be very closely aligned with those of Anorexia Nervosa, Bulimia Nervosa, or another eating disorder, however, the criteria for eating disorders are very specific and often exclude the majority of people suffering from body image and eating concerns. 

So, what exactly is the difference between disordered eating and an eating disorder? The most significant difference is simply whether a person’s symptoms align with the criteria defined by the American Psychiatric Association and are documented in the Diagnostic and Statistical Manual, or the DSM. That being said, disordered eating is not a diagnosis, but rather a term used to describe disordered eating patterns. Despite not being a clinical diagnosis, these patterns still deserve the attention and treatment that eating disorders do as they can often lead to eating disorders and cause severe health problems. 

Behavioral Symptoms of Disordered Eating

• Restrictive eating

• Fasting 

• Avoiding certain food groups (Not recommended by a physician. I.e. not avoiding gluten for someone with Celiac disease)

• Frequently skipping meals

• Refusing to eat

• Denial of hunger 

• Making excuses for not eating

• Only eating foods deemed “safe” by the person, usually those low in fat, calories, and sugar

• Lying about their food intake 

• Purging

• Self-induced vomiting

• Misuse of laxatives, enemas, or diet aids

• Exercising excessively 

• Binge eating

• Eating unusually large amounts of food in a short period of time

• Eating despite feeling full or not hungry 

• Eating until you are uncomfortably full

• Continuing to eat despite not wanting to

• Eating alone or in secret to avoid embarrassment 

• Feeling significantly distressed, ashamed, or guilty about your eating

Physical Symptoms of Disordered Eating 

• Restrictive eating

• Extreme weight loss or not making expected developmental weight gains

• Thin appearance

• Dizziness 

• Fainting

• Absence of menstruation 

• Low blood pressure

• Bluish discoloration of the fingers

• Thinning head hair

• Increased production of hair covering the body 

• Purging

• Chronically inflamed and sore throat 

• Swollen salivary glands in the neck and jaw area

• Acid reflux disorder 

• Gastrointestinal problems

• Severe dehydration (from purging of fluids) 

• Electrolyte imbalances 

• Worn tooth enamel and decaying teeth (from excessive vomiting) 

Signs of Disordered Eating 

• Intense fear of weight gain 

• Repeatedly weighing or measuring the body

• Frequently checking in the mirror for perceived flaws

• Often stating they are fat

• Covering up in layers of clothing or large clothing

• Social withdrawal

• Irritability 

• Not wanting to eat in public

• Preoccupation with food

• Distorted body image

Who is at Risk and Common Myths 

It is extremely important to note that eating disorders can affect people of all races, ages, ethnic backgrounds, body weights, body sizes, and genders. Men also have disordered eating patterns, it is not a women-specific concern. Older adults are also at risk for disordered eating, not just young adults and teenagers. You can be overweight or within a “normal” weight range and have an eating disorder or disordered eating. People who appear healthy can also have eating disorders, for example, athletes. That being said, the highest rates of eating disorders are among women between the ages of 12-25. 

*** Dieting is one of the most common forms and risk factors of disordered eating.  

The Diet Cycle and How Eating Disorders Are Maintained

While many people struggling with disordered eating develop an eating disorder, others do not and continuously live in this cycle of maintaining their disordered eating patterns. If not intervened, this is also how eating disorders are developed and perpetuated and increasingly harmful as well. This cycle, or the diet cycle, often begins with feeling unhappy with one’s weight or shape, resulting in the beginning of a diet or restriction period. This period leads to feelings of emotional and physical deprivation and then breaking the diet and overeating. Lastly, one may feel guilty about their eating patterns and unsure of “how to eat.” Then, the cycle begins again. 

Complications of Eating Disorders

Eating disorders can cause a multitude of physical and psychological complications. In addition to the physical symptoms listed above, at its most severe, eating disorders can be fatal. This can happen to anyone, even when someone is not severely underweight. Heart problems including mitral valve prolapse, abnormal heart rhythms, and heart failure are some of the most serious concerns. Additionally, osteoporosis, or bone loss, loss of muscle, fertility concerns for women, decreased testosterone for men, anemia, and kidney problems are also prominent complications. Furthermore, eating disorders are often coupled with other mental health disorders, primarily depression, anxiety, personality disorders, obsessive-compulsive disorders, alcohol and substance misuse, self-injurious behaviors, and suicidal thoughts/attempts. The most deadly mental disorder in the world is Anorexia Nervosa as a result of these physical and psychological complications. 

What do I do if I, or a loved one, is experiencing disordered eating?

Unfortunately, there is no guaranteed way to prevent eating disorders, much like any other health concern. However, physicians and mental health professionals could be in a good position to identify early indicators of disordered eating and help prevent the development of eating disorders. If you notice that a loved one is experiencing severe food restriction, purging, or binge eating behaviors, as well as low self-esteem and dissatisfaction with their appearance, consider talking to them about these behaviors and seeking help from a professional for treatment options and/or promote and discuss healthier behavior.

EMDR Therapy

What does EMDR stand for?

EMDR is an acronym for Eye Movement Desensitization and Reprocessing. 

What is EMDR used for?

EMDR is a psychotherapy treatment method most commonly used for clients experiencing distress from a traumatic experience/s. This therapy modality was designed to alleviate those feelings and symptoms of distress that are associated with traumatic memories. Picture it like this, if you were to have a splinter in your toe, your toe would not heal until you pulled the splinter out. However, once the piece of wood is removed, your body would be able to begin its healing process. EMDR works similarly, but for your brain. This treatment helps an individual work through what is blocking their emotional processing system from healing and “remove it.” Essentially, EMDR aids the accessing and processing of traumatic memories so that an adaptive solution can be made. This process typically looks like reframing negative beliefs, reducing physiological arousal, and decreasing suffering. 

How does it work?

Similarly to other therapy methods, in session, the client addresses what is causing them emotional distress. However, unlike traditional talk therapy, while the client is doing this, they are focusing on an external stimulus. Specifically, for this external stimulus, the therapist will direct the client to use lateral (sideways) eye movements or hand-tapping. This works by processing trauma with both hemispheres of the brain stimulated simultaneously. The idea behind this mechanism is that the client’s left side of the brain is currently being blocked from self-soothing, hence the bilateral stimulation assists them in bypassing this area of the brain where the trauma is stuck. This technique facilitates the accessing of the traumatic memory to strengthen the brain's ability to form new associations between the traumatic memory and more resilient memories. 

What does an EMDR session look like?

EMDR treatment is typically divided into eight phases:

1.  History-taking sessions are used to assess the client’s readiness, develop a treatment plan, and identify possible targets for EMDR.

2. Ensuring the client has several ways to handle emotional distress. 

3-6. Identifying a target and processing it using EMDR therapy procedures. 

7. Logging any related material that may arise outside of the session to determine closure.

8. Examining progress.

Each session lasts approximately one hour. After the initial session where the therapist and client focus on the client's history, they move on to the Rapid Eye Movement portion of the treatment, which is where the client will begin to focus on their trauma, their memories associated with it, and most notably identifying the beliefs they hold about themselves and the traumatic event. Next, the therapist will aid the client in formulating a positive belief to replace the negative beliefs they have previously associated with themselves and the event. This process occurs while the client is focused on the external stimulus and continues until the client is no longer significantly distressed by the memories, which is the goal of the treatment. 

Who could benefit from EMDR?

Individuals of all ages who have experienced a distressing event or a series of accumulated negative experiences could benefit from EMDR therapy. While this modality was initially designed and used for treating Post-Traumatic Stress Disorder, mental health care providers are expanding its usage for other conditions, such as panic disorder, phobias, and anxiety disorders. If you think you or a loved one could benefit from EMDR therapy, consider reaching out to an EMDR-trained therapist for treatment options. 

Generalized Anxiety Disorder

What is Generalized Anxiety Disorder?

Generalized Anxiety Disorder (GAD) is a mental health condition that can affect all age groups and is characterized by a constant feeling of being overwhelmed and excessive worry about everyday things. This disorder presents with excessive, frequent, and unrealistic worry about everyday things. 

How can I differentiate between anxiety and an anxiety disorder?

Almost everyone has experienced anxiety at some point in their life as it is a common emotion. For most of us, starting a new job, moving, and waiting to hear for news, can be things that result in us feeling tense or having worried thoughts. However, someone with generalized anxiety disorder might feel this way daily and so intensely that it affects their functioning. Generalized anxiety disorder is a chronic condition that involves excessive anxiety that interferes with daily life. That being said, someone with generalized anxiety disorder may worry about everyday situations or routine issues that others may be able to accept and ignore without a second thought. These ongoing worries that are difficult to control may be a sign of generalized anxiety disorder. 

Symptoms of GAD:

• Excessive anxiety and worry about a variety of events

• Restlessness

• Feeling on edge

• Fatigue

• Difficulty concentrating

• Irritability

• Muscle tension

• Difficulty sleeping 

• Shortness of breath

• Racing heartbeat

• Headaches 

Who is at Risk for Developing Generalized Anxiety Disorder?

Because there is no exact cause of GAD and it is likely a combination of environmental, biological, and genetic factors, generalized anxiety disorder can affect anyone regardless of age, sex, gender, race, etc. However, statistically, women are more likely than men to develop GAD. Someone might also be more likely to have generalized anxiety disorder if a close biological relative has it, they have experienced a traumatic event, they are in a constant stressful environment, they have experienced child abuse, or if they are managing a chronic illness. 

Generalized Anxiety Disorder Treatment

GAD is typically treated with psychotherapy, medication, or a combination of both. For psychotherapy, the most common modality used by mental health professionals is cognitive behavioral therapy (CBT). CBT works by understanding how thoughts, behaviors, and feelings are interconnected and how altering our thoughts can alter our behaviors and feelings and vice versa. A licensed mental health professional may use this treatment method to help someone identify their negative, worrying, or illogical thoughts to understand how they affect their actions and excessive worrying. They will then work with the client to unlearn these worrying thoughts and behaviors in exchange for learning more helpful thinking patterns. If you think that you or a loved one may have generalized anxiety disorder, or may benefit from this treatment, reach out to a licensed mental health provider or physician for help.

Social Anxiety Disorder

More than likely, all of us, especially introverts, have felt anxious in some situations. Maybe you were nervous on a first date or giving a class presentation. This in itself is not necessarily a display of social anxiety disorder as comfort levels in social situations can differ between people and personality types. However, social anxiety disorder, also referred to as social phobia, is something quite different. Social anxiety disorder is a chronic mental health condition identified by an intense, persistent fear when anticipating or participating in social situations. People with social anxiety disorder also fear that others are watching and judging them, leaving everyday interactions to cause anxiety, self-consciousness, and embarrassment. These reactions lead to avoidant behaviors that can disrupt one’s life and relationships. 

Examples of some situations that may cause distress to someone with social anxiety disorder include social interactions, being observed, and performing in front of others. More specifically, having a conversation, meeting new people, attending social gatherings, going to work, making eye contact, dating, using a public restroom, eating or drinking in public, performing in front of a crowd, etc. Social anxiety disorder is characterized by the fear of these situations that makes an individual exposed to possible scrutiny by others. Someone with social phobia is afraid that they will act in an embarrassing way or show anxiety symptoms, resulting in others rejecting them. In children, this anxiety may also be expressed through crying, freezing, clinging, or failing to speak. Regardless of its specific presentation, this anxiety is out of proportion to the actual threat posed by the situation and leads the person to avoid social situations and impacts their functioning. 

Symptoms of Social Anxiety Disorder can include constant feelings of:

• Intense fear of interacting with strangers

• Worrying about humiliating yourself

• Fear of situations where you might be judged negatively

• Fear of other people realizing you are anxious

• Fear of other people noticing physical symptoms that may lead to your embarrassment, including:

• Blushing

• Sweating

• Trembling 

• Dizziness

• Other physical symptoms that may occur are upset stomach, nausea, trouble breathing, fast heartbeat, muscle tension

• Avoiding speaking to people because you fear you will embarrass yourself 

• Intense anxiety about an upcoming social situation

• Intense anxiety during social situations 

• Avoiding situations that might be focused on you

• Debating and analyzing your performance in past or future social situations

• Expecting the worst possible outcome in social situations

• Fear of speaking or performing in public (if this is the only scenario causing intense anxiety, it is known as performance-type social anxiety disorder)

Treatment for Social Anxiety

Because social anxiety disorder is likely to continue in the long term, particularly when avoiding social situations, it is recommended that people seek treatment for the disorder. This phobia often leads to a limited ability to thrive at work, school, and in interpersonal relationships as well, resulting in a possible decrease in quality of life, further emphasizing the importance of treatment. 

The most common treatment for social anxiety disorder is cognitive behavioral therapy (CBT). This modality focuses on reframing thought patterns and teaching clients new ways of thinking about, behaving in, and reacting to social situations. Ideally, this process will reduce the client’s fears and anxieties. Medication is also a common treatment method for managing social anxiety, either alone or in addition to CBT. Reach out to a licensed mental health provider to learn more about social anxiety and treatment.

Internal Family Systems Therapy

What is Internal Family Systems Therapy? 

Internal family systems, also known as IFS, is a type of psychotherapy. This therapy modality is structured on the concept that every person is made up of several parts and is derived from different types of family therapy. The founder of IFS, Dr. Richard Schwartz, used techniques that he used with families and applied them to individuals as he thought of the mind as an inner family. Specifically, this theory works under the assumption that there are several “parts” living within us that “fulfill both healthy and unhealthy roles” and certain life events can force us out of those roles. However, it is important to note that these internal roles can change over time and there may be infinite parts within you.

What is the Goal of IFS Therapy? 

The goal of internal family systems therapy is to find “the Self” and bring the inner roles/parts together in order to heal from past trauma and correct problematic behaviors by restoring mental balance. IFS suggests that the self is who we truly are and we need to gain trust in the self. The self is sometimes referred to as the “absence of parts,” “inner wisdom,” or the “undamaged” part of oneself. However, every view of the self has in common the idea that regardless of what difficulty someone is facing, there is more to the self that can create healing and we are made up of more than our mental health problems. The thirteen main parts that coordinate to make the self are the 8 C’s and the 5 P’s:

• Confidence

• Calmness

• Creativity

• Clarity

• Curiosity

• Courage

• Compassion

• Connectedness

• Presence

• Patience

• Perspective

• Persistence

• Playfulness

The Three Common Roles

According to the IFS model, our parts often play into three main types, which are the firefighter, the manager, and the exile. The firefighter parts can be characterized as the protectors because they are activated when a trigger is present. The manager parts protect the self by using planning to avoid something that might be triggering and managing emotions. The exile parts are those that hold pain and trauma. An example of how these roles may present in a person is the exile being the trauma of abuse as a child, the manager being perfectionism, and the firefighter being alcohol use. 

Releasing the Burden

A therapist using IFS Therapy will then use a six-step process to help the client identify these parts and release the burdens that they carry and in turn restore trust in the Self. 

1. Find - identifying the parts that need attention

2. Focus - focusing on the relevant part

3. Flesh - describe the part and your experience of it

4. Feel - explore your feelings towards this part

5. Befriend - be curious and accept this part’s presence 

6. Fear - identify what this part fears 

What Concerns Can IFS Therapy Help With?

• Improving self-esteem

• Relationship concerns

• Career issues

• Grief

• Anxiety

• OCD

• Depression

• Eating disorders

• Substance Use disorders

If you are interested in learning more about Internal Family Systems Therapy or believe you could benefit from this therapy, consider reaching out to an IFS-trained therapist for treatment options.

Major Depressive Disorder

What is Major Depressive Disorder?

Depression, also clinically known as major depressive disorder (MDD), is a mood disorder that is characterized by persistent feelings of sadness and a loss of interest in previously enjoyable activities. This disorder is more than sadness in that it affects multiple aspects of your life and can lead to a multitude of emotional and physical problems. Many people with major depressive disorder also consider harming themselves or feel as if life is not worth living. Depressive episodes are not something you can simply “snap out of” and may require psychotherapy treatment and/or pharmacological treatment. 

How can I Differentiate Between the Blues and Depression?

 While sadness is a common emotion experienced by almost all of the population at one point or another, it is typically temporary and is caused by a specific occurrence. For example, sadness is a typical reaction to difficult life events, such as missed opportunities, a fight with a loved one, disappointment, loss of a job, grief, etc. However, while a major component of depression is sadness, depression is a disorder that is more ongoing and can have significant negative impacts on daily life and functioning. Clinical depression can be chronic and have recurring episodes for years, or happen only one time. Either way, the sad mood and loss of interest must last at least two weeks or more and affect one’s functioning levels to be considered depression.

Common Symptoms of Depression: 

• Depressed mood most of the day, nearly every day

• Irritability (especially seen in children and adolescents)

• Diminished interest in nearly all activities

• Significant increase or decrease in appetite

• Difficulty sleeping or sleeping too much

• Lack of energy

• Feelings of worthlessness or guilt

• Trouble concentrating

• Frequent thoughts of death, suicidal thoughts, or suicide attempts 

• Unexplained headaches or physical pain (especially seen in older adults)

Major Depressive Disorder Treatment 

Depression can be treated with medication, psychotherapy, or a combination of both. Some of the most popular types of psychotherapy treatment modalities used to alleviate depression symptoms are cognitive behavioral therapy (CBT), behavioral activation, and interpersonal therapy. Cognitive behavioral therapy focuses on adapting and adjusting negative thinking habits. Behavioral activation is structured around the idea that increasing activities that bring positive emotions can help break the cycle of depression. Interpersonal therapy concentrates on how depression impacts one’s relationships and how that in turn impacts their depression. Most therapists will use a combination of all three modalities to help the client improve their mood and energy. It is extremely important to note and remember that depression is not a weakness, nor is it a normal part of being a teenager or growing older. If you or a loved one think you may be suffering from depression, reach out to a treatment provider near you for help. 

Emergency Resources

If you are considering harming yourself or think you may attempt suicide, please call 911, your local emergency number, or 988, which is the national suicide and crisis hotline. 

If you believe someone you know or love is considering harming themselves, please stay with them until an emergency services provider arrives or take them to the nearest hospital emergency room.

Transitioning from College to Adulthood

College graduation is an achievement that brings along exciting, yet challenging, new beginnings for those transitioning into adulthood. Some people relocate, others begin a graduate program, some stay at home with their families, and many enter the workforce. This transition can be stressful as you say goodbye to roommates and friends and begin focusing on your own career or next steps. It is the time when you figure out your place in the world and realize how everyone’s journey is unique. 

It is important to understand that each individual will have their own path and to establish clear expectations about your new life to make the transition easier. What will your schedule look like? For most people, college graduation marks the end of one’s educational journey. Scheduled classes, tutoring sessions, and homework will become a thing of the past as a full-time job becomes your main focus. It is common to feel like you have lost your free time when working a typical 8-hour day five times per week. Although your schedule may be less flexible, it is now fixed and makes planning easier. Once your workday is over, you are completely on your own time without additional assignments to worry about. This can improve your social life as you are no longer balancing classes, a part-time job, and time for family/friends. Oftentimes, this new schedule can result in healthy boundaries between work time and free time. However, it is also important to note that for some people, this transition can cause hardships regarding one’s social life too. 

You may be free weekdays after 5pm, but it can be challenging to retain friendships. You could go from spending several hours per day with someone to talking on the phone once per week. Your friends may not live in the same city or state. It may be more challenging to make time for your friends but it is important to fill your free time with things and people you enjoy being around. If your friend moved away but they are still someone who makes you happy, why not put in a little more effort to regularly speak with them? Remember, they are likely experiencing similar changes, which can be helpful for navigating a challenging transition. 

Aside from friendships, the struggle to find work after graduation is also inherently stressful and puts extra pressure on the transition. Not to mention the financial instability that many recent graduates struggle with as they navigate unexpected financial crises and become financially independent. Many people assume the job they pick after graduation is the job and career path they will be “stuck with” for life. This is not the case. While you may find your dream job and want to stay at that company for years to come, that is not the likely scenario for most recent college graduates. That being said, it is crucial to remember the job that you choose does not equate to your identity and does not have to be linear. Sometimes trial and error are necessary to know what you want from a job and work environment. 

No matter what you find the most challenging about the changes from college to adulthood, this transition can be difficult for anyone. Be patient with yourself. Understand that your life is going to change. Find a way to balance the past parts of your life with the current. You have transitioned before, do not forget that growth and all the challenges you have overcome. Your early twenties are filled with new experiences, friendships, and growth. No one in their twenties has everything figured out. You may make mistakes but those will lead to new developments. Lean on your support system as you navigate becoming an adult. If you are struggling, counseling is a great way to work through your feelings about this transition. And of course remember, you are not alone!

Panic Disorder

What is Panic Disorder?

Panic disorder is a mental health diagnosis characterized by frequent and unexpected panic attacks. These attacks can be as often as multiple times a day or as infrequent as a few times a year. While the frequency and unexpectedness of the attacks are an important consideration in diagnosing the disorder, someone with panic disorder must also experience persistent concern about having additional panic attacks and their consequences or a significant change in behavior related to the attacks in order to avoid future panic attacks. However, it is important to note that not everyone who experiences a panic attack has, or will develop, panic disorder.

What Does a Panic Attack Look/Feel Like? 

Panic attacks can look and feel differently for everyone. Although, panic attacks are commonly identified as a brief episode of intense anxiety resulting in physical and mental health symptoms. These attacks are most often not a result of an external threat. 

Some physical symptoms that may be present when experiencing a panic attack are rapid breathing, nausea, trembling or shaking, chills, hot flashes, numbness, tingling, dizziness, sweating, a racing heartbeat, stomach pain, chest pain, upset stomach, muscle tension, shortness of breath, etc. 

Some mental symptoms that may be present when experiencing a panic attack are fear of death, feelings of being out of control, feelings of impending doom, dissociation, intense worry, a sense of detachment from reality, etc. 

Panic attacks typically last 5-20 minutes, however, mental and physical symptoms correlated with the attack may last hours. It is important that if you are experiencing these symptoms, and are unsure if they are a panic attack, you seek medical help as soon as possible. 

The Difference Between Anxiety Attacks and Panic Attacks

Many people experience anxiety, anxiety attacks, and panic attacks, so you may be wondering what the difference is. While anxiety attacks and panic attacks have some overlapping symptoms, they also have key differences, most notably regarding their duration, intensity, and causes. 

Duration: Panic attacks develop quicker and are much shorter than anxiety attacks, most commonly lasting about 10 minutes and peaking after a few minutes. Anxiety attacks on the other hand can last hours or days and build up gradually. 

Intensity: Panic attacks are more intense than anxiety attacks. For example, while anxiety attacks can also result in a racing heart or an upset stomach, panic attacks may also result in intense heart palpitations, shortness of breath, nausea, etc. 

Causes: Panic attacks can occur unexpectedly, even when one is not feeling anxious. Anxiety attacks are most often triggered by a stressor, such as an external threat or stressful event. 

Signs of Panic Disorder 

• An intense worry or fear about when the next panic attack will occur

• Avoiding places where panic attacks have previously occurred

• A fear of being out of control

• A fear of death during the panic attack

• Sudden and repeated attacks of anxiety 

• Physical symptoms during a panic attack as mentioned above

Treatment for Panic Disorder

Panic disorder is most commonly treated with either psychotherapy, medication, or both. After any potential physical cause of concern is ruled out, a healthcare provider may refer someone experiencing panic attacks to a mental health professional. Two of the most prominent psychological treatment methods for panic disorder are cognitive behavioral therapy (CBT) and exposure therapy. 

CBT is a modality designed to help one develop different ways of thinking, specifically about panic attacks in this case, and combat their current maladaptive thoughts. This method also targets a person’s behaviors in order to help them react differently to the physical symptoms that occur during a panic attack. CBT also uses mindfulness and relaxation techniques.

Exposure therapy focuses on directly confronting the fears and beliefs one holds about panic attacks and panic disorder. This might look like having the client engage in activities they have been avoiding or learning to manage panic attack symptoms while they experience them.

If you think you or a loved one could benefit from treatment for panic disorder, reach out to a licensed mental health professional for help.

Grief Therapy

Unfortunately, most of us are familiar with the term grief and the feelings that come with it. While grief is an overwhelming emotion that can affect people in all kinds of different ways, one thing that remains in common is that it is a natural emotional reaction to the loss of someone or something important. That could be not only the death of a loved one, but also the loss of a relationship, job, bodily function, etc. This adjustment to the physical or emotional absence of someone or something can be extremely difficult to navigate and move past, but grief counseling may be helpful in this aspect for someone who is struggling.

What is Grief Therapy? 

Grief therapy is a form of therapy that helps someone deal with psychological stress after a loss. Depending on the individual circumstance, grief counseling can help people process their new reality, address their reactions to the loss, provide emotional support, or help someone work through the wide variety of emotions people feel after a loss. Ideally, this treatment helps someone grieving get to a new place of stability after a life-altering change.

The mental health professional providing the counseling will facilitate the person’s adaptation to the loss by confronting what happened and restructuring their thoughts associated with it. This may look like helping the person accept the reality of the loss, process the grief, adjust to their new reality, and help them maintain a bond with what or who they are grieving while also becoming comfortable with their current situation. This process may be beneficial for someone experiencing grief directly after a loss, along a “typical” timeline and it can be helpful for those experiencing prolonged, abnormal, or complicated grief reactions. 

Common Grief Therapy Treatments

• Acceptance and Commitment Therapy: A treatment modality focusing on embracing the loss rather than fighting it.

• Cognitive Behavioral Therapy: This method helps the grieving person identify negative thought patterns and reframe them with positive thoughts and behaviors. 

• Traumatic Grief Therapy: This intervention emphasizes establishing a routine to help soothe the nervous system and regulate emotions. 

• Interpersonal Therapy: This technique focuses on the person’s current relationships and helps to identify their thoughts and emotions and improve interpersonal functioning.

Stages of Grief (Kübler-Ross Grief Cycle)

• Denial

• Avoidance, confusion, shock, fear

• Anger

• Frustration, irritation, anxiety

• Bargaining

• Attempting to find meaning, reaching out for help

• Depression

• Overwhelmed, helplessness, intense sadness

• Acceptance 

• Exploring options, planning ahead, moving on 

When to Seek Grief Therapy?

There is no set criteria for someone looking to attend grief therapy. If you have experienced a loss, going through the stages of grief, and find that it is too overwhelming, is disrupting your functioning, or you just want someone to talk to, seeking help from a licensed mental health therapist is a great place to start.