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At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

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Read our award-winning blogs for useful information and tips about anxiety, stress, and related disorders.

 

Busting OCD Myths and Misconceptions: OCD In Its Many Forms

Jill Stoddard

By Annabelle Parr

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The term OCD has been appropriated to describe neat freaks, those who get a kick out of organizing, and the Mr. Cleans of the world. People casually joke “I’m so OCD!” in reference to their color coded planners or their squeaky clean cars or their Instagram worthy closets. Not only is this use of the term inaccurate, the tongue and cheek expression minimizes the severity and suffering associated with obsessive-compulsive disorder (OCD). 

For those who actually meet diagnostic criteria for OCD, the characteristic obsessions and compulsions are far from cute or funny. According to the DSM-5, obsessions are intrusive, unwanted thoughts, urges, or images that create immense anxiety and distress; compulsions are the actions the individual takes to attempt to neutralize, suppress, or ignore the obsessions, and involve behaviors or mental acts which are rigidly applied in response to obsessions. OCD compulsions take up at least an hour of the individual’s day, and create serious impairment in important areas of life, including school, work, and relationships.

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Additionally, although most people tend to think of OCD as characterized by fears of germs or the need for things to be orderly, these are only two of many manifestations of the disorder. There are a number of categories into which obsessions and compulsions commonly fall, including checking, contamination, symmetry and ordering, and intrusive thoughts. These categories often overlap with one another and at the core all subtypes involve extreme difficulty tolerating uncertainty. 

Checking

Though the checking behavior is a compulsion, the compulsion is driven by a fear-based obsession regarding potential harm or damage that could occur if the compulsion is not engaged. Some examples in this category include checking locks, appliances, lights, and taps, checking for signs of illness or pregnancy, checking one’s valuables, or checking for signs of sexual arousal, as well as seeking reassurance. The checking behaviors – like the compulsions in all of the subsequent categories – are engaged multiple times, and often prevent one from maintaining commitments such as arriving to work on time, keeping social engagements, etc.

Contamination

In this category, the obsessive fear is related to harm as a result of being dirty or coming into contact with germs, and the compulsion typically involves excessive cleaning or avoiding situations which may result in contamination. Some common examples of feared stimuli include public or private toilets, restaurants, shaking hands, chemicals, sex, outside air, and crowds. 

Symmetry and Ordering

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The obsessive aspect of this category can either be related to the compulsion, where a lack of order causes great discomfort, or can be connected to other unrelated fears or intrusive thoughts such that the compulsion to create order is believed to prevent the feared harm (e.g. contracting a serious illness) from occurring. Items – such as clothes, books, pictures, and food – must be arranged symmetrically and just right.

Intrusive Thoughts

This particular subtype is sometimes referred to as “Pure O” (for obsession), as it is characterized primarily by obsessions and avoidance, but does not typically have overtly obvious compulsions present. Intrusive thoughts are a particular type of distressing obsession, characterized by involuntary, unwanted, highly distressing and often disturbing thoughts. 

Intrusive thoughts can be related to one’s relationship, where for example, one feels the compulsion to constantly seek reassurance of one’s partner’s feelings or faithfulness.  

They can be related to sex, involving intense fear of being sexually attracted to children, sexually attracted to family members, or regarding one’s sexual orientation.

Another particularly distressing form involves intrusive thoughts regarding violence, where one fears he will carry out violent acts toward himself, loved ones, or others.  

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Sexual and violent intrusive thoughts are experienced as especially disturbing, and individuals struggling with these thoughts are often hesitant to disclose them as they may believe that these thoughts are a sign that they are capable of such actions; they may also fear that these thoughts mean that they are a bad person or that they will be viewed as such. Despite the disturbing nature of these thoughts, individuals with OCD are the least likely to act on such thoughts, as they experienced as revolting; rather than indicating a propensity to carry out these actions, much of the individual’s time is devoted to suppressing the thoughts and avoiding and preventing the feared outcomes.

Intrusive thoughts can also come in the form of magical thinking, where the individual believes that thinking about something terrible – such as a natural disaster or death – makes it more likely to occur.

Finally, religious intrusive thoughts (scrupulosity) can take the form of intense fear that one is sinning, one must pray over and over, fear of blasphemous thoughts, etc. 

OCD Treatment

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The good news is that effective treatment is available for OCD. The gold-standard of treatment is currently Exposure and Response Prevention, a form of Cognitive Behavior Therapy in which the client is – in the context of a warm and supportive therapeutic environment – exposed to the distressing obsessions and prevented from engaging in the subsequent compulsion. Like all forms of exposure therapy, this approach allows for new learning to occur such that the association between obsession and compulsion is slowly broken down. The client typically learns over the course of treatment that catastrophe does not strike despite failure to engage former compulsions. Medication may also be recommended in conjunction with therapy in some cases.

OCD Is No Joke

OCD can severely limit one’s ability to engage effectively and meaningfully in life. The associated distress and anxiety can be overwhelming and painful, thus OCD is not something to joke about or trivialize. However, with effective treatment, individuals can learn how to manage distress in new ways such that they are not prevented from engaging in a rich and vital life.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

 

How Do I Know If I Need Therapy?

Jill Stoddard

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

When You Stress About Stress You’re Stressed

Jill Stoddard

Image source: https://www.amazon.com/Stressed-Desserts-Spelled-Backwards-Poster/dp/B017C9AZUQ

Image source: https://www.amazon.com/Stressed-Desserts-Spelled-Backwards-Poster/dp/B017C9AZUQ

What is your go-to when you feel stressed out?  Do you like a few glasses of wine, an hours long vent session, or a creative excuse to get out of a social engagement?  These are all examples of experiential avoidance—an unwillingness to experience uncomfortable internal emotions or sensations and active efforts to change, reduce, or eliminate them (Forsyth and Eifert 1996).  Does experiential avoidance work to alleviate feelings of stress?  Yep.  It works or we wouldn’t do it.  But how long does that last?  Look at your personal experience and take inventory:

1.     what do you do or not do when you feel stressed?

2.     what does it get you (i.e., what discomfort does it relieve)?

3.     what is its cost?    

When our reactions to stress result in only temporary relief but come at a cost to our health, our relationships, or other areas of importance, it’s time to reevaluate our relationship to stress. 

Think of it this way (Stoddard, 2019):  Imagine I have you in a little booth suspended above a barracuda tank.  I tell you, “Whatever you do, don’t get stressed and you will be fine.  Unfortunately, if you do feel stressed, the floor of the booth will open, dropping you into the barracuda tank.  But just don’t get stressed and you will be totally fine!” 

What do you think is going to happen?  Right—you’re stressed…and fish food.  Is it because you just didn’t try hard enough to control your stress?  Was the incentive not quite high enough?  Of course not—our most primitive instinct is to survive.  So why did you get stressed and end up swimming with the fishes?  Because when you are unwilling to experience stress, you are stressed about stress so you are stressed (Hayes, Strosahl, and Wilson 1999).  See the trap?  Your relationship to stress becomes one in which you evaluate it as bad, dangerous, and deadly. 

So, of course, you are stressed about having stress. 

So what should you do the next time you hear on Good Morning America or in the Huffington Post “Stress is bad for you!  Stress will kill you!  You shouldn’t get stressed!”  It turns out, stress has been wrongfully getting a bad rap (McGonigal 2013).  While stress does release adrenaline (the hormone thought to be harmful to the body), it also releases oxytocin, the bonding hormone that enhances empathy and motivates us to seek and give care.  Oxytocin is a natural anti-inflammatory—it’s good for our bodies and actually strengthens our hearts.  And, fascinatingly, all we have to do to mitigate the negative effects of adrenaline is simply appraise stress as helpful.

Come again?  Stress, helpful?  YES--stress can motivating!  Stress is what prompts you to prepare for the important job interview, watch over your small children in a crowded place, and get ready for the big game.  If you were totally chill, you’d likely bomb the interview, lose your kid at the mall, and blow the game.  As it turns out, there is an optimal arousal zone when it comes to doing well (Yerkes and Dodson 1908):  when stress is very high or very low, it has the potential to negatively impact performance.  But a moderate level of arousal is helpful. 

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The best way to manage stress is simply to change your relationship to it.  So stop struggling to avoid and reduce your stress (how’s that working for you, anyway?), and instead work on accepting that to be human is to know stress, and stress need not be our enemy.  You can do that by remembering:

1.     stress is motivating and can improve performance at moderate levels

2.     stress prompts us to seek connection with others and this is good for our health

3.     stress is only damaging when we evaluate it as damaging

4.     when we are stressed about stress we are stressed

Now, don’t get me wrong—I’m not suggesting you give up your meditation practice because it makes you feel less stressed.  There is nothing wrong with getting your bliss on—as long as your strategies don’t come at the cost of other meaningful and important pursuits.  So go ahead and yoga-it-up—just don’t neglect your friends and family while you’re at it.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Forsyth, J. P., and G. H. Eifert. 1996. “The Language of Feeling and the Feeling of Anxiety: Contributions of the Behaviorisms Toward Understanding the Function-Altering Effects of Language.” The Psychological Record 46: 607–649.

Hayes, S., K. Strosahl, and K. Wilson. 1999. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: The Guilford Press.

McGonigal, K. 2013. “How to Make Stress Your Friend.” Filmed June 2013 in Edinburgh, Scotland, video, 13:21, https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend/transcript

Stoddard, J. 2019. Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, and Stress Using Mindfulness and Acceptance. Oakland: New Harbinger Publications.

Yerkes, R. M., and J. D. Dodson. 1908. “The Relation of Strength of Stimulus to Rapidity of Habit-Formation.” Journal of Comparative Neurology and Psychology 18: 459­–482.

Trauma, PTSD, and Evidence Based Treatment

Jill Stoddard

by Annabelle Parr

When someone experiences a life threatening event, the nervous system kicks into gear to help them survive. It automatically initiates a fight, flight, or freeze reaction. Once the event is over, it’s natural to be emotionally, cognitively, and physically distressed by what occurred. However, for some individuals, the brain and the body can get stuck continuing to respond as if the threat is still present. When this occurs for an extended period of time, the person may be experiencing post-traumatic stress disorder (PTSD).

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From Victim Blaming to Recognition of Suffering

PTSD is often associated with combat veterans, as the diagnosis was developed in an effort to characterize and explain the cluster of symptoms that some soldiers experienced after returning from combat (Herman, 1997). Prior to the development of an official diagnosis, PTSD in soldiers was known as “shell shock,” and those suffering from shell shock were often blamed, told they were weak, and punished for their symptoms. In the late nineteenth and early to mid twentieth centuries, a significant number of women also exhibited symptoms of PTSD from sexual trauma and domestic violence. However, rather than psychiatric professionals acknowledging or investigating the trauma these women had experienced, they too were blamed for their symptoms, and were diagnosed with “hysteria,” which was explained as a manifestation of inherent female weakness and emotionality. In the 1970s, survivors of both combat and domestic abuse began advocating for themselves. It was not until 1980 that the American Psychological Association finally recognized PTSD as an official diagnosis (Herman, 1997).

What is Trauma?

Trauma can and does include both experiences in combat and sexual abuse, but it is not limited to these events. Trauma is defined by the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-V) as “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, 2013, p. 271). Exposure can include personally experiencing the event, witnessing the event occurring to another, learning that such an event occurred to a loved one, or being exposed to extreme details of a traumatic event (such as a first responder or police officer). While it is common for survivors to compare the intensity of their experience to that of another survivor and to minimize what they have been through, according to Dr. Peter Levine and Maggie Kline (2006) “trauma is defined by its effect on a particular individual’s nervous system, not on the intensity of the circumstance itself” (p. 37). Furthermore, as Dr. Judith Herman (1997) noted, “the severity of traumatic events cannot be measured on any single dimension; simplistic efforts to quantify trauma ultimately lead to meaningless comparisons of horror” (pp. 33-34). Trauma encompasses a wide range of experiences, including but not limited to childhood abuse, sexual assault or rape, emotional abuse, combat, medical procedures, natural disasters, car accidents, and physical assault.

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What is PTSD?

PTSD is characterized by intrusion in the form of repetitive and distressing thoughts, memories, or nightmares; avoidance of trauma-related triggers such as people, places, or situations; reactivity in the form of hypervigilance, exagerrated startle, irritability, or similar; and changes in beliefs and mood, such as self blame or detachment (for a more comprehensive list of symptoms, you can refer to the diagnostic criteria in the DSM-V)

While PTSD symptoms often begin soon after experiencing the trauma, they can surface months or even years following the event. It is very common to experience some symptoms of PTSD immediately following a trauma due to the natural reactions of the nervous system when faced with threat. However, for the majority of individuals, recovery tends to occur naturally and the symptoms resolve without treatment. For some, the brain and the body can get stuck, and continue to experience the effects of trauma long after the threat has passed.

Why Does PTSD Occur?

The effects of trauma are incredibly complex, and there is not one clear answer for why PTSD occurs in some but not others. When faced with threat, there are a number of changes that occur in both our brains and our bodies to maximize efficiency and to help us access the resources and responses that allow us the best chance at survival. One factor that seems to distinguish the experiences of those who develop PTSD is “a feeling of ‘intense fear, helplessness, loss of control, and threat of annihilation’….When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over” (Herman, 1997, pp. 33-34). Having felt extreme powerlessness at the time of the trauma (and continuing to experience powerlessness after the fact), the individual’s body and brain attempt to reclaim power by continuing to respond to the threat as if it were perpetually present. Feeling and behaving as if the trauma is still occurring in the present rather than lodged safely in the past is a characteristic experience of those with PTSD.

Treatment for PTSD:

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PTSD can be incredibly debilitating, tends to place a strain on relationships, and can impair the survivor’s ability to function in other important areas of life, such as work or school. However, the good news is that while we cannot undo the traumatic event, PTSD does not have to be permanent. Evidence based treatments are available to help survivors recover from the aftermath of their trauma.  Evidence based treatments available at CSAM include:

  • Prolonged Exposure (PE) involves gradually facing the memories, thoughts, feelings, and situations that the client has been avoiding since the traumatic experience. Avoidance may offer temporary relief, but can severely limit the person’s life and ultimately serves to maintain symptoms of PTSD in the long run.

  • Cognitive Processing Therapy (CPT) involves exploring the ways that the trauma has altered the way the client sees him/herself, others, and the world. CPT helps the person to learn new ways to cope with upsetting thoughts, how to challenge unhelpful thoughts, and how to reframe the thoughts in more helpful ways.

  • Eye Movement Desensitization Reprocessing (EMDR) involves bringing the traumatic experience to mind while the client moves his/her eyes from side to side or experiences tactile or auditory bilateral stimulation. EMDR can help the client to process the trauma in a new way.

  • Acceptance and Commitment Therapy (ACT) focuses on the use of experiential exercises to help foster greater acceptance of emotional experiences, decrease the power of negative thoughts, identify values, and help the client commit to taking action in service of his/her values in order to create a more meaningful and fulfilling life even in the face of pain. ACT also often involves exposure exercises to help decrease avoidance.

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Coping with PTSD and deciding to seek treatment takes immense strength and courage. The beautiful thing about treatment for PTSD is that although it is challenging, it gives survivors their power and their voices back. When PTSD limits confidence and life engagement, evidence based therapy conducted in the presence of a warm, supportive, empathic clinician can help restore a sense of safety and willingness to engage in a full and meaningful life.

CSAM’s Lead Trauma Specialist, Dr. Janina Scarlet, is a trauma survivor who is extremely passionate about helping other trauma survivors to cope with and recover from PTSD. Her approach includes finding strength in the trauma survivors. She says, “Every hero has a traumatic origin story. Your trauma does not define you. Your trauma is just the beginning of your quest. The rest is up to you.” She collaboratively works with trauma survivors to turn their pain into a superpower, allowing survivors to move past their pain, and find meaning, hope, and recovery.

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CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 

Herman, J. (1997). Trauma and recovery: The aftermath of violence – from domestic abuse to political terror. New York, NY: Basic Books.

Levine, P. A., & Kline, M. (2006). Trauma through a child’s eyes: Awakening the ordinary miracle of healing. Berkeley, CA: North Atlantic Books.

My Horcrux Diary

Jill Stoddard

guest blog post by Dr. Nic Hooper

Have you read the quote below by T.E. Lawrence?

"All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake up in the day to find it was vanity, but the dreamers of the day are dangerous men, for they may act their dreams with open eyes, to make it possible.”  

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I’m a dreamer. Always have been. Ever since I could remember, I wanted to do remarkable things that would make the world a better place. Over the years, I’ve had lots of ideas for how to do this but often I would ‘wake up in the day to find it was vanity’. In other words, the ideas remained just that; ideas. On a recent project, I became a ‘dreamer of the day’.

I research an approach to human suffering named Acceptance and Commitment Therapy (ACT). The pitch of ACT goes something like this: if we can be willing to experience all of our thoughts and feelings, both positive and negative, whilst continuing to move in valued directions, then we will do a decent job at this game of life. One night, after delivering an ACT intervention to teachers, I had this thought: “It is really easy to forget our values; I need to create something that will remind people of what is important to them.” In the following weeks I came up with the idea of an annual diary. For the most part, this diary would be like any other diary i.e. it would have days and dates and spaces to record meetings. However, it would also provide an opportunity for the user to record what is important to them at the beginning of each week.

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Ok, so there was the idea. Now I had to do something with it. The first step was easy; I loaded Microsoft Word and spent hours and hours and hours (with my co-author Dr. Freddy Jackson Brown) shaping the words and lines that would make up the inside of the diary. The second step was more difficult. I had to figure out how to take that file and turn it into a product. First question: a publisher or a printing house? No publisher was interested so we went with a printing house. Then, more questions. What sort of spine to go for? How thick should the paper be? How many copies should we buy? How should we sell it? What are the best postage and packaging options? How should we advertise it? How should we accept payment for it? How do we pay tax? Who is going to post them? How should we grow the product over time?

During the first and second steps I faced a fair bit of discomfort (i.e. seemingly powerful negative thoughts often crossed my mind: “this is a waste of time”, “nobody will like it” or “you should be spending this time with Max”). However, the third step of making my idea a reality brought the most discomfort: once I had the completed product, I sent it out there into the scary world. And given that success or failure has implications for how I feel about myself, my diary is a bit like a Horcrux in the Harry Potter story. In that story, the bad guy (Voldemort) poured his soul into a number of items and placed them out there in the world. Those items were called ‘Horcruxes’. His thinking was that this strategy would make him more difficult to kill.

Like Voldemort, I poured my soul into this Horcrux. And like Voldemort, any attack on the Horcrux feels like it kills a part of my soul (‘attack’ is an extreme word that is possibly misplaced here. By ‘attack’, what I mean is any evidence I see that the diary is not worthy, whether it be a lack of sales, little interest on social media or negative feedback). My Horcrux diary is now out there in the world fending not just for itself but, in some ways, for me also. A bit of my soul is unprotected; it can be scrutinized, criticized or ignored. It can fail. And if it fails then it will hurt like hell.

The feeling of vulnerability that comes with trying to do something remarkable is tiring, and it often makes me question whether it would have been better to stay a ‘dreamer of the night’. If my Horcrux is inside my mind then nobody can see it; nobody can hurt me. However, every time I think about this I come to the same conclusion. Although being a ‘dreamer of the night’ comes with built-in safety, if I didn’t do something with my dreams then I’d be living a life out of step with my value of making the world a better place, and consequently, I’d feel empty.

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Why am I telling you all this? For two reasons. Firstly, I want you to see how ACT is in my blood. Just in this blog you will spot how I used important ACT processes (willingness, defusion, self-as-context, values). Secondly, and more importantly, I want you to see that having ACT in my blood helped me to chase my dreams, and that it can help you to do the same. Chasing dreams will bring vulnerability but if you know what to do with vulnerability then you will be free.

Interested in checking out Dr. Hooper’s Annual Diary for Valued Action? Check it out here.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

#CureStigma

Jill Stoddard

by Annabelle Parr

This year for Mental Health Awareness Month, NAMI (National Alliance on Mental Illness) is focusing on curing mental health stigma. The campaign manifesto on the NAMI website reads:

There’s a virus spreading across America. It harms the 1 in 5 Americans affected by mental health conditions. It shames them into silence. It prevents them from seeking help. And in some cases, it takes lives. What virus are we talking about? It’s stigma. Stigma against people with mental health conditions. But there’s good news. Stigma is 100% curable. Compassion, empathy and understanding are the antidote (NAMI, 2018).

Stigma is a nasty virus, but this manifesto fails to capture the fact that stigma doesn’t just hurt the 1 in 5 who are struggling with diagnosable mental health conditions. It hurts every single one of us.

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Mental health exists on a continuum. When we create a false dichotomy that suggests that some people are mentally ill while everyone else is healthy and well, we fail to recognize the range of experience that falls somewhere in the middle. And we fail to recognize that where you stand on the continuum can fluctuate and change throughout life.

The continuum enters the realm of DSM diagnosis when a person displays a clinically significant level of functional impairment. In other words, to qualify for a diagnosis, the person must be unable to function in an important area of life as a result of the presenting symptoms. But there are plenty of people who are functioning seemingly well in relationships, work, school, etc., who appear just fine from the outside, yet inside they are hurting and need some help. These folks aren’t feeling “well,” but they don’t necessarily meet the criteria for a mental health diagnosis.

The thing is, while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.

With stigma, we all become isolated in our suffering. But with compassion (which means to suffer with), we can find connection in the midst of and even as a result of pain through our experience of common humanity. We all know loss, grief, heartbreak, anger, anxiety, sadness, regret, inadequacy, and disappointment. We all have our own version of the “I’m not good enough” story. What if, instead of burying these feelings deep in our shame vaults, instead we shared them? Stigma wouldn’t be able to survive.

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Just because pain is a part of being human, that doesn’t mean a professional can’t help us navigate the more difficult aspects of existence. Despite what stigma says, seeking therapy in the midst of struggle is a sign of strength and wisdom. Therapy can benefit anyone, no matter where the person falls on the continuum of mental health. In fact, even therapists benefit from therapy. A few of the CSAM clinicians decided to share a little bit of their own experiences as clients in therapy.

Dr. Jill Stoddard, CSAM Director, said:

I like to think of my mental health a lot like I think of my physical health--they both need ongoing attention and care to stay at their best.  When I get a small cough or cold, I might just manage it on my own with my neti pot and some Vics Vapo-Rub. But if I have strep throat or a broken bone, I'm going to seek out professional help and continue to follow up with my physician until I'm well.  Even when things are stable and there are no overt signs of trouble, I still see my dentist, optometrist, and dermatologist for regular check-ups.  So goes my mental health.  Life can get really painful.  If I'm dealing with smaller hassles, I might go to yoga or seek support from my friends or family.  But when my mom died, I went to therapy to help process my grief.  When my husband and I were feeling the distance that often comes with raising a young family while also working, we sought out couples’ therapy.  Now, our marriage is stronger than ever, AND we still see our therapist for sporadic "check ups."

Dr. Michelle Lopez, CSAM Assistant Director, wrote:

I think about mental health care as a lot like car care. If my car is having problems, it may need to be in the shop for a while. Other times, it might just need a quick tune up. It might also take me some time to find the right mechanic, and I might have to try a few out before I find the right one. But it’s important to pay attention to signs that the car needs service, because neglecting it is likely to lead to more problems. I’ve participated in therapy at various points in my life, and have sought help to work through life experiences and challenges such as coping with the physical and emotional pain of a physical injury, processing the loss of my dad, living with infertility, and creating a healthy work-life balance. Currently, my car is functioning quite well, but I make sure to take notice when that “check engine” light comes on. 

Dr. Janina Scarlet, CSAM psychologist and founder of Superhero Therapy, shared:

When my dear friend lost her battle with cancer, I was devastated. I couldn't sleep, I couldn't concentrate on my school work, and I found myself too overwhelmed to function. I decided to see a grief counselor. I had never been in counseling before and didn't know what to expect. My therapist was warm, compassionate, and understanding. She helped me process my grief and find meaning in this loss. I am extremely grateful for this experience as it allowed me to find myself again. 

Hopefully, in acknowledging the full range of human experience and removing the false dichotomy that currently separates us into We-Who-Are-Healthy and They-Who-Have-Pathology, we will begin to fill the space that is currently occupied by stigma with acceptance and compassion, both for ourselves and others.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References:

NAMI, 2018. Mental health month. Retrieved from: https://www.nami.org/mentalhealthmonth