What are the Signs and Symptoms of GAD

Generalized anxiety disorder (GAD) is one of the most common mental health conditions in the world. It’s defined as ongoing anxiety that is severe enough to interfere with daily activities.

GAD can have an extremely negative impact on your life. It can cause you to live with constant fear or worry, with little relief.

Unfortunately, because anxiety is so prevalent in today’s society, many people end up dealing with GAD, assuming the symptoms are “normal” or without getting an official diagnosis.

It’s important to recognize some of the common signs and symptoms of generalized anxiety disorder. When you start to connect the dots with what you’re feeling, you can reach out for help, receive a diagnosis, and get the treatment you deserve.

So, what are those signs and symptoms?

Time Is Important

You might be used to worrying about things. Even kids worry, and it’s normal. Maybe you’ve even been called out on your ability to think about the “what ifs” in a situation. But there’s a difference between regular worrying and anxiety.

Normal worries tend to come and go. They might flare up when a certain situation arises and fade away when that situation is done.

Anxiety doesn’t work that way.

One of the clearest signs of generalized anxiety disorder is experiencing symptoms for six months or longer. That includes worry that doesn’t really go away, no matter the situation. That’s often because GAD causes you to think about the “what ifs,” even if they aren’t realistic. Often, the symptoms of GAD are more intense than whatever the situation calls for.

Common Symptoms

With that in mind, it’s important to understand that everyone can experience anxiety differently. Extreme worry is just one of the symptoms. It can trigger various additional problems that can negatively impact your quality of life. Some of the common symptoms of GAD include difficulty sleeping, irritability, and an inability to relax.

Anxiety can also cause physical symptoms. Headaches, muscle tension, fatigue, sweating, and trembling are all common physical signs of GAD. Anxiety doesn’t give your body a chance to rest. It makes you feel like you always have to be on high alert. So, your body responds to that “fight or flight” mentality by doing what it can to defend and protect itself. The only problem is that when there’s no real threat, you will likely stay in that mindset, and your body will quickly tire and sore.

Because you’re putting your body through so much, it’s also common to experience lightheadedness and dizziness with anxiety.

Unfortunately, these symptoms are common with a variety of conditions. You might not immediately think of anxiety when you have headaches or fatigue. But, if you have multiple symptoms along with extreme worry, it’s a clear sign that your mental health is impacting your physical well-being.

Anxiety Doesn’t Happen Overnight

Worry can happen at any time. But GAD isn’t something you develop immediately. Rather, it’s a gradual condition. It can begin in childhood and continue to get worse over time. Anxiety doesn’t exclude anyone, and it doesn’t target anyone. However, research has shown that women are more likely to experience GAD than men.

What Can You Do?

If these symptoms sound familiar, know that you’re not alone. The good news is that GAD is often very manageable and treatable. But it’s not something you should tackle on your own.

If you’re struggling with anxiety, don’t hesitate to reach out to a mental health professional right away. Getting to the root of your anxiety is the first step in treating it. Anxiety therapy can also make it easier to manage your symptoms and regain control of your life.

Back to School Anxiety: Strategies for a Smooth Transition

As the end of summer approaches and the fall weather begins to set in, the excitement of a new school year can be tinged with a sense of anxiety for many young people. Back-to-school anxiety is a common phenomenon that can affect schoolgoers of all ages, from kindergarteners to college students. The mix of unfamiliar routines, academic challenges, social adjustments, and the uncertainty of what lies ahead can trigger feelings of unease. However, by recognizing the causes of this anxiety and implementing effective coping strategies, both students and their parents can make the transition back to school a smoother and more positive experience.

Let’s dive right into common school-related stressors for children, teens, and young adults. Your child may experience discomfort and fear due to any of the following:

The idea of separating from parents (separation anxiety)

Worries about meeting academic expectations, test anxiety

Concerns about peer/social interactions and conflict

The fear of bullying

Worries of sensory overload (such as navigating loud, crowded school hallways and cafeteria)

It is not at all unusual for young people to experience at least a little anticipatory anxiety leading up to the new school year — and for parents to notice a rise in worries. 

How to Identify Your Child’s Back-to-School Anxiety

You may notice your child asking many school-related questions about the grade they are entering and their new classroom or teacher as a way to seek assurance. Sometimes you may even notice your child asking the same questions repeatedly, in an effort to process their anxiety and find some reassurance from a parent. These questions are often socially related, and may sound like “What if my friends are not in my class? When will I see them? What if I don't have anyone to sit with at lunch?”

As the new academic year approaches, some families may notice their school-aged children and teens increasingly worrying about their image: their clothing, their physical appearance, or even if they have the “right” or “best” school supplies. 

In some cases, health may be affected: school-aged children and teens may experience trouble falling asleep or changes in sleep patterns in the days leading up to the first day of class or have increased physical complaints like headaches, stomachaches, and fatigue.

Some young people may attempt to cope with their back-to-school anxiety with avoidance behaviors surrounding school-related activities, including academic avoidance and even truancy.

The more parents can understand and empathize with their child, the more parents will be able to help their child find solutions to this period of psychological discomfort.

What Parents Should Know: Psychoeducation for Families with School Children

Becoming familiar and understanding your child’s school-related anxiety involves a deeper dive into the thoughts that are fueling the anxiety itself. Here are the different types of anxious thought patterns your child may be experiencing as the return to school awaits: 

Social anxiety is characterized by a fear of social interactions and/or a fear of negative judgment from others. In regards to going back to school, your child may experience social apprehension, fear of speaking up or presenting in class, or dread casual interactions and/or organized social events. Social anxiety is most commonly found in young children and adolescents and tends to start earlier for girls than boys (Lebowitz, 2021). Some other fears of children with social anxiety are: eating in front of others, using public restrooms, and answering a question in class (Lebowitz, 2021).

Academic anxiety comes naturally for many middle schoolers and high schoolers, especially for those who feel pressured to do well, or for those with perfectionist tendencies. Encourage your child to do their best every day, and that their best is good enough. You might even encourage them to understand that their “best” will look different from day to day, and that is also okay. Be supportive and encourage their best efforts, but don’t encourage comparison. “Do your best, don’t worry about the rest” is a helpful affirmation that your child can remember during their busy school day. Avoid using any language that pressures your child to perform to a certain standard. Practice radical acceptance of your child by affirming them for making a good effort. Avoid shaming or punishing your child for receiving a lower grade than expected. For many, self-esteem can be tied to academic performance. Remember to love your child unconditionally by offering praise when they show up and complete assignments, and when they don’t perform well on a test, validate their feelings and approach them with gentle curiosity and supportive language. Be a part of their solution.

Intrusive thoughts can create anxiety for many children. Intrusive thoughts are sudden, unwanted, and uncontrollable thoughts (often anxiety-based) that give rise to anxious thought cycles. A good way of navigating intrusive anxious thoughts is by externalizing them. Help your child understand they are separate from their thoughts by helping them practice mindful awareness of their thoughts. A helpful image for children is to consider their minds as the sky and to help your child visualize thoughts as clouds passing through the sky of their mind. It may be helpful to remind your child that weather, much like our thoughts, is a passing condition that doesn’t last forever. Another way to tackle intrusive thoughts with your child is to give the anxious/intrusive thoughts a name, like the “Inner Bully.” You can help your child self-soothe by giving them examples of how to respond to these anxious thoughts.

Here is how parents can help with back-to-school anxiety

Acknowledge and allow your child to experience anxiety instead of avoiding it. A natural inclination we may have with our anxieties is the avoidance of situations that provoke the anxiety. As a parent, you may also feel naturally compelled to protect your child from stressors or help reassure them that their worries aren’t necessary. Despite a parent’s best intentions, protecting children from what they fear can actually reinforce the anxiety thought cycle. It’s best to acknowledge your children’s emotions and help them brainstorm baby steps to empower them to take actions that can help them self-soothe and resolve their concerns while providing the necessary scaffolding to help them execute their problem-solving actions. Be sure to help your child identify the emotion they may be experiencing. For example, you might say “It sounds like you’re feeling anxious 

Be solution-focused. Parents are naturally inclined to protect their children, with a deep desire to eliminate stressors or help them avoid situations that cause anxiety. You may notice yourself doing this when you reassure your child that their worries won't come true. However, this can actually contribute to a negative cycle that reinforces anxiety in the long term. Instead, acknowledge your child's emotions, then help them brainstorm small steps to find solutions to their worries and concerns. This will empower your child to take action to help themselves and teach them healthy coping skills, and emotional self-regulation (a key ingredient to healthy parenting). For example, you might say, "It sounds like you're feeling anxious about your new history class. Why don’t we look at the syllabus together?" Boost your child by praising them for any brave behaviors, rather than letting them give in to their anxiety.

Gradual Exposure: Expose children to the school environment before the first day. This can include visiting the school, meeting teachers, or attending orientation events. Familiarity can reduce the fear of the unknown.

Set realistic expectations: Teach children that it's okay not to be perfect. Setting realistic goals and expectations can alleviate the pressure to excel at everything.

Positive framing. Help children reframe negative thoughts into positive ones. Instead of focusing on what might go wrong, encourage them to think about the exciting aspects of the new school year.

Open communication. Encourage open dialogue between parents and children about their feelings regarding the upcoming school year. By addressing concerns and uncertainties, parents can offer reassurance and support.

Practice school routines. Try out “a school day dress rehearsal” to help your child become familiar with their daily routine during the school year. Have your child set their alarm for a school day wake time that allows them enough time to get ready, eat breakfast, pack lunch, and gather any needed materials for school, all in time to take the “bus.”

Model behavior problem-solving behaviors and emotional self-regulation strategies. Demonstrate the types of behaviors and coping skills you’d like to see in your child as they navigate their school day. Children model what they see in others, especially parental figures. If your child notices you taking deep breaths before doing a difficult task, for example, they may be more inclined to do the same independently. A great tip for parents: use feeling statements to identify your emotions. This will increase your child’s emotional vocabulary, helping them articulate their inner experience and be better able to ask for help—a very valuable and positive coping skill that helps them work their communication skills to boot.

Extracurricular activities. Encourage participation in extracurricular activities or hobbies that your child enjoys. These activities provide a sense of accomplishment and opportunities for social interactions.

Help your child get adequate sleep. The shift from a summer wake-up schedule to the school year wake-up time can be very challenging for many children, particularly preteens. Fatigue from inadequate or not enough sleep can make children much more vulnerable to anxiety. A helpful strategy might be to gradually move your child's wake-up time earlier and earlier in short increments in the weeks leading up to the start of school. Help create calm in your child’s room by removing screens (TV, phone, computer) outside the bedroom at night, playing gentle music, diffusing essential oils like lavender, installing a soft night light, and making sure they feel physically comfortable and supported by their bedding.

Seek professional help: If anxiety becomes overwhelming and persistent, consider consulting a mental health professional. Therapists can provide coping strategies tailored to the individual's needs.

Back-to-school anxiety is a natural response to the changes that a new academic year brings. By understanding its underlying causes and implementing effective strategies, both parents and young people can navigate this transition with greater ease. Remember that addressing anxiety is a gradual process, and with patience, support, and a positive outlook, the return to school can be a period of growth, learning, and new experiences.

Click here for more information on anxiety therapy.

Why Adults Should Get Routine Anxiety Screening

What exactly IS anxiety? 

We have all heard of it, but how do we know if we have it? And how do we know if it’s something we should be paying closer attention to?

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, family problems, and relationships. But sometimes anxiety can interfere with our everyday functioning and activities. It’s important to understand the difference between “regular” anxiety and an anxiety disorder. 

Anxiety disorders are a bit different than run-of-the-mill anxiety in that they involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with our daily functioning and activities such as job performance, schoolwork, socialization and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

One of the most common anxiety disorders is Generalized Anxiety Disorder (GAD) which is characterized by excessive and persistent fear and anxiety about everyday events. This type of anxiety can interfere with daily life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events, which is a common reaction. People living with GAD experience frequent anxiety for months, sometimes even years.

Symptoms of GAD include:

• Feeling restless, wound-up, or on-edge

• Being easily fatigued

• Having difficulty concentrating

• Frequent irritability

• Experiencing headaches, muscle aches, stomachaches, or unexplained pains

• Difficulty controlling feelings of worry

• Having sleep problems, such as difficulty falling or staying asleep

According to the National Institute of Mental Health (NIMH), anxiety disorders are among the most common mental health issue in the United States, affecting about 40 million adults. Yet only about 37% receive treatment for their anxiety. The pandemic has only aggravated this issue, sending cases soaring over the past two years. According to one study cited by the task force, between August 2020 and February 2021 the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased to 41.5 percent from 36.4 percent. In addition, according to the World Health Organization, global prevalence of anxiety and depression increased by 25 percent during the first year of the pandemic.

So, what can we do about it?

For the first time, a panel of medical experts from the U.S. Preventative Services Task Force is recommending that adults under age 65 get screened for anxiety. These preventative screenings are designed to help primary care physicians identify early signs of anxiety during routine care, by using questionnaires and other screening tools.

Anxiety can go undetected quite frequently. The benefits of screening include early identification and treatment of an anxiety disorder. Based on the screening results, primary care physicians can refer their patients to a mental health care professional for a more thorough evaluation. 

Why is this important?

Mental health conditions are just as important as other physical conditions, and we really need to be shining a light on and treating mental health conditions with the same urgency that we do other conditions. The “invisibility” of mental health conditions, like anxiety, can contribute to being frequently undiagnosed, which can then lead to further problems down the road such as depression, substance misuse, insomnia, digestive problems, headaches and overall poor quality of life. The recommendation of these new screenings is one step further in normalizing mental health conditions by making them part of routine visits with primary care physicians. Utilizing these screenings can help detect early identification of anxiety so that people can be informed and be referred to a mental health professional for proper diagnosis and treatment.

References:  The National Institute of Mental Health; Diagnostic and Statistical Manual of Mental Health (DSM)

Click here for more information on anxiety therapy.

7 Effective Ways to Manage Anxiety and Stress

Anxiety and stress are words that have become regular fixtures in the collective pandemic and post-pandemic vernacular. While anxiety and stress are normative human experiences, these feelings are meant to be transient and fleeting, observed and allowed to pass through us without necessarily adding judgment or intervention. With that said, lingering concerns about health, economic stability, political division, climate change, and global relations have created a sense of chronic stress that has prompted Americans to seek psychotherapy and counseling services in record numbers for alleviation of symptoms, comfort, coping strategies, and tools. While a blog is never a substitute for tailored mental health advice, I wanted to help by sharing seven of my favorite anxiety and stress busters.

1. Walk It Out

Carving time out of your schedule to get out for a walk or hike in nature can help anyone to feel peaceful and grounded! I prefer to do this in the morning, when I can set an intention for the day, and get to experience an immediate sense of accomplishment for having prioritized self-care. Jim Rohn famously said, “either you run the day, or it runs you.” By taking time for yourself at the beginning of your day, you start some good feelings flowing, and set a precedent for creating pockets of unwind, where you can observe and take pleasure in what is around you. Walking, hiking, trail running, and trail biking also offer the additional benefit of my favorite feel-good chemical- dopamine! Studies have very conclusively found that individuals who exercise regularly are less likely to experience anxiety than those who don’t exercise. Invite a friend, neighbor, a family member, or even a family pet to walk or hike with you and enjoy the double benefit of feeling connected. We at LIFT do regular “walk and talk” therapy in all four seasons (both in-person and telehealth!) to stimulate fresh thinking and processing, change up a routine, and encourage our clients to “move a muscle, change a thought.”

2. Make a Gratitude List

This is a personal favorite way to center, and like #1, it’s a practice best engaged during the morning. With that said, it’s never the wrong time to write a gratitude list! You can write in a journal, in the sand, in a text to your therapist, on a diner napkin at breakfast, in the corner of a book, in your head, or on the notes section of your iPad. A terrific way to keep our minds off of a worry path is to focus thoughts on things that are good, beautiful, and positive about ourselves, and our lives. When we are grateful, we appreciate the value and importance of the people, places, and things who make up our world. I include small, ordinary things in my life on my list (my morning coffee, a book I’m reading or show I enjoy on TV, a joke I heard,) as well as big things (health, my family, my profession, my home.) I encourage clients to try to be as specific, and to include self-appreciation in the list! This can include personal appreciation that you took the time for a self-care ritual (a fresh manicure, a haircut), or even compliments on aspects of you that you are very glad to possess (a good sense of humor, a talent for cooking, a kind heart, a warm smile, a heart for social justice.) It is NO secret that what we focus on increases! Each day brings new problems and obstacles, so we must train the mind to pay attention to the good things. By focusing our thoughts on things that are good, beautiful, and positive, we can keep our minds from dwelling on what troubles us. Make a habit of appreciating your life! Challenge yourself to write down 3-4 pages of gratitude a day. Play some music and write in pretty or artistic handwriting. Include illustrations and exclamation points. If you do this practice daily, try to write different things every day! And, if you’re stumped on what to put down, talk to your therapist and ask her for some ideas. In fact, while you’re at it, put her on your list!

4. Chew Gum

Surprised you with that one, didn’t I? In fact, an intervention study was carried out to examine the effects of chewing gum on occupational stress and related outcomes. 101 volunteers from Cardiff University completed the study. The results showed that chewing gum reduced stress (both at work and outside work), reduced fatigue, reduced anxiety and depression and led to a more positive mood! Fascinatingly, chewing gum was also associated with perceptions of better performance (both at work and outside.) I don’t chew gum every day, but sometimes, on days when I remember to or am very busy, organic/natural gum can serve as a focus enhancer, helping me to stay in the moment and take one task at a time. *Gum is not intended to be over-used, and if you have a history of compulsive gum-chewing and feel this could be a trigger, you can skip right over this step and move straight on to #5!

5. Connect with Other People!

Clients have been reporting loneliness levels to us higher than ever before. The pandemic brought us inward in many positive ways, but many of us are having difficulty reconnecting with our support systems. Call to schedule time to spend with friends and family, whether to hang out or engage in a structured activity. Doing things in-person with those we have deeper connections with and feel close to grows our relationships, allowing us to feel supported and secure. If you feel anxious or stressed about something, talking about it with someone who listens and cares can help you feel more understood and better able to manage. Through openly sharing with others, you’ll put concrete words to what feels like vast emotional overwhelm, and you may realize that you're not alone. Ever feel like you can over-talk about a problem? Try spending time with others in ways that take talking off the table. Skiing, ice-skating, roller-blading, swimming, horseback riding, jumping on the trampoline, cooking classes, movies, concerts, and yoga classes are terrific ways to do so. Fortunately, many of these activities are also easy to enjoy in the pandemic, even as the weather cools. LIFT offers peer support groups that run throughout the year, with virtual and in person options. If you’re feeling perplexed on how to get involved in a peer activity, speak with your therapist to discern if they can get you connected with one of our safe and structured peer groups, or help you to find one that fits.

6. Take a Break from Social Media!

A 2018 University of Pennsylvania study found that reducing social media use to 30 minutes a day resulted in a significant reduction in levels of anxiety, depression, loneliness, sleep problems, and Fear of Missing Out (FOMO.) You don’t need to completely cut back on your social media use to improve your mental health. I am sure that by now, many if not most of you readers have seen the recent news on social media and its averse impact on sleep and mental health. Social media has now been linked to depression, anxiety, low self esteem, and even suicidality, most significantly in teens. (Although, I don’t know why we are surprised that an app designed to objectify and rank “hot” women against one another on a college campus makes women feel badly about themselves!)

I don’t think that responsible use of social media is all bad. Our Instagram handle, @liftwellnessgroup, features lots of body positive accounts, affirmations, mood regulation tools, inspiring stories, and relationship tips. If you look at who we follow, you’ll find a world of resources that are similar. Our social media accounts are almost all mental health related follows, which sure hit differently than the keeping-up-with-the-jones and influencer posts! Remember, what you focus on increases – so change the lens you’re looking at the world through! Cancel the triggering accounts and subscribe to things that make you smile. Social media will take on a whole new utility for you!

7. Get Enough Relaxation, Nourishment and Sleep!

Sitting in front of the TV or computer typically isn't genuine relaxation…Unless we’re talking about Ted Lasso! Depending on what you're watching or doing, it could even make you more tense. The same is true for alcohol, drugs, or tobacco., which may seem to relieve anxiety or stress, but actually create a false state of relaxation that's short lived. If you’re drinking alcohol in the evening to relax, what your body may really need is a few days off, focused on sleep and hydration. In order to really relax, remember that our bodies crave a routine of relaxation techniques. Deep breathing, yoga, meditation or even tai chi are practices that have an immediate demonstrable effect on the mind. In fact, deep breathing helps to relax a major nerve that runs from the diaphragm to the brain, sending a message to the entire body to relax, loosen up and let go!

Have you ever heard of the phrase, “Hungry, Angry, Lonely, Tired?” When we’re any of these things, we’re on the brink of emotional dysregulation and poor decision making. Not eating enough calories for your Body Mass Index and not eating a well-balanced diet WILL amplify or cause anxiety and stress. If you’re presently undereating or engaging in disordered eating behaviors, speak up and get help from a specialist. You will not feel an improvement in mood until your caloric intake is sufficient for your daily metabolic needs.

Foods that are rich in zinc such as oysters, cashews, liver, beef, and egg yolks have been linked to lowered anxiety. Other foods, including fatty fish like wild Alaskan salmon, contain omega-3 fatty acids. A study completed on medical students in 2011 was one of the first to show that omega-3s may help reduce anxiety. This study used supplements containing omega-3 fatty acids. I don’t enjoy fish, so I take supplements. In mice, diets low in magnesium were found to increase anxiety-related behaviors. Foods naturally rich in magnesium may help a person to feel calmer. Some examples include leafy greens, such as spinach and Swiss chard, legumes, nuts, seeds and whole grains. If you’re under the care of a dietitian at LIFT or elsewhere, ask them about your interest in mood-enhancing foods! After all, food is medicine!

I hope these tips are tangible, helpful and constructive. Let me know if you decide to integrate any of them in your wellness repertoire!

Also, please do note: If you or someone you know has stress, anxiety or worry that feels excessive, it may be a sign of an anxiety disorder. For someone who has an anxiety disorder, getting appropriate treatment from a health professional is important. While these tips are intended to help, personalized and professional treatment is the only way to remedy a true anxiety disorder.

Click here for more information on anxiety therapy.

So, you’re a woman. And, you’re living through a pandemic. Now what?!

As the ripple effects of the coronavirus pandemic continue to unfold and expand, one thing has become clear: women are under siege. 

At LIFT, we are advocates and allies for women’s whole health; and most preeminently, mental health, which includes emotional and psychological health, as well as social well-being. Why? Because the state of your mental health determines how you handle stress, how you relate to others, and how you make choices in life, and its presence (or absence!) is critically important at every stage of life from childhood to adolescence to adulthood. Mental health problems affect every facet of your life:  thinking, moods, and behaviors. 

It is indisputable that women have been disproportionately impacted by the pandemic. Since March of 2020, mental health has fallen into a sharp decline for both sexes, but most prominently, for working women. According to a Total Brain survey, levels of depressed mood in women have increased by 83% compared to 36% for working men. Stats from USC’s Center for Economic and Social Research show that ⅓ of working mothers in two parent households report they are the only ones providing childcare (compared to 1/10 of working fathers.) Since March, it is women who have suffered the greatest job losses, and who have reported the highest levels of psychological distress (namely, anxiety and depression.) Also since March, 64% of college educated mothers report having to reduce their work hours, compared to 36% of college educated fathers. 

The situational stress triggered by these compounding stressors, on top of the day-to-day load of responsibilities that American women were already hoisting, is contributing to depression and anxiety being reported in record numbers. Mental health issues are even more likely to present when there are underlying biological factors (brain chemistry, genes,) adverse life experiences (trauma, abuse,) or a problematic family history. Depression and anxiety pop up when the stress of an individual’s present situation exceeds their ability to cope. Difficulties such as moving office work, going remote, learning new technology, maintaining order and routine with kids, career and financial insecurity in the face of recession, minimal childcare, isolation from friends and family, increased demands of child schooling, and monitoring the family’s health, have pushed women to a breaking point. To make matters worse, self-care and stress management, (coping skills which may have already been hard to come by!), have gone by the wayside. Yet, without self-attunement and fulfilling our own needs, we risk physical, emotional, and mental ailments. Now more than ever, protective barriers must be in place to insulate ourselves from the risk of burnout, which can manifest in sleep problems, headaches, chest pain, poor diet, difficulty concentrating, irritability, loss of motivation and pleasure, anger, and loneliness. 

We can’t pour from an empty cup. Mental health activities and interventions are designed to help individuals cope. Sometimes I use an analogy: The RMS Titanic was described as “unsinkable,” because it was uniquely equipped with 16 water-tight chambers that could be sealed off in case of emergency. This gave the ship's captain, and passengers alike, the illusion of invincibility. It was only after the collision with an iceberg in the North Atlantic that the crew became aware of a tragic flaw in this design: the ship could withstand four cells filling with water, but not five or more. It was the compromise of the fifth watertight chamber that sealed the ship’s fate. I used this analogy recently when speaking with a group of women about the importance of self-care. If stress is the sea, pouring into the boat, then our self-care is our watertight compartments. And, for even the most impenetrable person, too much stress will overcome the protective measures in place, and drag us down.

What are your self-care strategies? These can be any interventions and activities, from Cognitive Behavioral Therapy (CBT) to Mindfulness, that center and ground you to conquer your day from a place of positivity, presence, and peace, rather than panic. A participant in group shared yesterday, “I have realized that this pandemic isn’t going anywhere, so I need to learn how to manage my stress now, and live my life now, regardless. This means finding ways to take care of myself- namely, therapy, walks with friends, virtual happy hour, workouts, and journaling- because I can’t wait for ‘later’ to arrive. I can't wait for the pandemic to be over to begin taking care of myself and living my life." Personally, I have recommitted to doing yoga once a week, even if my children are running in and out while I’m doing it. This one hour of time found has been a personal victory. I am strong, but not unsinkable, and that humble knowledge propels me to continue to seek moments to reclaim for self-care. Please share how you’re taking care of yourself right now in the comments, and reach out if you’re looking for fresh ideas, accountability, or support in your emotional life during this time.

Click here for more information on anxiety therapy.

Health Anxiety: What It Is, and When To Seek Help

In a world where a large chunk of our daily news intake is currently made up of tallies and news of illness spreading, it’s understandable that such thoughts may begin to take over our psyches. Even pre-pandemic, thoughts and obsessions about becoming seriously ill, worries about coming in contact with illnesses, or over-analysis of symptoms, were commonly reported amongst our patients. What happens when these thoughts, and potentially anxiety reducing actions, begin to interfere with our lives? When the worries become interwoven with everyday living? 

Health anxiety is a condition wherein we cannot stop thinking about potential symptoms and begin to catastrophize them. We often create rituals or habits of inspection to look for anything seemingly out of place and then gather as much information on them as possible. After all, armed with the World Wide Web at our fingertips, it becomes difficult to not look up that “throaty” sounding cough, or that “headache above eyebrows.” But what if the answers only serve to exasperate our anxious minds, rather than put them at ease? In the case of health anxiety, deep diving for more information does little to satiate the nerves that come along with the feeling that there is something wrong; something that only we can feel. 

In our daily lives, our bodies do so much to keep us functioning, much of which we don’t ever stop to think about. Our bodies regulate our breathing, our heartbeat and rate, and our sight adjusts for every stimuli we encounter. However, sometimes these are sensations which we become hyper—fixated upon, and they begin to consume more time, thought, and energy as they used to. When we begin interpreting these normal bodily functions with the thought that something may be wrong, we begin setting off alarms in our heads — alarms that may be false. Sometimes, being overly concerned with harmless physical traits may provoke unnecessary and extremely draining worry and reactions. Even more, the symptoms of this undue anxiety cause their own bodily reactions. 

Anxiety can manifest in a multitude of ways including increased breathing and heart rate, dizziness, tingling in our extremities, chest pressure, stomach upsets, and so on. This begins feeding into a cycle which only perpetuates the anxiety and causes us harm, especially when we begin seeking reassurance from doctors. 

Can you spot any of these symptoms popping up in your life? You are far from alone. Health anxiety is now classified as Somatic Symptom Disorder or Illness Anxiety Disorder. The first step in finding relief begins with understanding and self-awareness. 

According to Mary Dobson: “Health anxiety is experienced by many of my patients who are indispensable in their own lives due to young children, important work, aging parents, and other imperative responsibilities. To me, health anxiety reveals that an individual is thankful for their life, and understands its preciousness. Perhaps the individual has experienced the premature or sudden loss of a loved one or friend, and posits that a similar fate could befall them. I like to reframe health anxiety as a way for patients to recognize how much they appreciate and value their lives, and how aware they may be that they are doing unique work on this planet in roles that provide them meaning, purpose, and designation. Such factors would make someone fear a loss. If ‘freedom’s just another word for nothing less to lose,’ then the opposite is also true. Buddhist monks sometimes meditate on the image of their own decaying corpses as a way to channel perspective and thankfulness into the mundane activities of the day. Morbid as this practice sounds, health anxiety is not so dissimilar. So, I encourage patients to vocalize their gratitude; and rather than fight their anxieties, channel them into a meditation, and let them add to the richness of their lives rather than diminish them.”  

If you suspect you are battling health anxiety, do seek support. Carrying big worries alone is arduous and ultimately fraying. if you have been to doctors for your physical symptoms, you may want to seek a counselor to help you bear the weight of these thoughts and sort through the mental symptoms in partnership and collaboration. By examining thought processes, patients can overcome the constant weight that anxiety about health has added to their lives. 

Co-written by Natasha Pawa and Mary Dobson.

Surviving the Holidays: Managing Expectations and Disappointment through the Gift of Presence, Given and Received.

This holiday period, kicked off with Thanksgiving and spanning through the New Year, can contain joy, elation, and the creation of family memories that last a lifetime. Yet, simply reviewing that sentence will reveal the pitfalls this very same season bestows. The holidays in our modern world exist on two separate but actual planes: 1.) spiritual and historical traditions with deeply rooted meaning and rich purpose, intended for reflection, shared celebration, and community, 2.) the commercially driven mania and hysteria sold in stores and through the media, which implicates Americans in a con of deliberately over-spending, over-eating, and over-doing in a craze that sustains capitalism and balances the checkbooks of major retailers.

Increasingly, I have born witness to a movement of Americans returning to the roots of what the holiday season means to them. In order to do this, we each as individuals must become clear about what this season represents in our lives. For many, it may be an attempt to recreate the feelings of warmth and nostalgia experienced in childhood for our own children. Some will believe that this is done through gift-giving, in the exchange of the material. Others may desire a closeness and intimacy with family that never existed to begin with, and that year-long, subtle longing becomes acutely painful during a season in which everyone around them appears to be contentedly enjoying perfect relationships, perfect lives, in a perfectly festive setting. This juxtaposition, created by comparison, can create a sense of cognitive dissonance: my expectations do not match my reality. Uh oh. Here arrives the twin sister of Expectations. Meet: Disappointment.

How do we escape the trap of disappointment on ‘special occasions,’ or worse, entire ‘special seasons,’ in which our socially programmed inner voice says, “everything should be perfect during this time.’ Life does not comply with this initiative, because (spoiler alert!) life does not know that it’s the holidays! Life continues on, and does not make exemptions from doing so for special occasions. Examples of this are easy to find: People get into fender benders on their birthdays. Children end up in the ER in need of stitches on Thanksgiving. Parents get the stomach bug on Christmas Day. People get laid off during Hanukkah. On a less radical level, this holiday season, you can be almost certain of these things: siblings will fight. Lights will get tangled. Precious gifts will get lost in the mail. Cards will be returned to sender. You will bicker with a loved one. These events are relatively benign and ought not cause us pain, but rather mere disappointment. However, pain will occur when we tell ourselves promptly afterwards, ‘this shouldn’t be so. Something is wrong, because this shouldn’t be happening to me during the holidays. This is not happening to other people.’

Where do we get this idea that life should cease being real life during the holidays? Well… we do it to each other, don’t we? During a time meant to foster genuine connectivity in communities, we send Christmas card letters that read like a family CV. We post only the ‘good stuff’ to social media. We sign up for anything and everything that will foster that merry feeling we crave - and if it doesn’t, we sign up for more. We do it because it’s what we’ve been taught to do: celebrate with a measure of disingenuousness.

So, what is it that we can do to combat this mass insincerity? I begin by speaking about it. Bringing these topics to light and using humor to contrast our holiday hopes and dreams with what actually transpires, helps. Being gentle with ourselves and speaking with love and tenderness to that still, small voice, which intuitively knows stuff doesn’t buy connection, and that busyness won’t fill the need for meaning, helps too. Also, reminding ourselves that we can ‘unfollow’ people who do not bring us joy, or who feed into this collective, insatiable desire to complicate this season. Lastly, perhaps most importantly, using the tools of self-forgiveness and acceptance to manage the disparity between what exists in our minds as the ideal, and what exists between us and some of the people we love. Relationships with your extended family will not suddenly become conflict-free because it is a special season. People will be who they are, and act in accordance with their typical behavior. Individual human psycho-pathology will not cease to exist because it’s a special time of year. Hard, hard truths, which acceptance can cure, and judgment and the inner critic will never approve of.

Prescription for Wellness. . . Give the gift of radical acceptance to yourself and your loved ones this holiday season. Allow what is to be: the child who won’t smile for the family photo. The aunt who is aloof. The in-law who can be moody. The cousin who has too much to drink. The dog who pees on the carpet. The bickering siblings. They are your people, imperfect and flawed as we all are, and the holidays are not about perfection, but about what they represent to you.

For me, the holiday season is about the traditional music of my childhood, the lights brightening the darkest time of year (even though they were tangled), the cozy evenings in front of the fire with family (even if they’re bickering), the smile on a loved ones face when they see you’ve thought of them with a thoughtful token (even when it’s the wrong size), the taste of homemade cookies (even if they contain kid-baker’s boogers and snot), the moments shared with friends and family (even when someone annoys you, or says the wrong thing, which they will, because life continues to be life and life does not know it’s the holidays.) And these things are good, if we can take them for what they are, and know that we are not guaranteed a perfect holiday season, but we are guaranteed a chance to be present and practice acceptance every day of the year – and if we can accomplish this feat during the holidays, then we are spirituality, love, and peace, in action.

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