Eating Disorder Recovery: 3 Tips to Navigate the Summer Months
Written by: Laura Lahay, MA
I absolutely love the summer months. I love the great amounts of sunshine, the blooming of plants and trees, getting to do fun activities like swimming, boating, fishing, roller-blading, etc., and having extra time to spend with friends and family. A favorite memory I have of the summer months as a child was getting to swim pretty much every day (sometimes multiple times a day) in our backyard pool. I anticipate and look forward to these months as they approach, but I know for others, especially those who are recovering from eating disorders, the summer months can create discomfort, bring up immense insecurities, and feel overwhelming to navigate.
It is common for a majority of people to become more aware of their bodies during the summer months. With summer clothing covering less of the body, having a less structured schedule with more time to think about one’s body, more social events or obligations to compare one’s self to others, and more time to be on social media platforms, it can be hard not to give more attention to one’s body and physical appearance during the summer. It is particularly difficult for those who are in the recovery process from an eating disorder, as each of the above factors and more can be triggering and difficult to avoid.
It is brave to engage in the recovery process at any time of the year, but especially during the summer months, as they can be the most challenging to navigate. So if you are currently on a recovery journey from an eating disorder, know that you are brave and seen during this time.
I wanted to share three tips that might help give support to anyone who is choosing recovery during the summer months or knows of someone who is struggling and could benefit from this information.
Tip #1: Identify Trigger Places, Events, and Habits and Talk About How to Navigate Them
Triggers are sensory reminders that can cause certain symptoms to resurface. Triggers can be anything from the smell of a certain kind of perfume to a loud, abrupt voice to seeing pictures on billboards of people in bathing suits. I would encourage someone who is recovering from an eating disorder during the summer months to be mindful of their specific triggers during this season. These triggers might look similar or different to other people who are in recovery, and that is ok. The key is to determine what one’s specific triggers are and then talk about how to navigate them throughout the summer months. If a person’s trigger is seeing lots of pictures of people in bathing suits, a way to navigate that trigger could be to limit their social media time during the summer months. If a person’s trigger is excessive amounts of free time during the summer, a way to navigate that trigger could be to make a daily schedule for themselves to follow to create a routine. These ways of coping do not have to become the norm for a person; they can be used as a helpful tool temporarily to further protect one’s mental and emotional health during the summer as the person is continuing to recover.
Tip #2: Focus on Doing Activities That Have Nothing to Do With Changing The Body
The summer months are a time when a majority of people talk about “getting into shape.” This can mean spending more time at the gym, doing excessive outdoor exercise, or attempting to eat a healthier diet. These goals are by no means a bad thing for certain people. For those who are in recovery from an eating disorder though, they can be triggers and make the person feel pressure to engage in further unhealthy patterns or behaviors for them in the midst of recovery. In order to continue to protect one’s mental health, I encourage my clients who are in recovery from an eating disorder during the summer to intentionally find activities they can do that have nothing to do with changing their body. This can be things like gardening, reading a favorite book, going mini-golfing with friends, backyard stargazing, creating DIY projects, visiting the local library, volunteering, doing puzzles, or having a water balloon fight with friends. There are so many fun activities one can do to create memories this summer that have nothing to do with changing the body. I would encourage a person in recovery from an eating disorder to make a list of these activities and begin checking them off.
Tip #3: Create a Summer Affirmations List
Self-talk is the dialogue a person has with themselves about themselves. The way a person talks to themselves affects one's self-esteem and self-perception. If a person is consistently engaging in negative self-talk, this can create a negative self-image and affect one’s mood and functioning. It is common for those who are in recovery from eating disorders to be working on challenging and reframing their negative self-talk to create further acceptance of themselves. Fostering healthy self-talk during the summer months can be difficult for lots of people, but can be especially difficult for those in recovery from an eating disorder. A helpful way that I encourage my clients to engage in healthy self-talk is to create a “Summer Affirmations List.” This is a list of affirming statements about themselves and their body image that they can look at when needing to challenge some of their negative self-talk. Some affirmations clients will write include: “I am more than my body”; “I love and accept my body just as it is today”; “I take care of my body and my body takes care of me”; “It is ok to love myself now as I continue to grow and change.” I encourage my clients to place this affirmation list in a place where they will easily see it such as their bathroom mirror or their bedroom wall, or I encourage them to make it their screen saver on their phone during the summer. It is important to find ways to remind oneself of healthy self-talk during the summer months when in recovery.
The summer months can be challenging, especially in recovery from an eating disorder, but they are possible to navigate. For those who are in recovery during these summer months, know that you are doing hard work that does not go unnoticed. Keep prioritizing your healing journey and remember to have some fun in the sun.
To make an appointment with Laura, please visit: Contact
Behavioral Activation for Depression: What, Why, and How
Written by Kat Harris, PhD, LCP
Behavioral activation is an important component of Cognitive Behavioral Therapy (CBT). Cognitive Behavioral Therapy includes many components and is based on the principle that thoughts/beliefs (Cognitions), emotions, physical symptoms, and behaviors are all intricately related. Helping someone feel better using CBT would typically involve changing unhelpful thoughts/beliefs (Cognitions), emotions, and behaviors via a variety of tools such as cognitive restructuring, emotion regulation and distress tolerance skills, mindfulness, behavioral activation, coping skill development, interpersonal effectiveness skill refinement, trauma processing, etc. CBT is considered a Evidence-Based Practice (EBP)/an Empirically Supported Treatment and is the gold-standard treatment approach across many client concerns.
Specifically, changing behaviors is one of the core goals in CBT, as it is thought that behavioral change allows for healthy corrective experiences that can alter unhealthy beliefs about the self, world (including others), and one’s future. Avoidance and withdrawal, some of the key features of depression and other disorders, inhibits an individual's opportunity and ability to obtain corrective experiences and positive reinforcement from their environment. Therefore, behavioral activation treatment involves encouraging “activation” and participation in “anti-depressant” activities…interaction with one’s environment in a way that offers opportunities for positive reinforcement and increases in self-efficacy (a person’s belief in their ability to exert control over their lives and their world).
To learn more about depression, see our Depression Specialty Page.
Thinking Errors in Health Anxiety
Written By Dr. Kat Harris, PhD, LCP
Thinking errors, also known as cognitive distortions, are basically thinking patterns that can be problematic in that they are often inaccurate, unhelpful, and can be harmful to someone’s mental health. Individuals with Health Illness Anxiety Disorder (formerly known as Hypochondriasis) tend to engage in specific types of thinking errors that we try to target in treatment.
Of note, feeling anxious and worried about health can be a normal experience for many people over the course of our lives. And, anxiety itself is not necessarily a bad thing and is meant to protect us in the face of actual danger. It becomes a problem though when it becomes excessive, distressing, impacts quality of life, and when it occurs in response to unlikely or unrealistic threats. Individuals with Health Illness Anxiety Disorder tend to experience excessive anxiety, both in terms of intensity and frequency of that anxiety, and their fears tend to be out of proportion to the actual likelihood and cost of having what they are afraid of occurring. Their fears also tend to persist, despite reassurances that their fears are unlikely to occur (e.g., via doctor’s visits, tests, etc.).
Intolerance of Uncertainty
Individuals with Health Anxiety often feel that they must have 100% certainty, that they must eradicate all doubt, and that 100% certainty is possible as long as they figure out a way to achieve that certainty (e.g., researching, obtaining reassurance from others including doctors, body scanning, etc.). Any possible doubt that their fear could be true is considered intolerable and unacceptable. Any bodily sensation that is not readily explainable by a benign explanation is considered potentially threatening.
Catastrophizing (Fortune-Telling and Negative Interpretations)
Individuals with Health Anxiety tend to make catastrophic assumptions and/or future predictions about the meaning of their physical symptoms (e.g., this back pain means I have cancer, trouble remembering things means I have Alzheimer's). The meaning we assign to anything that happens to us has so much importance in the way we feel about it, and in Health Anxiety this is very much true. If an individual experiences back pain and assumes the meaning of this pain is likely due to something non-threatening (e.g., I must have slept wrong, I might have pulled it when I was exercising) versus assuming the meaning is something sinister (e.g., cancer), then that individual would be less likely to experience anxiety, panic, and distress.
The Big 3
The Big 3 Thinking Errors tend to be common across all anxiety disorders including Health Anxiety:
Overestimation of the Cost: Individuals with Health Anxiety tend to overestimate the consequences of their feared outcomes
Overestimation of the Likelihood: Individuals with Health Anxiety tend to overestimate the likelihood of bad things happening
Underestimation of Self-Efficacy: Individuals with Health Anxiety tend to under-estimate their ability to handle feared outcomes
Overestimation of Responsibility
Individuals with Health Anxiety tend to take on a lot of responsibility for ensuring that they are not responsible for missing a “sign” that something is wrong with their body. For many individuals with Health Anxiety, it’s the one, two punch of being afraid that they will have some serious or terminal illness AND that they couldn’t live with themselves if they had missed the opportunity to heal/address that illness if only they had caught it earlier.
Perfectionism and Black and White Thinking
Individuals with Health Anxiety have little tolerance for normal “body noise” or imperfections/deviations from the way they believe their bodies should behave, and often set their bar for being worry free as being only when they have the absence of all symptoms, disease, injury, or pain. And as we age, we experience more and more “body noise” and other minor ailments which increases distress and anxiety for individuals with Health Anxiety. Examples of body noise can be temporary pain, temporary changes in sleep patterns or appetite, temporary stomach/GI distress, temporary orthostatic changes in blood pressure, etc.
They tend to also have perfectionistic standards for their doctors and other medical professionals, and may not feel satisfied despite multiple tests providing contrary evidence to their fears. They may spend significant time finding the perfect doctor or the perfect tests, and may feel unsatisfied that tests/procedures they have received were accurate (e.g., “the doctor seemed distracted while he was performing the test so I don’t trust the results”). They may also feel unsatisfied unless they have a complete explanation for all of their symptoms, and believe the lack of explanation or “knowing” means that their fears are true or that it means something serious is occurring.
Exposure-Based Cognitive Behavioral Therapy is a treatment approach that attempts to alter these thinking patterns/errors via learning principles and the development of safety associations. See our Health Anxiety page to learn more: https://www.oakheartcenter.com/health-anxiety.html
Helpful Considerations for Infertility Newcomers
Written by Erin Mitchell, MSW, LCSW
If you are new to the concept of infertility or infertility treatment, this post is for you. Infertility is defined as a disease characterized by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with their partner. Infertility can also refer to a person’s inability to sustain a pregnancy to term. Not all couples have to wait the full year before seeking treatment, as there are other factors that can decrease that timeline.
It’s important to understand that infertility is something that is far more common than most people think. 1 in 8 couples have difficulty getting pregnant or sustaining a pregnancy to term.
One of the reasons that it feels so uncommon is because many people choose not to talk about their infertility diagnosis and experience; however, it really is more widespread than most imagine. A couple ages 29 to 33 years old with a normal functioning reproductive system has only a 20-25% chance of conceiving in any given month (National Women’s Health Resource Center). After six months of trying, 60% of couples will conceive without medical assistance (Infertility As A Covered Benefit, William M. Mercer, 1997).
Infertility is something that no one is ever really prepared for in their lives. Most have learned what needs to be done to prevent pregnancy, but there is very little readily available information about difficulty getting pregnant or difficulty sustaining pregnancy to term. One of the most helpful websites I have found for learning about infertility is Resolve.org. If you are concerned that you may have undiagnosed infertility, you can use their Personal Assessment Tool. If you have already been diagnosed with infertility, you can learn more through Infertility 101.
How would you go about learning if infertility is something that you are experiencing? The first step would be to talk with your OB/GYN or primary care doctor. They should be able to provide you with a guideline of what would need to happen before you can be referred to a Reproductive Endocrinologist (RE). An RE is a doctor that specializes in treating infertility.
Infertility treatments can be covered by insurance, but are not always, so it is important to know what your coverage happens to be before proceeding. The following states have mandates in place to make insurance cover infertility treatment: Arkansas, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York and Rhode Island.
Beyond the actionable considerations for infertility, it is important to consider the emotional impact of this diagnosis. For many individuals, this is a long process with many ups and downs along the way. It is normal to feel very emotional during this time. Emotions may also be heightened if one is taking hormonal medications, which are common in most infertility treatments, making managing emotional responses even more difficult.
So, the big question is, how can you and your partner navigate this turbulent time? Below you will find some suggestions.
The list above has been edited for clarification and brevity. It is originally sourced from Infertility Counseling: A Comprehensive Handbook for Clinicians, Second Edition, by Sharon N. Covington & Linda Hammer Burns, found on page 187.
Dear College Graduates
Written By Dr. Pamela Heilman, PsyD, LCP
First, I want to say, Congratulations! Completing your college degree is an amazing accomplishment. In addition to the regular stressors of getting through college, you managed to do so in the middle of a pandemic! Give yourself credit for the result of your hard work and dedication.
As someone who regularly works with college students, my guess is that you are experiencing a mixture of emotions in light of your graduation. Excitement, pride, fear, and sadness tend to top the list. It is common to experience all of these emotions! While people are congratulating you and patting you on the back, you may be worrying about what to do next or whether you will get a job.
Here are some encouraging statistics for graduates. As Thier (2022) summarizes in Fortune, every year Monster produces a “State of the Graduate” report which provides information on the current job market. According to the latest report, companies will hire 26.6% more college graduates from 2022 than in 2021. Additionally, 72% of employers have increased entry-level salaries in the last 12 months. While many job-seekers assume the employer has the upper hand, 57% of hiring managers indicated that job candidates have the power. Currently, it is estimated to take an average of 4 weeks to fill an entry-level role. This has increased 57% since 2019. Whether you already have a career plan or you are in the process of figuring out your next step, here are some things to keep in mind.
Bring on Gen Z: Hiring the Newest Workers. Monster. https://media.monster.com/marketing/2022/US_BringOnGenZ.pdf
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, OOH FAQs, at https://www.bls.gov/ooh/about/ooh-faqs.htm
Career Indecision. Career Research. https://career.iresearchnet.com
Their, J. (2022, April 26). 2022 grads are set to outlearn last year’s cohort-and the year before that. Fortune. https://fortune.com/2022/04/26/2022-grads-set-to-outearn-last-years-cohort/
Postpartum/Maternal Mental Health
Written by: Bridgette Koukos, MA, LCPC, NCC
May 4th is World Postpartum/Maternal Mental Health Day; therefore, I felt it is important to shed light on this area. 1 in 5 new mothers and 1 in 3 mother's of color will experience to some symptoms of Perinatal Anxiety or Depression. It is also important to mention that approximately 10% of fathers struggle with postpartum symptoms as well.
To start I will briefly explain what Postpartum Depression (PPD) and Postpartum Anxiety look like. Anxiety is something that causes avoidance as it provokes a flight response. When you become anxious you may notice that your heart begins to race, your muscles tense, you may feel sweaty and/or faint. PPD is sometimes mistaken for what people call the “baby blues.” However, the symptoms for PPD are more intense, last much longer, and may interfere with a parents ability to care for their baby. PPD symptoms can present during pregnancy, but most often occur within the first couple of months after birth. Some symptoms of PPD include but, are not limited to: depressed mood, mood swings, withdrawing from family and friends, thoughts of harming oneself, difficulty bonding with your baby, intense irritability, and/or intense anger/agitation.
As I mentioned above, symptoms can appear at any point during pregnancy as well as up to the first year after childbirth. An Acronym that might be helpful to remember in combating and coping with Postpartum Anxiety and Depression is SNOWBALL. I know, you're probably thinking what?!, But hang with me here, as this word can be important to remember when taking care of maternal mental health.
Sleep- It is important that new moms get enough rest. There are a multitude of negative consequences associated with not getting enough sleep, some of which include difficulty thinking clearly and low distress tolerance.
Nutrition - Consuming foods that are not only healthy but that will also promote a speedy recovery is extremely important, and more so if breastfeeding.
Omega 3 - Research has shown that consuming fish oils may help reduce anxiety and depression in new moms.
Walking - Getting out for a short walk can be incredibly beneficial.
Baby Breaks - It important to make sure that new parents take time away from baby if at all possible. Whether it be a trip solo or with our partners to go grocery shopping, taking time to visit with family or friends, or engaging in self-care activities such as getting hair or nails done.
Adult Time - Making sure we pencil in quality time with other adults can be a protective activity.
Liquids - It is important to make sure we are drinking enough water daily. This is especially true if a new mom is breastfeeding, as this will help compensate for the water their body's needs in order to create breastmilk.
Laughter - It is important to remember that we need to find humor in situations and cut yourself a break.
Prolonged Grief Disorder: A New Mental Health Diagnosis
Written by: Erin Mitchell, MSW, LCSW and Kat Harris, PhD, LCP
While grief and the process of grieving can be a normal and a healthy experience, sometimes a significant loss and the grief associated with it can become a problem for someone in that it starts to seriously impact their ability to function, their ability to maintain relationships, etc. and may cause significant related symptoms such as depression, anxiety, post traumatic stress, substance use, etc. Therefore, clinical intervention may be useful or needed in order to help support the individual in processing the loss and re-creating meaning in their lives and to help reduce symptoms such as depression and anxiety.
Previously, grief reactions that caused significant distress or impairment were designated under the “Other Specified Trauma - and Stressor-Related Disorders” category within the diagnostic criteria for mental health disorders. The technical term for it had sometimes been referred to as “Persistent Complex Bereavement Disorder” and denoted as a specifier under the trauma and other stressor related category. Sometimes significant and persistent grief reactions were also referred to as “Complicated Grief.”
Prolonged Grief Disorder
In the new text-revision of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR), “Prolonged Grief Disorder” has officially been added to better represent significant and persistent grief reactions and highlight how impairing and devastating complex grief reactions can be. Symptoms might include: identity disruption (e.g., feeling as though part of oneself has died), denial or disbelief about the death, avoidance of reminders that the person is gone, intense emotional pain (e.g., anger, bitterness, deep sorrow), difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future), emotional numbness, feeling that life is meaningless, and intense loneliness (i.e., feeling alone or detached from others). An individual with Prolonged Grief Disorder may experience intense yearning for their lost loved one and may become preoccupied by memories of their loved one or have intrusive distressing memories of their loved one.
While intense grief at the loss of a loved one can be very normal, for some individuals, their experience of grief and the intensity and duration of their symptoms may suggest that they may have Prolonged Grief Disorder. Everyone’s journey through grief is as unique as the type of loss and the value that an individual placed on what or who they lost.
Treating Grief Might Include the Following:
Helping the individual reach out to supportive people and decrease isolation from others. A supportive person may include a family member, a friend, spouse, or support group. Social support can be a significant protective factor against unhelpful ways of coping and more serious symptoms of depression or anxiety. Support systems also provide the opportunity for healthy processing of the loss.
Express feelings in a healthy way and help manage difficult and intense emotions. This might also include talking about the loss and the circumstances surrounding the loss. In the past, grief was thought to have steps that an individual would walk through until acceptance was obtained. Now it is seen as a fluid state that allows for variance and fluctuation. This means that the emotions experienced as a result of grief may ebb and flow. Grief episodes may be triggered by a predictable person, event, or item; or may be completely unpredictable and seemingly strike out of the blue. Grief features a wide variety of emotions, sometimes even within a day. For many people, grief may feel like it takes over their lives for a time. A therapist can gently walk alongside you through this turbulent time and help you find ways to express these difficult emotions.
Help the individual take time to heal. This is easier said than done. Ultimately, in order to be successful at being patient with yourself after loss, it is important to have healthy expectations of how long the process of reaching acceptance will take. There is no timeline for grief, however for many people the intensity of the grief they feel decreases over time as they work to process their feelings and work through the loss. How long this may take depends on a wide variety of factors including: relationships, grief experiences, the nature of the loss, and many more variables. One’s experiences with grief should not be compared to anyone else’s individual experience of grief. Again, an individual’s experience of grief is uniquely theirs.
Help the individual start thinking about the future and establish new meaning in their lives without their loved one. For some individuals, imagining a meaningful life without their loved one might seem impossible. A therapist can help the person slowly start to allow themselves to start thinking about the future. Finding meaning can mean very different things to everyone and is not something that anyone else can determine for you. It might mean re-evaluating your own values, purpose, or life. It might mean examining your beliefs around death and life. It might mean finding ways to honor and remember your loved one and carry on their memory and legacy.
Help the individual stop or reduce avoidance of reminders of the loved one. While avoidance might work in the short-term, it can cause problems in the long term, including keeping the person stuck and isolated. Avoidance may reduce opportunities for re-establishing meaning, and learning that they are capable of getting through the loss and navigating memories of their loved one. It's important that the person find a way back into living.
Levels of Care in Mental HealthCare
Written by: Dr. Kat Harris, PhD, LCP
Many people think of two things when they think of therapy: traditional outpatient therapy, where you meet one-on-one with a therapist, or inpatient therapy where you are admitted to a hospital for safety reasons. However, there are actually several in-between options that may be a good match for your needs depending on the “dose” of treatment you need. The more severe the symptoms and the more impairment the symptoms cause, the more likely a higher level of care will be indicated to best help you get better.
A “Needs Assessment” usually refers to the kind of assessment done by a mental health provider, specifically in higher levels of care, to ascertain the “needs” of an individual seeking services. This assessment will include a recommendation for the level of care indicated for that client depending on a variety of factors including severity, duration, and intensity of symptoms, and level of distress and impairment caused by those symptoms.
An outpatient mental health care provider may recommend a higher level of care for their clients if they are concerned that they need a greater “dose” of therapy, if they are concerned about their client’s safety, if treatment progress is limited or stalled, if there is evidence of a significant deterioration of functioning or increase in symptoms, etc. Higher levels of care may afford greater support, especially outside of normal business hours, access to a diverse interdisciplinary team of professionals, access to community resources, etc. The goal would be to “step down” care back to outpatient services once the client is feeling better.
Levels of Care
Outpatient Treatment: This is the most traditional level of care and will fit most people’s needs. Usually in this setting you see a mental health therapist once or twice a week for between 40-53 minutes or a medication manager (e.g., psychiatrist, primary care physician, nurse practitioner) every few weeks to few months. Examples of outpatient facilities include private practices (groups of providers or providers who work independently), community mental health centers, outpatient behavioral health services through hospitals or healthcare centers, etc. There are also varying degrees of support offered through outpatient centers/resources.
Some facilities are able to offer something sometimes referred to as "wrap-around services." This means that the outpatient facility offers various forms of outpatient services to help support the individual such as traditional therapy, medication management, therapy groups, on-call crisis services, etc.
Intensive Outpatient Programs (IOP): At this level of care, client’s would attend a therapy program anywhere between 3-4 hours a day, sometimes only a few days a week. The therapy program might include group therapy, psychoeducation presentations, meetings with an individual therapist, meetings with a psychiatrist, and an experiential component (e.g., music therapy, art therapy). At this level of care you go home at the end of the day and your participation is voluntary.
Partial Hospital Programs (PHP): This level of care is very similar to an IOP settings (and most of the time client’s start in a PHP and then “step down” to an IOP setting within the same location and program). With this level of care a client might attend anywhere between 5 and 6 hours a day, 5 days a week. At this level of care you go home at the end of the day and your participation is voluntary.
Residential Treatment: This level of care is similar to PHP programming; however, the client’s sleep on a unit in the program and programming might last a little longer throughout the day. At this level of care you don’t go home at the end of the day and your participation is voluntary.
Inpatient/Acute Care: This level of care is reserved for situations where a client’s symptoms are severe enough that the person’s safety or ability to function are at risk, and therefore the person needs to be closely monitored. This might also include situations where a client needs to make drastic changes to their medications and therefore need to be monitored closely. This is a short-term treatment, and the person is usually “stepped down” to a PHP/IOP program as soon as possible. At this level of care you don’t go home at the end of the day and a person's ability to end treatment is sometimes partially determined by the attending physicians.
It's also important to note, that specialized services (e.g., addiction services) might have an even more diverse range of levels of care services.
What is Happiness?
Written by: Erin Mitchell, MSW, LCSW
What is Happiness?
Happiness is a word we use almost constantly in our daily language. We are bombarded with advertisements promising that we can pay money to buy this item or go on this trip to be happy. It is something that we have aspired to for so long, and yet what does it mean to be happy? Is it a state of being? Or is it an emotion? What are your thoughts on happiness? How permanent of an experience can it be?
According to Harvard professor Daniel Gilbert, “We all want to live happily ever after. To experience more pleasure than pain. More delight than despair. More joy than sorrow.” There is so much truth in that statement, we don’t want to sign up for struggles, however struggles will happen anyway and we just want the good to outweigh the bad. The reason it can be important to consider how permanent happiness is for you personally, is because it can change your relationship with the idea of being happy. If you believe that happiness is an emotion, than you would also believe that it cannot exist all the time. It would have to make room for all of the other emotions that are part of everyday life. On the opposite side of that spectrum, if you believe that happiness is a state of being, then you may believe that it is an overall contentedness with life and less of an immediate experience. What do you believe?
So once we define what happiness is for ourselves; how do we encourage happiness in our lives? One of the first places to begin is by figuring out what we value in our lives. Everyone has values that are a little bit different, so it is beneficial to consider which ones matter most to you. Do you really value independence? How about family? Peace? Love? Wisdom? Relaxation? Safety? Beauty? Adventure? If you are looking to find a list of possible values, try searching for a Values Clarification worksheet. There are a number of them online that may help you to determine what they are for you. There is also a helpful article written by one of our wonderful clinicians, Dr. Pamela Heilman, called Let Your Values Be Your GPS.
There is no wrong answer when it comes to the values in our lives, they just are. Once you have an idea of what your personal values happen to be, consider which ones are present in your life right now. Which values are you missing? Think about ways you better add those values into your life. If you know the things you feel strongly about or value, you can feel a greater sense of fulfillment and overall contentment.
Another important factor that plays into our overall happiness is our social support. Humans have thrived because we are connected to one another and don’t do well in isolation. For many people, the pandemic has worked to further isolate us from the people we care about. Having friends, family, and/or overall connections with others is very important to our wellbeing. Give some consideration to how much time you are spending with the people in your life who are supportive to you or even just share similar interests with you. We have more ways to connect with others than we ever have before, it is just a matter of using them.
No one can tell you how to be happy, it truly is something you must seek for yourself. By understanding your own definition of what happiness means, finding out and living your own values, and by spending time with others you care for; you have a greater chance at finding your own happiness in your life. That does not prevent bad things from happening, but it does help you to have a better ability to recover from the bad times.
What to Expect in CBT Treatment Series: Posttraumatic Stress Disorder
This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.
My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.
Posttraumatic Stress Disorder Treatment
What is Posttraumatic Stress Disorder (PTSD)?
Post-Traumatic Stress Disorder (PTSD) results from witnessing or being exposed to death, threatened death, or actual or threatened serious injury (American Psychiatric Association, 2013). Following such a terrifying event, our brains sometimes recover. Sometimes they do not. This is why PTSD is considered a recovery disorder (Resick et al., 2017). Symptoms include intrusive memories, efforts to avoid memories, increased negative emotions and thinking patterns, and hypervigilance or hyper-arousal (increased alertness and related physical symptoms). These are symptoms we all can experience after a traumatic event for a short period of time. However, PTSD occurs when these symptoms persist and start to impact your life, long term.
What will we work on?
If you seek PTSD treatment from me, you will have two treatment options:
The first is called Cognitive Processing Therapy or CPT. In CPT, we will focus on challenging unhelpful thoughts and beliefs that have resulted from your trauma (Resick et al., 2017). Additionally, I will help you process the traumatic memory and related emotions. By modifying beliefs related to your trauma and by effectively processing (as opposed to avoiding) the traumatic memory, you can start to recover from the trauma. I see PTSD as a disorder that causes my patients to relive the traumatic event, over and over again. I want you to be able to stop reliving the event. In order to do so, we need to process the event, so that you can put it in long term memory storage. Instead, PTSD asks you to continue opening the worst page of a scary book in your brain. We will take a look at the whole book so that you can close it and only look at it when you choose to, as opposed to when it intrudes into your mind (Resick et al., 2017).
The other treatment I offer is called Prolonged Exposure Therapy (PE). In PE, we will focus on gradually processing traumatic memories and challenging avoidance related to your trauma (Foa et al., 2007). What does this look like? You will talk about your trauma and be asked to do things you have been avoiding. One symptom of PTSD is avoidance of both the traumatic memory and situations, people, and places related to the traumatic event. In order to recover from PTSD, we must challenge this avoidance and re-enter life, despite the continued fear that something bad may happen. Prior to the trauma, you lived in the world and accepted the risks of doing so. I hope to help you learn to do this again. Of note, I will not ask my patients to do something that I myself would not do. I will not ask you to enter situations that are likely dangerous. We will modify all exercises according to CDC guidelines during the COVID-19 pandemic.
Why engage in this treatment?
For some, PTSD has completely debilitated their ability to live a comfortable and full life. For some, they are reliving their trauma every single day. So, it seems you have two choices. You continue living as if the trauma is still happening, or you decide to face the trauma directly so that you can get back a life without daily threats and fear. I am assuming that you are reading this page because you are tired of reliving your trauma. I am assuming that it is getting in the way of success, health, sleep, or enjoying the present moment. If so, you may want to give treatment a try.
Why this treatment works.
Every time you think of your trauma, your threat brain (the amygdala) is igniting (Resick et al., 2017). Every time you think of your trauma, your brain is telling your body to fight, flight, or freeze (the three threat response options we have). Both of these treatments aim to adjust this response by processing the trauma, facing the trauma, and returning to your life or to more rationale ways to view it.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007) Prolonged Exposure for PTSD: Emotional Processing of Traumatic Experiences: Therapist Guide. Oxford University Press.
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD. The Guilford Press.