Tag:

anxiety

Finding Your Way

{Yountville, California}

I woke up yesterday morning with a sense of dread and struggled to get out of bed, yet ended the day feeling energetic and liberated. Lately, I’ve been making conscious efforts to prioritize myself for the sake of maintaining my sanity. As a result, my mood and anxiety levels have improved almost instantaneously after making a crucial decision regarding my work schedule and the next step to take in my career. If you have any important decisions to make, I strongly recommend holding off on any impulsive, irrational decisions unless you’ve had time to relax and get in the right state of mind. So often our minds get bombarded by all the stressors in our lives that we lack any reserve to think clearly. So take a break, talk it out with others, weigh your options, and trust that your instincts will take you down the right path.

August 1, 2015 6 comments

Psychiatry

Conquer Your Fears (Part 1)

written by freudandfashion

{Lake Tahoe, California}

At the request of one of my awesome readers, I am writing a post on conquering our fears. Being an ENFP personality type (Extroverted, Intuitive, Feeling, Perceiving), I interpreted this in a more global, existential sense: getting over the fears and barriers that may interfere with moving forward in life and/or discovering one’s life purpose. However, others may be more interested in something more specific such as the treatment of specific phobias and social phobia, so I will be writing on conquering symptoms of those diagnoses in future posts next week.

Every psychotherapist has their own style, but the following are questions that I may ask my patients when it comes to conquering some of their biggest fears (if they can even put a name to what their biggest fears are because oftentimes, people are not even sure of what they’re afraid of):

1. Identify your fear. Once you’ve identified your biggest fear (ie, when it comes to a certain situation, such as pursuing a new job, finding love, etc), what is the very 1st thought that comes to mind if I was to ask you to close your eyes and think of the following question: When it comes to _______ (insert goal here), what is the one thing you are most afraid of??

Once aware of the biggest barrier/fear getting in the way of your goal, being consciously aware of this fear puts you more in control.

2. Origins of the fear. Where do you think this fear stems from? Have you experienced a similar, familiar sense of fear in your past or during your childhood?

Having a certain level of fear is normal because the reaction helps identify danger and take action to protect, but when the fear becomes excessive, there’s usually an origin to such fears based on past experience. Recognizing the connection with your past and how irrational the fear is in the present time can be enough for one to take action towards handling the fear more effectively this time around.

3. Take the next step. What small steps can be taken to slowly start working towards overcoming your fears?

For example, someone who is afraid of heights may start by going up to the roof of lower level buildings and working their way up to whatever their end goal might be to conquer the fear of heights (ie, skydiving, looking down while at the top of the empire state building, etc). Or, someone who is afraid of pursuing their dream career might start out by researching how to achieve the career, reach out to others to get advice, or start submitting applications to obtain the educational requirements or job experience needed to improve chances of getting their dream job.

4. Be open to disappointments and any challenges that come along the way. Fear of failure is a common barrier towards taking risks in life. Overcoming fears takes time and practice, so try to be as open as possible to learning and growing from the process. Surround yourself with those who support you in your goals and failures, and motivate you to stay on track. Wanting to give up is a normal feeling (I’ve experienced this numerous times, especially in the process of becoming a doctor) and NOT a sign of weakness.

But each time you get overwhelmed by the fear, ALWAYS REMEMBER and believe in yourself enough to recognize that you have a choice: either have power over your fears, or give power to your fears. So visualize the end goal, look your fear straight in the eye and say “f*** you, I’m the one in control” (yes, I’ve actually told some of my patients to say this).

July 23, 2015 4 comments

Personal

Brighter Days

written by freudandfashion

{Napa, California}

I am so appreciative of the supportive comments I received after sharing my personal experience of physician burnout. I’ve had similar experiences, especially during medical school and residency, but never felt comfortable enough to share until recently. In my practice, I work with so many patients who suppress their emotions. I identify with them wholeheartedly because I am just like them. During residency, I made excuses to avoid meetings with my supervisors because rather than discuss patient cases, the meetings would somehow turn into therapy sessions where I’d cry and feel embarrassed for exposing my vulnerabilities. At the time, suppression and isolation were the only ways I knew how to cope, but it’s a pattern I am actively trying to break ever since I started seeing a psychotherapist during my fourth year of residency.

A common phrase that I mention to my patients (which was told to me by my amazing sister, who is a marriage and family therapist) is that “if you suppress yourself, you depress yourself.” We all suppress ourselves to some degree, but once able to overcome the barriers {our own internal barriers (i.e. cultural, self-criticism, etc), in addition to external barriers (such as the immense pressures and expectations placed on physicians)}, then we have a better chance at achieving wellness and exerting more control in our lives and our careers.

June 27, 2015 6 comments

Personal

Reconnect

written by freudandfashion

{Miami Beach, Florida}

Lately, my ability to write and stay connected via my blog and social media requires far more effort than usual. I’ve written in previous posts that when life gets overwhelming, one of the first things that fall to the wayside is my blog. I’m trying hard to stay consistent on posting because the last time I put my blog aside, I ended up taking a one year hiatus from September 2013 through September 2014. I sound like a broken record when I find myself regularly struggling with life balance, though I’m well aware that the ability to find balance is an ongoing process.

This weekend, I’m headed to northern California to visit my family for Father’s Day and am looking forward to reconnecting again. I also have group therapy today before catching my flight, so i hope to get some feedback from my therapist and group members regarding my disconnect and self-critical self.

I know that I am human, “nobody’s perfect,” and we’re entitled to our good and bad days. Yet, I just can’t help getting frustrated when I don’t feel like myself. I’m sure several of you out there can relate?

June 20, 2015 8 comments

Psychiatry Travel

Coping With Travel Anxiety

written by freudandfashion

{Miami Beach, Florida}

With the summer season fast approaching, many have upcoming plans for vacation, which may trigger high levels of anxiety related to travel. Several of my patients request medications to alleviate anxiety to have on hand for their upcoming trips (mostly a small supply of anxiolytics such as benzodiazepines or sleep aids). Though I travel often, I also experience feeling anxious with each trip and have a routine that I religiously perform a few days before in effort to minimize my anxiety. My routine seems pretty standard to me, but I’ve traveled with several people who are either much more last-minute and disorganized or plan everything months in advance and arrive at the airport 2-3 hours early. Long story short — everyone’s different, so find out which techniques/strategies work best for you.

In effort to find the most common causes of anxiety related to travel, I performed a literature search (the number of studies are limited and all of them pretty old before the year 2000) and discovered a research article titled “Anxiety and Health Problems Related to Air Travel,” a study led by Dr. Iain McIntosh which identified frequency of perceived anxiety at certain stages of travel and use of strategies to reduce the anxiety. The results are summarized as follows:

Stages of air travel with highest frequency of perceived anxiety:
- Take-off and landing
- Flight delays
- Customs and baggage reclaim
Strong relationship between overall anxiety and frequency of reported health problems
- Women have slightly more health problems related to air travel than men
Most frequently used anxiety-reduction methods:
- Alcohol use (one third of the surveyed participants)
- Distraction or relaxation techniques
- Doctor-prescribed or over-the-counter medication (5%)

Since I’m always on the lookout for resources to provide my patients, I found the following links useful:

Articles on tips to cope with travel anxiety: “10 Tips For Nervous Flyers,” “How to Relieve Flying Anxiety,” “10 Foolproof Tricks to Beat Flight Anxiety.”
Apps specifically for anxiety: 5 Apps To Help You Cope With Anxiety
Travel Apps: App For That!, Best Travel Apps for 2015
- I personally use the following apps, which decrease my anxiety about traveling to new places: specific airline carrier apps (to check flight status, etc), Uber, Yelp, Instagram (several travel bloggers have accounts & may even respond to any questions you post to their account), Skype, Kayak, Hotel Tonight

And, in conclusion, I personally recommend the following techniques to make sure your anxiety doesn’t get the best of you:

Don’t put too much pressure on yourself to have the PERFECT trip. I used to be guilty of this and would feel bummed if I forgot to do something on my “must-see/must-do” list. Putting too much pressure on yourself creates more stress rather than being present and fully enjoying each moment of your vacation.
Take some time-out to re-energize yourself. Especially to the introverts out there — visiting the most touristy places means LOTS of people and crowds, which can be manageable, yet in small doses. If you find yourself feeling exhausted after being around hoards of people, then give yourself permission to take some time for a solo activity right after (ie, chill and watch tv or do some reading once you get back to your hotel, etc).

Thought of the Day: Does travel make you anxious? And if so, which strategies help relieve your anxiety/stress?

June 17, 2015 5 comments

Psychiatry

7 Ways Exercise Improves Mental Health

written by freudandfashion

{Rancho Cucamonga, California}

Not a day goes by where I don’t ask myself the following question: Should I, or shouldn’t I go to the gym today?

You don’t have to be lectured by a doctor to know that exercise is good for you. We all recognize that exercise provides positive benefits on our overall health and mood, yet do we religiously incorporate physical activity into our regular routines? Trust me, even as a physician who preaches the importance of incorporating non-medication alternatives such as exercise into wellness plans, I empathize with the struggle to prioritize physical activity in our busy schedules. Yet, if you’re interested in even more specific ways that exercise can enhance your mental health, I compiled a list of information that I often provide to my patients:

1. Target your mood. Exercise has been shown to be just as effective as antidepressants for the treatment of depression. A study led by Dr. James Blumenthal found that an exercise program provided equal benefits in mood as regular doses of Zoloft (a commonly prescribed antidepressant). Also, a Cochrane review (which is a systematic review of all high quality research relevant to a specific research question) found that exercise is associated with a greater reduction in depression symptoms compared with no treatment.

2. Alleviate anxiety. I can attest to this, for my ability to manage stress (especially when in clinic) declines after missing several workouts, though my coworkers say I mask my anxiety fairly well (which is hard for me to believe!). Aerobic exercise has been shown to be an effective treatment for several anxiety disorders. One study found that exercising at 70-90% of maximum heart rate for 20 minutes 3 times a week has been shown to significantly reduce anxiety sensitivity.

3. Boost concentration. Exercise elevates the brain’s levels of dopamine and norephinephrine, which are important chemicals involved with focus, attention, and our executive functions (planning, analyzing, prioritizing, organizing, initiating, and completing tasks/activities). Some people with ADHD are able to manage their symptoms with exercise alone, though many find the ideal treatment regimen includes medication plus exercise. For more helpful info, I often refer my patients to ADDitudeMag.COM.

4. Sleep better. Though the most common method utilized to treat insomnia is via pharmaceuticals, I am always on the lookout for ways to improve sleep without the risks of dependency and tolerance that many sleep aids have. Regular, physical exercise raises core body temperature, which can benefit the initiation and maintenance of sleep.

5. Improve heart health. People living with mental illness tend to have higher risks of cardiovascular disease. Over 50% of adults with serious mental illness are obese. Among individuals who are overweight, losing 5% of body weight can improve risk significantly and one way to accomplish this is through lifestyle modifications such as increased exercise.

6. Connect with others. Social connectivity has been found to be one of the factors that contributes to happiness and well-being. Whether you have a walking buddy, join an exercise class, or join a meet-up group for hiking, etc, physical activity may provide an opportunity to socialize and engage with others.

7. Sharpen your memory. Studies on exercise and prevention of dementia were mostly limited to studies performed on rats, but I did find one promising study which found that older adults involved in a 6-month aerobic training program positively impacted cognitive functioning.

I often tell my patients that they don’t have to be marathon runners to experience the benefits of exercise. The most important aspect to keep in mind when choosing your preferred form of exercise is sustainability — your chosen form of exercise should be something congruent with your interests, goals, and can be easily incorporated into your routine, whether it’s walking, running, playing basketball, yoga, dancing, etc.

Thought of the Day: Which type of exercise have you found to improve your mental health?

Photo by Marlon Santos

May 28, 2015 10 comments

Personal Psychiatry

Social Toughness

written by freudandfashion

{Ventura, California}

I may be an extrovert, but I grew up struggling with social anxiety and still find myself battling it to this day (if this combination of extrovert/socially anxious sounds confusing, you can check out a post I wrote here). I remember being in pre-school and the teacher reporting to my parents that I never talked (I was selectively mute, meaning I kept silent while at school but talked in other environments such as home), which made it hard to befriend other kids. Therapy and pushing myself to be in uncomfortable settings (I took public speaking courses, ran for leadership office positions in high school even though I didn’t speak, and continue to be in group therapy which is extremely difficult for me) have helped me tolerate the anxiety, though I still get overwhelmed each time I go somewhere new or unfamiliar.

The first time I ever ate out at a sit-down restaurant alone was after working late as a post-graduate researcher at UC Davis. I felt nervous and swore everyone was staring at me, but felt accomplished after finishing my meal and leaving the restaurant. Even though I work part-time, I usually spend my off-days running errands, cleaning, blogging, catching up with paperwork, etc…most of the time staying at home in my comfort zone. I try to plan solo outings every once in awhile to reinforce my copings skills, so this week, I decided to take a break and enjoy an outing alone for at least a few hours with no responsibility and no to-do list except to explore downtown Ventura. I remember the fun days of residency when my friends and I would explore random towns in Oregon, though I hardly get the opportunity to do the same since moving back to southern California (showing friends around Hollywood and all the LA touristy spots doesn’t count).

I’ve had several patients whom I’ve helped work through their symptoms of social anxiety and it’s always rewarding to hear them tell me about their recent outings. So here’s a few pictures that I took from my solo outing this week:

{Shopping for a good cause}

{windy Ventura Pier selfie}

Thought of the Day: If you struggle with anxiety, which techniques have you found helpful to overcome it?

May 14, 2015 11 comments

Psychiatry

May Is For Mental Health

written by freudandfashion

It seems just like yesterday that I wrote about Mental Health Awareness Week (see my post here), and I’m happy that the entire month of May is devoted to educating the public about such a prime aspect of our wellbeing. I hope that communities will continue to grow and strengthen in their understanding of mental health so that nobody ever has to feel isolated in their struggles. For me, each day provides an opportunity to educate about mental health (though my siblings have to constantly remind me to “stop working”/psychoanalyzing on my days off). If you follow me on Instagram, I plan to post daily information related to the field for the remainder of the month of May.

When brainstorming something to write to commemorate this month, I felt that my response to a question that MedDebate asked me during an interview seemed appropriate:

In your opinion, How do we eradicate the stigmas associated with mental health conditions?

I believe that eliminating stigma requires empathy, self-awareness, and normalization of mental health discussions. Many still believe that mental illnesses are signs of weakness rather than the fact that they are true neurologic diseases. Educating and raising awareness are important factors for understanding issues in mental health, but education can only go so far without empathy. To be completely honest, even I had my own stigma going into the psychiatric profession and it wasn’t until I acknowledged my own mental health issues that I was able to be more open, relate even more to my patients, and reduce stigma in my mind. The more people are willing to talk about their own mental health, the more people can connect with one another to normalize discussions of mental health-related issues.

May 11, 2015 6 comments

Personal

Drift Away

written by freudandfashion

{San Diego, CA}

My whole week was a bit of a blur. I sometimes wish that I could take a vacation for a few months and have no responsibilities whatsoever. Where would I go? I have no idea. What would I do? No clue. Come to think about it, having no responsibilities for an extended period of time might be depressing. After all, my entire life has been devoted to my career, which is a huge part of my identity. Without my work, I’d lose my sense of purpose especially since being a physician makes up a large percentage of who I am. Perhaps that’s why retiring can be so hard (I have several retirees who present with depression). With that in mind, I suppose the better alternative to an extended vacation would be to continue working, but at a comfortable pace with firm limits and boundaries in place. It sounds so simple. After all, I know my limits and the workload I can handle before getting overwhelmed…but it’s my job to reinforce it. I guess reinforcing it is sometimes harder than the job itself.

March 28, 2015 6 comments

Psychiatry

Antidepressant Awareness

written by freudandfashion

I have a love/hate relationship with antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Basically, I love them when they actually help my patients, but hate the intolerable withdrawal that may occur when taking patients off of them. If you’ve ever contemplated abrupt discontinuation of an antidepressant, consult your doctor before stopping them altogether, particularly if you’ve taken them for at least six weeks.

In my practice, I never hesitate to prescribe antidepressants when indicated, however, I always warn my patients of potential withdrawal effects that may occur if the medication was to be discontinued in the future. Informed consent and patient education should be given before a physician prescribes any new medication. Over the course of my training and practice in psychiatry, my observations of the negative impact of weaning off antidepressants shocked me, mostly because I never learned about the phenomena in textbooks the way that I learned about other withdrawal syndromes (such as alcohol, opioid, methamphetamine, etc). From flu-like symptoms to acute somatic pain symptoms — I witnessed a full range of issues (see below for a more extensive list). The unfortunate thing is that patients often internalize the symptoms and believe there’s something wrong with them, though typically the only factor that changed since the last visit was lowering the antidepressant dose.

A telling statement was hearing a patient say that getting off an antidepressant was worse than getting off heroin. Antidepressant discontinuation is no joke. And the unfortunate thing is that many people aren’t aware of the negative withdrawal effects that may occur from lowering the dose or discontinuing the antidepressant. I was fortunate to have an amazing mentor during residency training, who taught me that “slower is better” when it came to lowering the dose of antidepressants. A literature search for any research articles regarding weaning off antidepressants yields little results, therefore, guidance on how to take patients off of them is minimal.

I am NOT writing this post to bash antidepressants especially since they have improved the quality of life of many. However, I AM writing this post to raise awareness because I see this issue OFTEN. And if this information encourages one person to advocate for him/herself and the symptoms they experience, then mission accomplished!

Possible Antidepressant Withdrawal Symptoms:

insomnia
agitation
worsened anxiety
resumption of depressive symptoms
headache, “brain zaps”
stomach upset
flu-like symptoms
increased pain
tiredness
nightmares
dizziness
suicidal thoughts

March 20, 2015 21 comments

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