Tag:

psychology

New Year’s Resolution Ideas To Enhance Your Mental Health

Not sure about you, but I got tired of writing down the standard New Year’s resolutions on my list (such as losing weight, making more money, etc) several years ago. Research has shown that people typically lose momentum to carry out their resolutions within the first 6 months, so why not make a list that enhances your life and contributes to happiness for the long run rather than relying on a number (ie, pounds lost, money earned, etc) to determine whether or not you succeed?

Achieving your resolution is a process…it has ups and downs…successes and failures. If we learned to embrace the process, we’d likely maintain momentum (ie, “okay so I ate a lot of chocolate and pastries on Valentine’s day — I’m going for a run the next day,” rather than the negative self-talk such as “I’m such a fatty and a failure because I ate a piece of chocolate”). I say, get over it and move on — after all, you’re human. You either have the option of stressing and obsessing about that one piece of chocolate (thus increasing your cortisol levels leading to increased fat storage) or owning up to eating that piece of chocolate and viewing it as fuel for your workout or a well-deserved treat. Perhaps self-love and forgiveness can also be a resolution? Since awareness of the importance of mental health has been gaining more traction lately, let’s make 2016 a year to focus on your overall mental health and well-being.

The following are some ideas that I share with my patients on a regular basis, in addition to some resolutions that I plan to incorporate into my own list for 2016:

1. Improve your sleep patterns. I listed this as #1 because it’s actually at the top of my own list since I stay up way too late despite having to wake up early in the morning for work. Sleep is correlated with your health (insomnia is related to hypertension while too much or too little sleep increases the risk of stroke, for example), levels of concentration, and mood. So how much sleep do you need? You can check out the National Sleep Foundation’s recommendations for amount of sleep here.

2. Substitute some of your least healthy food habits with more nutritious options. It has been shown that those with better quality diets were less likely to be depressed and people who eat higher amounts of processed food was associated with increased anxiety. Here are a couple of substitution ideas:

Instead of soda: try flavored sparkling water, fruit-infused water, unsweetened iced tea. (This is how I quit drinking soda about 4 years ago)
If you eat fast food on a regular basis, aim for an option that perhaps is charbroiled instead of fried (ie, grilled chicken sandwich instead of battered).
If you want to fulfill the craving for fried food, be sure to use oil from healthier sources (ie, coconut, olive, and grapeseed oil).
Instead of snacking on white or milk chocolate, switch to dark chocolate.

3. Make more of an effort to connect with others. This can be as simple as smiling or saying “hi” to people that you walk by on the street to making more of an effort to talk to a co-worker whom you normally don’t speak to, or re-connecting with an estranged family member. Social interactions with those you are close to, in addition to acquaintances, are linked to a greater sense of belonging and happiness.

4. Give back by volunteering. Volunteer work increases social connectedness and has been shown to lower levels of depression, especially for people over age 65.

5. Discover the exercise/sport/gym/physical activity that you love so much it becomes part of your regular routine rather than a chore/hassle. Rather than committing to losing weight, why not first find the physical activity you enjoy and desire to participate on a regular basis? Then, the benefit of engaging in the activity leads to getting in better shape. It’s really all a matter of perspective. If you focus on a specific number of weight to lose, then you’re more focused on the end outcome (and that could entail unhealthy habits such as yo-yo dieting, starving yourself to meet that number, or overexerting yourself at the gym — basically, methods that are unsustainable and add excess stress to your body).

6. Take up a new hobby. In effort to live a more balanced life, having a hobby can be a healthy distraction away from your everyday stressors. I’ve been meaning to improve my golf skills ever since I first played a round during residency several years ago (okay, maybe I didn’t play all 18 holes, but still). I’ve already bookmarked a few golf courses to check out and plan to go to the driving range in January. Anyone care to join?

7. Spend less time on your smartphone/social media and more time engaging in real conversation (and life in general). Americans have been found to spend an average of 4.7 hours/day on their smartphones. This is going on my list as well because I’m definitely on my phone way more than I should be. Although social media can be a great source of support to connect over mental health issues, it has also been linked to insomnia and increased anxiety in the teenage population. I believe that adults are likely also impacted by social media in a similar manner, so reminding ourselves to unplug more can lead to less distraction and greater productivity to accomplish the other resolutions on your list.

Photo by Marlon Santos

December 29, 2015 26 comments

Personal therapy

Recognize Your Limit

written by freudandfashion

(Unflattering sick post from my Snapchat)

Well, in addition to the stress of the holidays (which I wrote about here), among other stressors, was also the added stress on my body having made an impulsive decision to switch from a high protein (mostly animal-based) diet to a Vegan diet practically cold turkey. I watched several Netflix documentaries that turned me off to carnism and found myself repulsed at the thought of even eating my daily hard-boiled egg for breakfast (those who know me know this has been my routine to start my morning for the last 2 years). Well, in addition to also getting a stomach bug, all the combined stress culminated a few nights ago when I experienced the symptoms listed above (see photo) and was out of commission the following days. I welcomed the opportunity to rest (fortunately it was my day off, then had the weekend) especially since I haven’t been sleeping well in the last few weeks.

{more Snapchat (username = freudandfashion) posts}

Well, I guess my quick (because I really want to go out for a run since I have more energy today) and main point of this experience is the importance of listening to our bodies and being aware of the need for self-care when we’re overwhelmed and approaching our limit. I could’ve forced myself to sleep earlier (but I didn’t), could’ve more properly planned a better way to ease into eating more plant-based protein (but I didn’t), and could’ve allowed myself to relax rather than stress about the perfect gifts to buy (I’m still not done with my Christmas shopping, but whatevs), but sometimes we get so wrapped up in the moment that our own needs become an afterthought.

If any of you identify with me and the stress I’m experiencing, then it’s nice to know I’m not alone. And if so, I hope you start this week being kinder to yourself and take the proper measures to maintain your sanity for the remainder of the year (and thereafter).

December 20, 2015 9 comments

Psychiatry

The “No Bullsh**” Guide For Getting Through The Holiday Season

written by freudandfashion

Ahhh yes, the television commercials convey cheerfulness and joy with the contrived images of gift giving and preparing for a massive holiday feast, but the reality is that people probably identify more with Ebenezer Scrooge than Martha Stewart. If a part of you feels too guilty and ashamed to admit that you’re not filled with holiday glee, then consider the following questions:

Do you want to roll your eyes when asked how excited you are about spending the holidays with your in-laws?
Do you feel obligated and forced to buy gifts for everyone?
Have you lost loved ones and the holidays serves as a reminder that they’re not present to celebrate with you and the family?
Did you recently go through a divorce or breakup and feel even lonelier now that you have nobody to drag to holiday parties or kiss on New Year’s Eve?
Are you struggling financially and can’t afford much of anything except to spend a quiet, typical night at home?
Are you trying to stay sober and the holidays tend to trigger using again?
Do the holidays cause more anxiety and depression because you’re expected to be happy even though you’re really not?
Do you hate dealing with annoying crowds of shoppers trying to get those last minute gifts?
Do you beat yourself up for waiting until the last minute to buy gifts (and then tell yourself that you’ll get all your Xmas shopping done early next year, yet repeat the same pattern. I’m raising my hand for this one)?
Have you been good about diet and exercise, but worry that Thanksgiving, Christmas/Hannukah/Kwanzaa/”insert celebrated holiday here” and New Year’s will test your discipline and make you gain all the weight you’ve worked so hard to lose?
Would you much rather say “screw it” and purchase an extravagant gift for yourself instead of trying to find the perfect gift for everyone else?

If you answered yes to any of the questions, then you’re definitely not alone. The above questions are just a few of the common issues that I heard from my patients and friends within the last few weeks. I’d say that the majority of my patients and people that I know perceive the holidays as far more stressful than joyful. I recall the holidays being so much fun as a child due to getting time off from school, receiving Christmas presents, building sticky gingerbread houses that were actually made of graham crackers, and going on trips with the family, but the holidays are definitely not as fun when you’re the adult responsible for planning the festivities. If you are one who tends to struggle during the holidays, then the following are a few tips to help you get through the next few weeks until New Year’s Eve is over (then you at least have some time to breathe until Valentine’s Day comes around):

1. Set boundaries, boundaries, boundaries. If you’re a “Yes Man/Woman” (someone who always says “yes” and has a hard time saying “no”), then you not only have to deal with the stress of planning for the holiday, but also the overwhelming pressure to please everyone since you’re the reliable person whom everyone depends on (or the schmuck whom everyone takes advantage of), which leads to internal feelings of guilt, exhaustion, anger, and resentment if you can’t carry out all the duties expected of you, but then blame everyone else for not helping you (you probably also don’t feel comfortable asking for or accepting help, right?).

If you fit some components of the description above, here are a few ideas to try:

Talk to your therapist (and if you don’t have one, you might want to consider getting one because your issues with setting boundaries probably aren’t limited to the holiday season).
Use the Yes/No Method.

2. Don’t overexert yourself if you don’t want to attend so many holiday gatherings. As mentioned in #1, the key is learning to say “no.” Weigh the risk/benefit of attending each event, and attend the ones where the benefit outweighs the risk (ie, attending your boss’ holiday gathering may have more benefit than attending a coworker’s potluck dinner/white elephant gift exchange). And if for some reason you actually have to attend a party that you can’t get out of, then stay for a bit and come up with an exit plan (I used to make up excuses such as “I promised to dog-sit for a friend” or that I’m not feeling well, but now tell the truth because I find that people are generally pretty understanding or can tell when you’re lying).

3. If you know you’re going to eat a feast and have a hard time avoiding all the amazing holiday desserts and egg nog, then plan ahead yet also be realistic. Stressing out about your exercise regimen and what you’re going to eat causes even more stress. Weight gain and disease is not caused by one or a few days of eating unhealthy during the holiday, but rather the trajectory of your lifestyle choices over time. If you eat a lot during Christmas dinner, then utilize those carbs with a good workout the following day, or plan on making healthier food choices thereafter. It’s truly better to move on after a day of indulgence rather than perseverating on the guilt (trust me, it took me over a year of living with my brother, who is a personal trainer/unofficial psychotherapist, for me to get over the guilt of eating unhealthy a few days at a time).

Here’s another article that might be useful for managing your diet/fitness goals during the holidays.

4. Make sure you set up appointments with your therapist or psychiatrist during the holiday for preventative measures. Although many health professionals are away on vacation during the holiday, plan ahead by setting an appointment before your therapist or psychiatrist leaves to make sure you have enough med refills or to check-in for support and maintenance. There should be coverage in case any urgent issues arise while they’re away, so make sure you have the contact information handy. And, of course, if safety becomes a concern, then call 911.

5. If you have a known seasonal component to your mood, put into action what has typically helped your mood to get you through the year (med and non-med approaches). I wrote a previous post on Seasonal Affective Disorder (SAD) and another post on how to cope with Summer seasonal depression, though the general principles apply to Winter seasonal depression as well.

6. Plan on staying sober during the holidays. Similar to #4 above, I always ask my patients if they’ll need a follow-up appointment with me during the holiday season to check-in and provide additional support to maintain sobriety. The holidays can be quite triggering for relapse, especially if everyone around you is inebriated by the plentiful cocktails, champagne, and spiked egg nog. The following resources provide great tips for getting through the holidays sober:

5 Ways to Survive The Holidays Sober
HOME Podcast by Holly (of Hip Sobriety) & Laura (of I Fly At Night): The Holidays

7. Coping with grief. I found this post quite informative for the bereaved during the holiday. One tip that I found most valuable was the importance of surrounding yourself with those who support you the most rather than undergo the exhaustion of trying to suppress your grief and sadness at numerous social gatherings.

8. Treat yo self. Okay, I admit it — the first few items I bought while Christmas shopping were for myself, but I couldn’t help it! It’s far more anxiety-provoking trying to come up with which item to buy for someone else than it is for myself (I mean, at least I know that I’ll appreciate what I bought for myself, whereas I have to risk feeling butthurt (this word is actually in the dictionary) if someone returns an item that I bought for them). To some degree, buying myself a gift is a form of stress relief in addition to a reward for getting through the entire year. And if buying something for yourself is not within budget, then deduct the cost from the gift you planned to buy the person you like the least.

If you have any other tips to cope with the stress of the holiday season, would love to hear from you! And rather than saying the generic “have a happy holiday,” I’ll end this post by saying “Hope your holiday is low-stress and may you enjoy (or tolerate) the season as much as you possibly can.” 🙂

Photo by Marlon Santos

December 11, 2015 9 comments

Personal

Mixed Feelings

written by freudandfashion

{Inland Empire, California}

I contemplated skipping my weekly blogpost today, mostly because I got a headache each time I sat down to type. But then I recalled my previous pattern of taking brief hiatuses from blogging, which eventually turned into a year long hiatus, and were mostly triggered by feeling too overwhelmed or stressed at the time. Not going to repeat that pattern again this time around. Social media has become so perfectly curated, which I believe is necessary to maintain to some degree (not sure anyone wants to see a photo of me taken immediately after I wake up in the morning), however, real life is far from perfect. I know my trigger was the horrific mass shooting in San Bernardino, which is only minutes from where I grew up and nearby Arrowhead Regional Medical Center (the hospital that treated several of the victims), where I completed my medical internship and most of my medical school clerkships. Whereas I’m normally cheerful, goofy and chipper on my Snapchat videos, I wanted to be real and instead talked about my shock and dismay. Oftentimes people are afraid to show their true emotions due to fear of negative perceptions, but I wanted to be truthful about my sadness, anger, and frustration. And as much as I’d like to write something profound about the psychological manifestations of how we might all be feeling, I don’t have much to say other than that I’m still in shock that something so horrifying could happen, let alone reach so close to home. I believe that in the next few days, I’ll be more cognizant of how I plan to respond. But until then, rather than beat myself up about not having a plan of action, I think I’ll allow myself to be human and experience whatever mixed emotions may arise.

Photo by Marlon Santos

December 4, 2015 9 comments

therapy

Express Gratitude Daily

written by freudandfashion

I rarely used to tell people that I appreciated them. I recall rejecting and criticizing kind things done for me, gifts given to me, etc, mostly because I focused more on the superficial/material aspect rather than the thoughtfulness and intent. When people tell me that I possess a “positive energy,” I’m often a bit surprised because I used to exude such negativity. One way that I was able to shift my perspective was by expressing gratitude on a regular basis. Such a feat isn’t as easy as people may believe. Solely telling someone that they “just need to be more positive” doesn’t help much, or at least I find those statements quite annoying because such statements negate the fact that there’s probably an underlying reason for the lack of optimism (ie, low self-esteem, depression, traumatic upbringing, grief, etc). The expression of gratitude takes time and practice, and when you’re not used to sincerely telling people that you’re thankful, then it’s going to feel awkward at first. For example, if a relative buys you a hideous Christmas sweater, focus more on the kind gesture rather than the dissatisfaction of the gift itself. As time goes by, the practice takes less effort and feels more sincere (ie, “Thanks Aunt Sally, the sweater will keep me warm during the winter months”).

If you need even more motivation to be thankful, the expression of gratitude also has many benefits: increased happiness, better physical health (more willingness to seek medical help, more involvement in physical activity), and increased self-esteem, to name a few.

In addition to sincerely saying “thank you,” the following is a list of strategies that may enhance feelings of gratitude (experiment and find out which ones work best for you to carry out on a regular basis):

1. Write a “thank you” note. Some people feel more comfortable with writing than verbalizing. Giving someone a note shows that you took the time and effort to write a few kind words.

2. Keep a gratitude journal. Take some time at the end of your day to recall 1-2 things that you were thankful for, or you can also designate one day per week to reflect on the things you were thankful for from the week. I’m not organized enough to carry a journal (I ended up writing on post-its which would clutter up my nightstand), but think it’s a great way to keep track of things you’re grateful for on a regular basis. My variation of journaling is doing a weekly “Thankful Thursday” post on my Snapchat (my username = freudandfashion if you’re interested in my weekly reminders).

3. Think of what you’re grateful for (as a regular practice, or during prayer if you’re religious). If you’re like me and can’t remember to write in a journal, then practice thinking or saying aloud to yourself what you’re thankful for from the day. Choose the time of day (I prefer bedtime right before sleep) and make it routine.

4. Express gratitude directly in person. This is my preferred route. As a psychiatrist, I strive to make sure I communicate directly because I believe it’s integral in relationships, including the development of good therapeutic connections with my patients. Ways to express gratitude directly includes buying coffee for coworkers (coffee at work always makes me happy!), taking a friend out to lunch, stopping by to visit a friend, etc.

5. Shift your perspective from negative to positive. If you find yourself in an angry mood, try shifting your focus by thinking of something that went well during your day. If you’re stuck in traffic and find yourself getting tense and irritable, try to express gratitude at that very moment. Saying what you’re thankful for can shift your mood as it changes your focus.

A lot of people tend to think that you have to express thanks for only major things such as having a supportive family, an education, a decent job, etc, but you can definitely be thankful for even the smallest thing that went well during your day. I’ve expressed gratitude for things such as hitting all green lights on my commute to work, seeing a cute dog that made me smile, not getting a parking ticket while out in Hollywood, etc. Basically, you can always find something to be thankful for. And with today being Thanksgiving, no better day to start implementing this practice than today!

I wish all of you a happy Thanksgiving! xoxo, Vania

Photo by Marlon Santos

November 26, 2015 19 comments

Featured Guest Blogger

Why A Pre-Med Student With Bipolar Disorder Posted on YouTube Against Medical Advice

written by freudandfashion

{Logan’s transformation leading up to disclosure of his mental illness}

I recall browsing through Logan Noone’s Instagram last year, taking note of his scenic photos of the great outdoors and noticing the huge smile on his face pictured standing on snowy slopes or sitting among friends at sporting events. His profile stated he was a mental health advocate, and other than that, my assumptions of him were based on his seemingly happy and active lifestyle. Fast forward to a few weeks ago when I received a thoughtfully edited email from Logan informing me of his status as a non-traditional pre-medical student in pursuit of a career in medicine, particularly Psychiatry. What stood out and impressed me the most about Logan was his tenacity — little did I know that behind his picturesque Instagram posts was a man who battled and has since gained control of his bipolar disorder. After watching his viral YouTube video about recovering from bipolar disorder, I knew that he’d make a valuable asset to the medical community to advocate for change and reduce stigma, especially since the culture of the medical field tends to discourage such disclosures of having mental illness. Therefore, I’m excited to have Logan contribute to my blog as he discusses his motivation to become a physician and how the school shooting at Sandy Hook influenced his decision to go public with his diagnosis.

__________________________________________

“There is an old story about a blind man heading towards a well, and there’s a guy who’s watching. If the blind man falls into the well, who gets the blame? If you’re watching something you can prevent, you’ve got to do something.”

– Manoj Bhargava

It’s February of 2013, about two months after the devastating shooting at Sandy Hook Elementary School in Newtown, Connecticut. The total fatalities are still hard to swallow: 20 children, 6 staff members, and the mother of the shooter were found dead on December 14, 2012. The entire world was shaken and struggling to find a reason for this senseless tragedy. The storyline seemed all too familiar: a person suffering from mental illness committed horrific gun violence.

Now, let’s rewind the clock about 8 months. I was 22 years old and newly graduated from college. While the rest of my classmates were celebrating after graduating or starting up a new job, I found myself in the emergency psychiatric ward. Two years of severe mood swings, alcohol abuse, insomnia, anxiety, and a breakup culminated in my first manic episode. I found myself overwhelmed with euphoric feelings, rapid speech and grandiose thoughts. This feeling continued to evolve over the course of 5 days with no sleep, paranoia, and auditory hallucinations.

I displayed the basic symptoms of bipolar disorder. Also, considering my family’s history of the disorder, it was pretty easy for my psychiatrist to diagnose me with Bipolar Disorder Type 1. The medical staff outlined how I would have to live my life with the support of medication, therapy, and support systems. However, the medical staff also indicated I needed to be cautious whom I disclose my bipolar disorder to. “People’s opinions could change when they find out you have bipolar disorder. It could hurt your employment, housing, or social life.”

Fast forward back to February 2013. I hardly told anyone about my mental illness, I was insecure and utterly hopeless. Images of the Sandy Hook shooting were everywhere. It seemed like the public stigma towards mental illness literally could not get any more intense.

To understand my struggle, consider that I grew up about 40 minutes north of Sandy Hook elementary. My mom is an elementary art teacher, and my father served on the public school board in our town for nearly a decade. I knew I could never commit a crime like Sandy Hook. But, because of this tragedy and other similar shootings, the public perceived my mental illness as a threat.

People with mental illness can recover, and they are more often victims of violence rather than the perpetrators. If I continued to remain silent about my mental illness, there was no way I could expect the stigma surrounding mental illness to change. I knew that I had to help repaint society’s poorly painted picture of mental illness and lead by example.

Living openly with my mental illness would require bravery, or so I thought. During February of 2013, I finally joined a mental illness speaker’s bureau and shared my Bipolar Disorder Recovery Video online. I quickly realized my expectations for being publicly open about my mental illness were different from reality. Saying that I received an overwhelming amount of positive support would be an understatement. Within two weeks, the video had over 15,000 views. The video was shared by many of my friends, reposted on numerous mental health websites, and featured on Fox News. I connected with old friends and even new people from all over the world.

I was pleasantly surprised by the amount of support I had received from my disclosure. Perhaps people are more accepting of mental illness than I expected. I originally thought being open about my mental illness would require a courageous effort. I was wrong.

Being open about my bipolar disorder is simply a logical and honest choice. 1 in 4 adults suffer from some type of mental illness. It’s only logical that our society start to recognize and accept that we all will be personally impacted by mental illness in our own life or through someone we love. The mere statistics prove that there is an incredible amount of people just like you in the world.

I’d be lying if I said living openly with my mental illness was all “smooth sailing.” Of course, I’ve met people that aren’t supportive of mental illness or its treatment. Numerous times, I’ve had people tell me mental illness isn’t real, or my medication will simply turn me into a zombie. I’ve even been congratulated that I am not violent because of my bipolar disorder. Um, thanks…

But I don’t let these negative incidents regret my decision. When I first encountered these opinions, I was furious and insulted. But now, 3 years after my disclosure, I’ve grown wiser in my demeanor. It would be naïve of me to think that a social change could occur without a few bumps in the road. Now, rather than be upset by ignorance, I get motivated by it, and do my best to change opinions through a healthy and respectful dialogue.

My openness has changed what I want out of my career. I found that simply acknowledging my mental illness allowed others to feel comfortable talking to me about their mental health challenges. There is no better reward than knowing that you helped someone also fight mental health stigma, pursue professional help, or better yet, stop them from hurting themselves.

Shortly after disclosing my mental illness, I decided I wanted to work in the mental health industry in some capacity. I felt I could make the biggest contributions to mental health if I help improve the scientific understanding of our brains and mental illness. Frustrated by my own personal experiences with psychiatrists, I want to be a psychiatrist that could connect with their patients in a more natural manner and help inspire them to tackle stigma head on as well. With that in mind, I am currently preparing to apply to medical school in 2016.

Being open about my mental illness helped me find my own inspiration, passion, and drive. I couldn’t simply be a bystander to a problem I knew I could help fix. That’s my style.

For more info on Logan Noone, check out his YouTube Videos below. You can also find him on Instagram.

Bipolar Disorder Recovery Video: https://www.youtube.com/watch?v=bvdrFowzG94

Sacramento NAMI Walk Speech 2013: https://www.youtube.com/watch?v=KRKQSyPYIEE

November 17, 2015 5 comments

Psychiatry therapy

Tips To Control Your Angry Mood

written by freudandfashion

{Monterey, California}

Up until I graduated medical school, I used to be irritable and impatient on a regular basis. Not many people would think I had anger issues (particularly due to the way my anger manifested, which was mostly unassertive and passive, see below) except for those who received the brunt of it, which is often the case for most people. I also used to feel guilt and shame for having an angry temperament as a child, until I opened up about the issue during individual and group psychotherapy. It was quite therapeutic to hear that several group members (whom I least expected given their present demeanor) reported being angry during childhood as well, and even more helpful to gain the insight needed to identify triggers for my anger, in addition to more productive ways to express and cope with it.

We’ve all experienced anger before, and there’s various ways it can present itself. The spectrum of anger can manifest as brief, subtle annoyance to full-fledged rage. Though anger can be constructive (ie, used as motivation to create change or solve a problem), the more problematic expressions of anger are more outward via yelling, physical aggression (punching and throwing things, etc), or violence. Others may also express anger in an unassertive way (which can also be quite volatile) by isolating, holding it in, and not expressing the anger at all which often leads to more passive-aggressive and pathological forms of coping such as taking it out on others via hurtful comments, putting people down, being vengeful by indirectly trying to get back at people without communicating the reason why, etc.

Developing healthier ways to express anger has many benefits, which include health (anger is known to be associated with increased risk of having a heart attack, hypertension, diabetes, migraines, self-medicating with substances such as alcohol, etc), improved communication in relationships, and a gained sense of control over your emotions. Though the origin and persistence of your anger can be quite complex to fully understand (I tend to formulate my patients’ issues psychoanalytically, which can be theoretically confusing to many (including myself) except Sigmund Freud, who first laid out the theory), the following are some concrete strategies that can help keep your anger in check, which I also teach my patients and use on myself:

1. When your anger gets triggered, slow your response rather than reacting on impulse.

When anger gets triggered, our brain perceives the situation as a threat and automatically reacts by going into fight or flight mode and the response is believed to last less than 2 seconds. Therefore, since we can go into a rage from 0 to 100 instantly, we can take control of our behavioral response by using tactics that allow us to regroup and think through how to respond. Some tactics include the following: take a couple of deep breaths, count to 10, step away and excuse yourself briefly, grab a drink of water, etc.

Another similar example/situation — Have you ever received an email or text message that was so upsetting that you immediately started aggressively typing a hostile reply? I’ve reacted this way many times (and have also typed blogpost drafts out of anger), yet the rule of thumb is do not send content that is typed in a heated, angry state of mind, but rather to wait and respond when you’ve cooled down because you might send something you’ll regret (and an email/text message is a permanent record that you can’t take back).

2. Recognize your initial signs of anger.

I often ask my patients to identify the initial signs they experience when anger gets triggered because being mindful can put a stop to the progression to an outburst or response they might regret. Utilizing Tip #1 above is even more useful if we can quickly recognize our body’s initial response to anger.

To give an example, the following is my usual pattern of response that occurs when my anger gets triggered: eyes get wide, chest tightens, heart races, facial muscles tense, fists tighten.

I’ve practiced this technique numerous times and have become far more mindful and self-aware in the last few years (therapy and yoga helped) to the extent that once I notice my chest tighten and heart race, I quickly take deep breaths to calm down. So next time you get angered, pay attention to how your body responds.

3. Once you’re in a calm state of mind, express your anger.

When people hold in and suppress their anger, it often becomes internalized (and may experience depression by directing the anger inward) or builds up to the point that it leads to an eventual huge, uncontrollable outburst. I used to cope this way with anger as well where I’d yell and scream hurtful things and bring up anything and everything that upset me in the last few months. Once you’ve calmed down in the moment, try to assert and state your concerns in a clear, direct way rather than waiting until you’ve reached your boiling point.

I admit that I used to also react by either saying nothing or passively turning to someone next to me and saying mean, hurtful things that were loud enough for the person who upset me to hear (yes, I know this response is sooo high school circa Rachel McAdams in Mean Girls), so I felt awkward at first when practicing to be more direct at communicating my anger. However, just like with anything in life, you have to keep practicing and eventually you’ll learn to successfully express yourself and get your point across in order to feel understood and heard.

4. Identify the underlying cause of your anger in the moment, and if the issue is minutiae, let it go.

Numerous things can trigger anger (a negative comment, criticism, lack of sleep, not getting your coffee fix, drugs, depression, medications, anxiety, stress, grief, kids not doing their chores, your sports team losing, bad luck with fantasy football picks, a friend wearing the same outfit as you, a pimple, tardiness, misinterpretation of a text message, someone lying to you, PMS, delayed flight, someone cut you off on the freeway, etc, etc — I think you get the point). If the trigger is something small and trivial (ie, getting cut off in traffic), recognize that reacting in anger won’t solve the issue (that’s right — stepping on the gas and tail-gaiting the SOB will not make the situation any better…I only know this through experience) and expends so much energy that can be more productively utilized elsewhere. However, if the underlying cause might be a major issue you’ve struggled with throughout your life (for example, having social phobia and being extremely sensitive to judgment and criticism) then please refer to #6 below.

5. Diffuse your anger by getting some exercise or channeling that energy into a workout.

This point is pretty straightforward — anger triggers increased stress and exercise is always a good way to lower stress and expel the anger from your system.

6. Seek professional help.

If your anger is causing substantial impairment in your life (work, relationships, etc), then don’t be afraid to seek help from a professional (psychotherapist, your regular medical doctor, psychiatrist, anger management, etc). I mention numerous times in my blog how much psychotherapy has helped me personally and those I’m closest to can vouch for the noticeable improvement in the way I manage stress and anger.

November 13, 2015 13 comments

Featured Guest Blogger

How a Nurse Practitioner Living With Bipolar Disorder Takes Control In the Workplace

written by freudandfashion

I first came across Ann Roselle, an acute care nurse practitioner, via Twitter after reading the extremely personal and brave post that she wrote for the online magazine, Ravishly, which poignantly highlights the humiliation she experienced during one of her numerous psychiatric hospitalizations. Given the stigma that surrounds mental illness, many may feel ashamed to disclose their diagnoses (especially as a professional in the medical field). However, Ann writes so openly about living with postpartum onset bipolar disorder as a guest contributor on several websites and in her blog, Bipolar&Me. She dispels the misconception that people diagnosed with bipolar disorder can’t live fulfilling lives, have a successful career, balance numerous roles and responsibilities (wife, mom of 3 boys, mental health advocate, blogger, to name a few), AND cope with the fluctuations in mood characteristic of bipolar disorder. I am a huge fan of Ann’s writing and am honored to have her contribute to my blog as she discusses her commitment to maintaining stability in her personal and professional life.

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“It’s stylish to talk about mental health, especially how we maintain our own.” As a nurse practitioner who lives with a serious mental illness, bipolar I disorder to be exact, how could I not fall in love with a blog with a psychiatrist who talks so frankly about mental health and her practice?

I am a surgical nurse practitioner, specializing in cardiac surgery. I am fortunate enough to be able to be open about my disorder in the workplace. I had fears initially about being open, however with time I believe it has proven to be a positive experience. In my case, living with bipolar disorder never proved troublesome with my training as I was diagnosed after I had been in active practice for six years. So, the questions that beg to be asked are — How does my illness impact my patients or influence my interactions with them? And how do I maintain stability with full-time employment in a stressful environment?

First, it starts with the moment you accept that you have an illness. That you have an illness you are going to need to learn to manage as one manages any chronic illness. And, I won’t lie — accepting the diagnosis is hard. I didn’t want to accept my diagnosis for a long time. I cried and mourned the vision of the life that I thought I was going to have, that I was supposed to have, thinking everything changed in the moment I received my diagnosis. It took a long time for me to realize nothing had actually changed and that the life I wanted and envisioned was still there waiting for me to seize it.

Part of my seizing the day, so to speak, was to commit myself to doing what I needed to do and stop fighting with my treatment team. Stop fighting the need for medication. To stop being the non-compliant patient I would roll my very eyes about as a practitioner. I showed up for appointments, attended groups faithfully in the early days, and took my medications. I played with my diet trying to find a proper nutritional balance. I quit drinking on a regular basis. I became fanatical about ensuring proper sleep hygiene and getting rest. I fully admit that I am not great about the exercise piece as my work hours limit my ability to get to a gym on workdays and I am so busy with my family on days off. I’ll get there, though. Exercise helps mood and I feel infinitely better on the days I’m physically active.

Now, what about nursing practice you ask? What about those patients? Ultimately, if you are in treatment (on meds, working with a therapist, a prescriber, or even have a support group to fall back on) and stable, the disorder has no bearing on your practice. None. I hold the view my bipolar disorder is a chronic manageable condition no different than diabetes or hypertension. I learned (and am still learning) to manage my moods in the same vein that a diabetic learns to count carbohydrates and manage their blood sugar.

Emotionally, I have always had the ability to hold myself together for the hours I am at work and dealing with patients. My patients will never know I carry this diagnosis. I may fall apart once I get home and feel safe to do so, but never within the walls of my employment. I also make it a rule that no matter what happens, no matter the co-morbid psychiatric diagnosis my cardiac patients may carry, I never reveal myself to them. They come for cardiac care and not to hear my story. I do find I have become more empathetic to those who carry psychiatric diagnoses. I discourage staff from saying inappropriate and stigmatizing things both in and out of earshot of patients. There is a huge difference in a patient who is emotionally labile because of a mood disorder and a patient who is emotionally labile trying to cope with their physical illness. I view it as my responsibility to help staff understand such a critical difference. Emotional lability in and of itself does not a bipolar make. I make sure my patients’ home medication regimens are adhered to as closely as possible. And when a patient is acutely decompensating in terms of their mood or mental status, I make sure that medically we have dotted our I’s and crossed our T’s before calling the psychiatry consult service.

I’m not perfect. I have days I need to take a time out and walk away. This is beyond the usual code blue that may have been upsetting for staff or seeing a patient I really cared about suffer from a devastating complication. I have colleagues who respect that need and allow me the moments I need to compose myself and come back calm and ready to do my job.

I am fortunate to do what I do. And I am fortunate to be able to practice with both the patient and provider perspective.

While I am only human, at the end of the day, I think all those I encounter are better for it.

For more of Ann Roselle’s writings, check out her blog, Bipolar&Me. You can also find her on Twitter and Facebook.

October 27, 2015 7 comments

Medicine Psychiatry

Reach Out And Connect With Someone

written by freudandfashion

{Rancho Cucamonga, California}

I’m approaching a new phase in my life by moving on to a new practice, which will be my second job out of residency. As excited and hurried as I was to leave my first job and move on to the next, with this being the last week in clinic, I’d have to say that I’m quite sad. I’ve had several friends tell me that they don’t get along with their coworkers, that they haven’t developed friendships with anyone on staff, that they mostly are “in and out” of clinic to see their patients and get all the documentation done while minimally interacting with their peers. How fortunate am I to have developed a sense of family and strong teamwork with those whom I work with?

I hear that one of the drawbacks of going into private practice is a sense of isolation not having a team of professionals to bounce ideas off of or interact with on a daily basis. However, I do know that the practice I’m joining will provide valuable experience learning what it’s like to practice psychiatry in a different clinical setting. And even cooler is that the actions and morale of the group I’m joining have given me enough confirmation to prove that I’ve made the best choice for myself and my career.

If you notice a theme in several of my posts, it’s the concept of “family” and teamwork. I have several patients whose stress levels and depression gets triggered or exacerbated by a sense of loneliness and isolation due to lacking the friendship, camaraderie, sense of belonging, and the support we as humans need. Numerous studies have found that social relationships provide emotional support and contribute to stress relief and better quality of life. The following are some examples of how social support enhances mental and physical health:

Addiction
- Recovery from substance use often leads to the dissolution of former friendships that were associated with an individual’s propensity to use drugs or alcohol. Therefore, recovery-oriented support (such as 12-step programs) are critical early in treatment as someone begins to build and develop a healthier network of support. Higher levels of social support are linked to decrease in substance use whereas lower levels of social support prospectively predicted relapse.

Post Traumatic Stress Disorder (PTSD)
- for childhood sexual abuse survivors, a combination of self-esteem and appraisal support (an individual’s perception of being valued by others and that he or she is capable of getting advice when coping with difficulties) was useful in preventing the development of adult PTSD.
Cancer
- Supportive group intervention for women with metastatic breast cancer has been associated with lower mood disturbances and less maladaptive ways of coping with terminal illness.
Work Stress
- Social support at work has been shown to have direct benefit on workers’ psychological well-being and productivity.

THOUGHT OF THE DAY: Identifying and building your own support network can take quite some time and effort, but the enhancement on your quality of life will make it well worth it. Which supports do you identify as being most integral in your day to day life?

October 22, 2015 21 comments

Featured Guest Blogger

Why A Social Worker Turned His Passion for Bicycling Into a Mission

written by freudandfashion

One of the best things about blogging is the opportunity to meet like-minded, motivated people in the mental health field who are passionate about making a greater impact in the community. When I first came across Bike and Brain on Facebook, I was impressed by Matt Ryan, LMSW (the founder of Bike and Brain) and his selfless goal to successfully blend his career as a social worker and love for bicycling into a mission that promotes bike riding’s benefits on mental health. What started as a blog one year ago has evolved into an active operation that organizes group rides, provides free bicycles to New York City residents, and is expanding its efforts by becoming a nonprofit organization (continue reading to learn how you can support his cause and enter to receive a free bicycle below). Therefore, I am excited to feature Matt as my first guest blogger as he discusses bicycling and its positive impact on mental health.

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Life can quickly become chaotic. We deal with stress from work, relationships, children, and health, to name a few. Too much stress can cause us to feel out-of-control, which can be extremely uncomfortable. In fact, excess stress can be detrimental. As life stressors build, we may experience anxiety and even depression. We may feel like giving up when life appears too much to handle. We may begin to neglect our priorities. Unfortunately, giving in to this feeling only exacerbates the situation. So how do we regain our sense of control?

Whether you’re in control of your own company or the TV clicker, control can be a great feeling. People exert a great deal of effort in life to gain control. You can certainly argue that having too much control may be problematic, but possessing a certain level of control is crucial in order to lead a fulfilling life. It’s important to be in control of your emotions, diet, exercise regimen, sleep patterns, relationships, etc. Furthermore, it’s key to be aware of your role in all of these facets of life. There are obviously things that we can’t control such as when we are mistreated by a friend, loved one, or a rowdy neighbor who keeps us up all night. However, we can control how we respond or how we choose to handle these situations. Learning to control yourself within the important facets of your life can help build confidence, which in turn can make life more enjoyable.

I am a social worker in NYC and it’s safe to say things can feel pretty out-of-control. One of the things I do to stay grounded, motivated, and focused is ride my bicycle. I ride daily and can truly say it plays a crucial role in my life. Bicycling gives me a feeling of control and confidence that transcends into the other compartments of my life. You may be asking how this could be possible — how can riding your bike help any other area of your life?

First off, riding the bicycle provides me with a tangible feeling of control. I determine how fast the bike travels, where it goes, what gear it’s in, and when it stops. The ability to manipulate the bicycle is a reminder that I do have the ability to control things. Merely having the knowledge that I can be in control is beneficial to my daily life. If all else fails, I can utilize my experiences on the bike as a reference point.

Second, riding the bike forces me to direct all of my attention on one thing, which is the road. I am in the moment while on the bike. There is no time to dwell on the stresses of life since distractions could potentially cause an accident. All five of my senses are engaged and my mind is focused. I can feel the wind in my face, the pedals on my feet, and the bars in my hands. Being completely focused on the moment is an extremely powerful tool also known as mindfulness. Essentially, I am putting aside my stress for the duration of the bike ride. This does not eliminate the stresses I may be experiencing. Rather, it is creating free space in my mind so that I may deal with the stress in a more constructive way once I am off the bike.

Finally, cycling makes me happy. Not only does the physical activity release endorphins, but it is the one hobby that provides me complete joy. When everything else may feel out of control, I know that I can hop on my bike to re-charge. In essence, my bicycle acts as my safety net. Cycling will always reinstate a level of confidence and control that is needed to regain my motivation.

And for the record……

I am in the process of creating a nonprofit organization in NYC. We work to provide functional bicycles to people who may not have any other means to obtain one. We believe that there is no reason why we can’t provide people with a FREE bicycle in a city as wealthy as NYC. We have donated a handful of bicycles to date. Each donation has an amazing story attached (Check them out here!).

We will also be giving away a free bicycle (pictured below) on Thanksgiving. Anyone can win this and we will ship it anywhere in the USA. Completely free. All you have to do is like our page on Facebook to enter.

For more information on Bike and Brain, check out their website here.

Photos courtesy of Matt Ryan

October 13, 2015 7 comments

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