Tag:

psychology

Set Free

{International Rose Test Garden, Portland, Oregon}

Okay, I’ll be honest. I’d much rather watch a documentary on Netflix (anyone have any suggestions?) and let my mind wander than write a blog post right now. Escaping to Oregon earlier this week for the first leg of my vacation provided a perfect combo of nostalgia, tranquility, and connection. Rather than psychoanalyze and process the impact that my trip had on my psyche (as I usually do in my posts), I’m instead going to reminisce and share pictures from my trip, which hopefully captures the essence of my time spent there. I still have one more week of vacation left, so if my writing doesn’t have as much structure and depth as usual, that’s because my writing is characteristic and reflective of my current, free-flowing state of mind.

{Washington Park, Portland, Oregon}

{Portland Japanese Garden}

{Yachats, Oregon}

{Devil’s Churn, Oregon}

July 18, 2015 15 comments

Personal Psychiatry

Open Doors

written by freudandfashion

Up until a few years ago when I graduated from residency, life appeared to have a linear, predictable path: obtain high school diploma, finish undergraduate degree, get accepted into medical school, graduate from residency, secure a well-paid job as a psychiatrist.

Yet, throughout the entire process, I encountered several challenging experiences trying to adjust to each new phase. When I moved away from home for college, I was so excited to live with four girlfriends and finally feel independent enough to lead an exciting college life. However, I can vividly recall the day my parents helped me move and when they left, I cried. For several days, all I wanted to do was isolate in my room. Eventually, I became more comfortable with my living situation and newfound independence, but my initial desire was to flee back home as often as possible.

For medical school, I was fortunate to get accepted into a school within 30 minutes from my hometown, so I was familiar with the area and lived with family that first year while adjusting to the grueling academic demands. It was so nice to come home to a hearty meal prepared by my grandmother or aunt after a full day of lectures, anatomy lab, and studying.

However, when I moved away to Oregon for residency (a state I never even visited let alone knew anybody who lived there), I felt extremely lonely and isolated. At some point, my program director suggested that I see a psychiatrist because I wasn’t performing very well on tests. I felt like a failure. Yet, finally realizing that I needed help was when I started to evaluate myself in order to create change. It’s the time that blogging became an outlet for social support and connection that I felt was missing at that point in time. It was the period of my life when I became more self-aware, made long-lasting friendships, discovered my leadership ability, and became chief resident. Such a pivotal point in my life motivated me to evaluate myself and discover my resiliency based on how I overcame my struggles.

When I rotated at the student psychological center at the local university, I saw several patients who struggled with transitioning to college life. I completely identified with them. I currently have several patients going through major changes (divorce, moving away for school, starting a new job, recently losing their job, getting married, expecting their first child, etc). I emphatically listen and validate their experiences — going through life change WILL challenge your usual ways of coping (ie, one may cope by isolating, keeping thoughts to themselves, working out at the gym more, confiding in a friend, etc). And sometimes, depending on the stressor, the usual copings skills may not be enough to overcome the challenge.

And here lies the dilemma — Even the most linear path in life has its challenges. Do you face the challenge head on, or do you recognize your limitations and choose a different path, or do you justify ways to avoid the situation altogether?

Photo by Marlon Santos

July 15, 2015 11 comments

Personal

Thankful Thursdays

written by freudandfashion

{Los Angeles, California}

I haven’t done a Thankful Thursday post on my blog in awhile (though I do a weekly “Thankful Thursdays” series on my Snapchat account), but figured I’d do one this week especially since my two week vacation is coming up the following week, which I’m long overdue and looking forward to. As I mentioned in one of my previous posts, I have been experiencing burnout from work, which has led to general feelings of detachment, mood changes, and decreased ability to efficiently maintain my responsibilities at work. Though my vacation isn’t until next week, I’ve been trying to relax and enjoy myself this week, which was accomplished by taking a spontaneous trip through Los Angeles, including the amazing Getty Museum. I am thankful not only for the break I’ll get, but for the fact that I recognized my need for self-care not only for the sake of myself, but also so that I can better support, care for, and be present for my patients.

Though of the Day: What are you thankful for from this week??

For background information of the reasoning behind my Thankful Thursdays posts, check out my 1st post of the series here! (And subsequent posts here and here).

{Santa Monica sunset}

July 9, 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

Personal

Reset, Recharge

written by freudandfashion

{Miami Beach, Florida}

I talk A LOT about mental health (in case you haven’t noticed), so I’ve appreciated the opportunity to put psychiatry-related thoughts aside for the last week while on vacation. And I haven’t psychoanalyzed one thing while in Florida, which is a record for me! I recognize how burned out I was getting, especially since I slept a whole lot during my first few days of vacation. In the past, I probably would’ve felt guilty about saying I was tired of talking about mental health, but sometimes taking a break from your interests and passions makes you appreciate them even more. I intend on using my final days of vacation to soak up more sun, take a boat ride along the bay, shop, enjoy delicious Cuban dishes, and anticipate feeling fully recharged by the time I return to work next week. Hope you have a relaxing weekend!

Beautiful lanterns at the Shore Club

June 6, 2015 10 comments

Personal Psychiatry

Being Me

written by freudandfashion

{Chino, California}

My group therapy session last week left me feeling rejected, embarrassed, sad, self-conscious, and angry (all in that order). Somehow, I became the focus during group and the subject matter stirred up emotions of being an outcast preteen, which I thought I’d outgrown. I didn’t have very many friends in elementary school. Kids often made fun of me and singled me out for various reasons (one was related to race since there weren’t very many Asians at my school at the time). I clearly still remember the boy who called me names as I was shooting hoops by myself on the playground as he repeatedly told me to go back home to China (I am Filipino). Apparently, as I experienced during group therapy, the memory still effects me with just as much emotion today as it did when I was a kid, which sounds ridiculous especially since I’m a grown adult who has accomplished so much in my life. Yet, I’m sure we all have memories as a child that we either vividly recollect, suppress, or completely block out of our minds due to the pain they once caused. As much as I hated having these feelings come to the surface, I trusted in the therapeutic process and knew that re-experiencing the emotions would lead to greater insight.

Now that one week has passed, I felt different going back into my group therapy session this weekend. I was able to consciously separate the feelings I had as a kid from the grown adult I am today. During group, I shared the wave of my emotions I had experienced in the interim, as well as how my cultural background and traditional upbringing impacts my communication with others (ie, in Filipino culture, assertiveness is often viewed as being arrogant and disrespectful, whereas in American culture, assertiveness is often expected and rewarded). The outcome was a sense of validation from my group cohort, for they wanted to understand the reasons why it’s so hard for me to talk and express my opinion during group. Sure, I had to feel like crap and relive components of the hurtful experience, but the outcome is that I’m able to distinguish how those deeply ingrained feelings continue to impact my interactions with others today (ie, fear of feeling misunderstood, withholding my opinion due to fear of being judged, feeling prone to scrutiny, etc). There’s something therapeutic about being consciously aware of the origins of your emotions, whereas prior to this exchange, I felt out of control of the emotions as they were triggered. I realize that I’m not the self-conscious, shy kid I used to be. During my latest group therapy session, I recognized my ability to let down the walls that I had built to protect myself from criticism/judgment. The ultimate outcome = feeling more open to being myself.

As a result of this experience, I have even greater respect for those in therapy. It’s not easy processing painful emotions and many have experienced far more difficult and traumatic events in their lives compared to me. For anyone who believes that therapy is designed to make you feel good after each and every session, you’re wrong. Therapy takes far more work and courage than anyone can even imagine.

Photo by Marlon Santos

May 26, 2015 12 comments

Personal Psychiatry

A Cluttered Mind

written by freudandfashion

Current state of mind = disorganized.

My typical morning routine before heading to work looks pretty turbulent and disjointed. I usually hit the snooze button several times, check my email and various social media accounts in bed with my eyes half open (and probably “like” the most random, obscene pictures on Instagram and Facebook while in a somnolent state), slowly get up to conduct my basic hygiene rituals, throw numerous pieces of clothing on my bed while selecting an outfit based on my mood, then run downstairs to grab all of my belongings (purse, food, coffee), then proceed to get into my car when I suddenly realize that I forgot something, rush back inside to recover the forgotten item, then speed off in my car and head to work. Monday-Friday = same routine. I used to get jealous of my friends who’d wake up early enough to sip their morning coffee, read the paper or watch the news and get ready for work at a leisurely pace. I wish my routine could be more linear. However, my routine has existed for years and works for me. No harm is caused, other than leaving a mess that looks as if a tornado ripped through my bedroom.

I contemplated writing a post that provides tips on how to be more organized, but refrained since there’s plenty of articles and books on the subject. Plus, I’d be the last person anyone would listen to on the topic of organization. I’ve had family members, friends, exes, teachers, tutors, medical directors, etc, try and teach me strategies to better organize my life. And did I listen? Sometimes, but mostly no. I experimented with various methods and eventually cultivated my own process that works best for me. Therefore, I will at least list my tactics since sometimes it’s helpful to know what works for others:

Start the morning with a to-do list: if you’re one who can keep your to-do list straight in your mind, then more power to you. I, however, have to jot down my list otherwise nothing gets done.
Keep only one planner/organizer: at one point, I was writing things in my planner, penciling appointments into a separate calendar, entering activities into my google calendar, sticking post-its in random places = STRESS trying to keep track of everything. I’m old-school and like writing things down, so I keep one planner and make sure I list all my notes, to-do list, appointments, etc, in my planner so that I know exactly where to look.
Recognize patterns in your disorganization:
- Prioritize sleep — productivity, cognition, concentration, and overall ability to function, are directly correlated with sleep. I am most disorganized if I don’t sleep well the night before. Once I was able to identify this pattern, I learned not to be so hard on myself on those days and made sure to prioritize getting a good night’s rest on subsequent days.
- Maintain your routine as much as possible — when my weekly routine changes (for example, due to travel, etc), I have a much harder time getting re-situated upon my return. However, recognizing this pattern reminds me that I need to either be more proactive or go easier on myself if my house or office looks even more disastrous than usual (yes, I’m one of those people who takes several days to unpack my suitcases).

Though I’m currently a bit more disorganized than usual, I know that I’ll eventually get back on track. Today, I wrote my to-do list and proudly checked off half of the items listed. Over the years, I’ve learned not to beat myself up if I wasn’t able to complete everything on my list. Tomorrow is a new day and it’s not the end of the world if I have a few extra items listed and has a negligible impact in the grand scheme of things.

Therefore, my main advice is to discover what works for you. The most validating statement ever made to me about my perceived disorganization was when my mentor told me that it’s okay to find comfort in chaos. While some people prefer neat, tidy, and systematic, others may function better in a less controlled environment. Just because my routine isn’t the same as my friends’ doesn’t mean that I’m abnormal.

Thought of the Day: Which techniques help you most with organization?

Photo by Marlon Santos

May 21, 2015 12 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 therapy

Choose Your Therapist

written by freudandfashion

The one thing that has made me the most self-aware, insightful, and empathetic towards others, especially my patients? Psychotherapy. Everyone can benefit from going to therapy. I probably refer 80% of my patients to a psychotherapist, especially since I believe that the best treatment plans consist of more than just medications (or may benefit from therapy alone, depending on the case). When choosing a therapist for myself, I was fortunate to have a trustworthy former supervisor refer me to two great therapists since I first started therapy during residency, though I realize that most people don’t have the luxury of having a go-to person to help them navigate their local mental health resources. I pride myself and put effort into referring my patients to therapists whom I believe will be a good fit. If you’re wondering whether or not you’re ready for therapy, I wrote a previous post that addresses that question here.

The following are some guidelines/tips that I use when choosing a therapist for my patients or suggestions I would give friends/relatives if they were looking for one themselves:

Keep in mind that the most crucial factor for effective therapy is the connection you have with your therapist. The connection is important for feeling safe, developing trust, and creating a mutual understanding of your goals in therapy. Even if the therapist listed trained at the most elite programs or was Dr. Phil himself, if the connection doesn’t develop over time, then it’s best to move on to a different therapist.
If you see a psychiatrist and feel that he/she knows you pretty well…Ask them for a therapist referral based on your history and goals in treatment. Note: if your psychiatrist does NOT know you very well and solely focuses on medications and symptoms, then see bullet points below. I work part-time for a Health Maintenance Organization (HMO) where we have designated therapists/case managers (who may or may not know the patient/client) make the referral, yet I’ve made efforts to connect with the contracted therapists so that I have a sense of their therapeutic style to gauge which therapists would work best with my patients.
If you have a friend or family member currently in therapy…Ask if they’d be open to inquiring with their therapist to provide any recommendations for you (Note: make sure your friend/relative actually likes their therapist and trusts their recommendation).
Nuts & Bolts:
- if it’s important to see a therapist who accepts your insurance:
  - take a look at the in-network provider list, or search online directories such as Psychology Today (there’s a section under the profile of accepted insurance plans) and research information on the therapists online. I recently gave a close friend the gift of psychotherapy sessions as a birthday present (yes, I try to be both creative & meaningful with my gift-giving ideas) and since I didn’t live in the area, I resorted to an online therapist search.
- Whether or not you need to see an in-network provider, when narrowing down your list, consider the following:
  - Gender preference
  - Photograph – this is not intended to be superficial. Since having a connection is important, you’d likely want your therapist to appear like someone you can feel comfortable sitting across from and opening up to.
  - Location – if transportation is a crucial component, then limit your search to local therapists. I personally drive one hour to see my therapist in Los Angeles, but I’m okay with the distance because I’m willing to drive further in order to see my therapist, who came highly recommended, versus seeing someone questionable, yet closer.
  - Cost – if on a budget, there are several therapists who offer discounted fees on a sliding scale dependent on your income. If you’re a student, be sure to look into your school’s counseling and psychological services (usually covered if you pay for student health benefits). If you work for a large employer, they may have Employee Assistance Programs (EAPs) that provide confidential counseling services for their employees. However, if choosing to pursue out-of-network providers, mental health professionals in private practice may charge anywhere from $50 to over $200 a session depending on location, credentials, and experience, though cost can be greater in larger, metropolitan areas (for example, in Los Angeles, a psychiatrist who provides both medication management and psychotherapy may charge around $400/hour).
When in doubt, try it out. Yes, I’ll admit that some of my referrals haven’t worked out, but for the most part, the initial experience may solidify even more which qualities you prefer in a therapist. I’ve even had a few patients request to see a a different psychiatrist other than me for specific reasons (usually because I look too young) and that’s okay because this is your treatment and we each have our preferences. When you meet for the first time, take note of how you feel while interacting with the therapist (do you feel invited to share, does the therapist have a genuine interest in understanding you, does the therapist seem invested in working with you to help determine the issues impacting you the most?). Keep in mind that just like any relationship, building the therapeutic relationship may take some time, but as long as there’s forward movement in the process, then I hope you commit and stick with it!

Any other comments or suggestions?? If any of you are in therapy, I would love to hear of tips/information you found helpful when choosing a therapist, or, if you’re a mental health professional, I truly welcome your thoughts on how to choose a therapist as well!

April 22, 2015 13 comments

Personal

Lessons of the Week

written by freudandfashion

{Playa Del Rey, California}

If you read my last post, you’ll know that my mood has been a bit off this week. Yet, now that it’s Friday, I can reflect on the positive lessons I learned from the experience.

1. Be cautious of making any crucial decisions when you’re feeling emotionally off. Let’s just say that losing control of my emotions led to an impulsive desire to regain control, which manifested as having the urge to make irrational decisions (regarding my job, therapy, and relationships). Fortunately, I gained enough insight and control of my emotions in time before committing to anything!

2. No matter how stressed, angry, or upset you may be, if possible try your best to remain present for others. I felt exhausted during clinic yesterday. Then, one of the last patients on my schedule tells me that I’m the only doctor she has who listens and doesn’t make her feel as if she’s being judged. I was touched by her comment (and I also thought, “wait shouldn’t every doctor be that way?”). I don’t suppress my feelings of lethargy (in fact, if my patients ask, I’ll be honest and tell them if I’m feeling a bit more tired), but I make sure that my energy levels and mood don’t interfere with the connection I have with my patients. If it does interfere with my interactions, then it’s a sign that I’m in need of a vacation!

3. Grief is tough and very confusing. Period. If support is available, please utilize them. It took me awhile to reach out, but I’m glad I did. And I appreciate all of you for reading, commenting, and helping me realize that I’m not alone.

April 17, 2015 6 comments

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