When it comes to New Year’s Resolutions, there are so many possibilities for self-improvement that we find ourselves considering.  These changes can center around physical or mental health, relationships, work, and so many other options.  This is the time of year when so many of us look toward the future and think deeply about the future self we want to become.

If creating a resolution (or maybe a few) this year; it may be beneficial to consider one need, one want, and one thing you would like to continue.  These three options have the benefit of addressing multiple aspects of your life.  Is there something in your life or within yourself that you need to change or needs to be addressed?  

Additional Considerations:

• How can you go about making that change occur?  
• What issues may you encounter in making that change?
• Are you starting something from the beginning?  If so, have you made sure to begin slowly?
• How long are you giving yourself to make this change happen?  An entire year is a very long time, so consider milestones for you that happen more quickly (ex. monthly or seasonal milestones).
• Who is supporting you in these changes?
• Are you trying to take one change at a time?  Each change we make in life, even the good ones, are stressful and too much at once tends to be too difficult for many of us to manage.

As much as this time of year has many of us focusing on the new, it is also really important to acknowledge changes that you have made this year.  It can be so very easy to continuously strive for the future, that we don’t often take the time to look around at where we are in life and acknowledge what has brought us to this particular moment and appreciate the work we have already done.  What changes have you navigated within yourself and with others this past year.  How is where you are today different than it was on January 1?  Has there been something that you have changed internally or externally?  Acknowledge the you that has gotten you to this moment before moving toward the future.  We are always a work in progress, so stopping to notice your work along your journey so far is an important acknowledgement.

The following are tips for loved ones/support persons and how they can provide support for someone battling addiction. I will begin with some statistics to help everyone understand the significance of addiction: 

• 21 million Americans have at minimum 1 addiction,
  • Of those 21 million Americans, only 10% will receive treatment.
• Approximately 20% of Americans who have depression or an anxiety disorder also have a substance use disorder
• 90% of people who have an addiction started before they were 18 years old.
• Alcohol is the most widely abused substance, yet most untreated
• Smoking cigarettes results in over 480,000 deaths every year in the United States

Recovery is most successful when individuals have a healthy support system in their corner. Below you will find some helpful tips on how we can support individuals during their recovery process. 

Tip 1: Actively Listen to Your Loved One with Addiction.

Since the beginning of the COVID-19 pandemic, there have been an astronomical amount of individuals experiencing depressive and anxious symptoms, and some of these individuals have turned to substances to cope. It is important that we check in on them and have conversations on how they are actually feeling and doing. Engage in active listening skills such as being present in the conversation by demonstrating the ability to paraphrase or summarize what they said. This shows them that we are paying attention.

Tip 2: Patience.
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It is important that we keep in mind changes do not occur overnight. Though your loved one may have taken the steps to cease their unhealthy behavior, it does not necessarily mean they will immediately stop making poor choices or cut ties with unhealthy peers. 

​Tip 3: Educate Yourself

There is nothing we want more than for our loved ones to enter into recovery for their addiction; however, while they are working on themselves, we need to work on ourselves as well. Learning about the biological, social, and psychological processes that underlie addiction can be a great place to start. For example, you can learn about how addiction disrupts parts of the brain that are responsible for impulse control, judgment, and alters the dopamine pathways. The more you learn, the better you can understand how to support your loved one. It's also a great way of showing that you are invested in their recovery. It can also be healing for loved ones to better understand the addiction process to help them start to make sense of the many complex and difficult emotions that can arise in loving someone with an addiction. 

Tip 4: Setting boundaries

This is super important. Having poor boundaries can perpetuate unhealthy and maladaptive behaviors on the part of our loved one with addiction. As the support person, we try to “help,” but what we really are (un)knowingly doing is possibly enabling their addiction and their addictive behaviors. Examples may include providing our loved one with money, a place to live, a car to drive, food, or bailing them out of their legal troubles. It is imperative that all parties take inventory of their enabling, codependency, or unhealthy related behaviors in order to benefit everyone involved in the long-run.

Tip 5: Seek Your Own Support

As support persons, we need to learn to let go, engage in our own self-care, and seek our own support so that we can learn how to effectively cope while our loved one is active in addiction. Support can come in various ways such as individual therapy, family/couples therapy, support groups, etc. 

Whenever I am working with families, I encourage them to attend support groups such as Al-Anon (Alcoholics Anonymous) or Nar-Anon (Narcotics Anonymous). Additionally, children whom have a parent with an addiction can seek out support from Alateen Teen Corner support groups. If you are an adult child of an alcoholic, you can seek support from ACoA (Adult Children of Alcoholics).  Alternatively, some (in/outpatient) treatment facilities will also provide free low-cost support groups.

​Lastly, and I cannot stress this enough, seek your own individual therapist to help you through this time.​

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.

OCD Treatment

What is OCD? 

I describe OCD to my patients as having “sticky brain” or “itches” that need to be scratched or something bad will happen. If we look at our diagnostic manual, obsessions are defined as thoughts, images, or impulses that reoccur and are intrusive in a way that causes anxiety/ distress (American Psychiatric Association, 2013). Compulsions are defined as actions or mental acts that take place in response to the obsession. In other words, OCD consists of having an intrusive thought and feeling the urge to undo or prevent the thought from coming true through some sort of mental or physical act.  

What will we work on? 

Exposure and response prevention entails learning that our thoughts are not as powerful as they feel. In treatment, you will learn to “sit with” intrusive thoughts without doing anything to neutralize or get rid of them (Foa et al., 2012). In addition, you will learn to do things and confront stimuli that make you feel anxious and distressed so that you can see it is not actually dangerous to do that thing or be around that object. For instance, some people with OCD think that they will run someone over if they drive a car. By driving a car over and over again, without going back to check to see if they hit anyone, they will see their intrusion was not accurate and fear will diminish. I will assist with both exposure to intrusions/ feared situations and also with preventing a response afterwards. The goal of this therapy is to learn that anxiety/ distress/ an “itch” to ritualize does not last forever and decreases eventually. In addition, you will learn that the anticipated consequence of having an intrusion are not very realistic. I often tell my patients that I would not ask you to do anything that I myself would not do or that most people would not do. I will instead ask you to engage in behavior that could have risks but risks that most of us are willing to or required to accept. 

Why Engage in this Treatment? 

Consider the ways your life has been negatively impacted by your OCD. Consider the time you have lost to getting stuck on thoughts or doing compulsions (Grayson, 2014). Logically, do your compulsions 100% prevent the bad thing from happening? Does your OCD interfere with spending time with loved ones?  Does your OCD make you late for things? Does it impact your ability to enjoy your life? If so, you may want to give treatment a try. 

Why this treatment works? 

A natural way to reduce fear is to do the thing your fear over and over again, until the discomfort or fear fades (Foa et al., 2012). We see this with driving a car. We are all terrified when we begin but over time, we learn that we can do it. Exposure and response prevention follows this logic but also science. Over time, the threat brain (known as the amygdala) stops activating every time you have an intrusion and stops directing you to a compulsion. As you desensitize yourself to a fear, our rational brains take over and we no longer feel fear. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and Response Prevention for Obsessive-Compulsive Disorder: Therapist Guide (2nd ed.). Oxford University Press.

Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.

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.

Panic Disorder Treatment

What is it? 

Most of us, in our lifetime, will experience a panic attack. However, when you develop panic disorder, you experience frequent, unexpected panic attacks (or surges of intense fear and discomfort) accompanied by either a fear of having another panic attack or change in behavior related to attacks (American Psychiatric Association, 2013). In other words, you live in fear of having another panic attack and have panic attacks that feel like they hit you out of the blue. This is often a very hard way to live. 

What will we work on? 

1. Exposure therapy: The goal of exposure therapy for panic disorder is to learn to sit with and tolerate physical sensations of panic (Craske & Barlow, 2007). For instance, if you experience heart racing and difficulty breathing during panic attacks, I will recommend that you engage in various exercises that induce those symptoms. We can learn to tolerate anxiety. We do not need to panic to panic. In exposure therapy for panic disorder, you will engage in what are called interoceptive exposure exercises that will desensitize you to panic sensations (that are not paired with an actual threat). 

2. Psychoeducation: Panic is not harmful (Craske & Barlow, 2007). In fact, it is there to keep us safe during a threat! We will discuss this and ways to remind yourself of this when your body is telling you danger is present. 

3. Coping skills: Coping skills for panic will include changing breathing that often leads to hyperventilation (Craske & Barlow, 2007). I will also help to challenge the way you are thinking about panic. I aim to help you see that you will be able to cope with the panic and situations in which you feel panic. You do not need to run from panic sensations. They will come and go if you face them. 

Why Engage in this Treatment? 

Panic attacks are painful and debilitating. Consider the ways your life has been negatively impacted by having panic attacks or by your fear of having additional panic attacks. Consider the time you have lost recovering from panic attacks or planning around them (Grayson, 2014). Does the panic impact your job, relationships, or ways you can spend your time? If so, you may want to give treatment a try. 

Why this treatment works?

Panic attacks are essentially false alarms in the threat detector (the amygdala) in our brain. This treatment aims to reset your alarm system by artificially triggering it. Research has demonstrated the effectiveness of this approach (Craske & Barlow, 2007). 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Craske, M. G., & Barlow, D. H. (2007). Mastery of Your Anxiety and Panic: Therapist Guide (4th ed.). Oxford University Press.

Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.

It’s highly likely that upon reading the title of this endless musing, a very understandable and natural reaction would simply be, “Dang bruh . . . that’s . . . that’s just heavy.” Guilty as charged I suppose, though that doesn’t negate the necessity of looking at something like the topic of identity and giving it the adequate space it requires in daily living. 

For example, when’s the last time you met someone and upon introduction and stating your name, the other party prompted you with the question, “Very nice to meet you . . . who are you?” If we’re really thinking about this for a moment, the answer would be never as that’s a fantastically bizarre inquiry to ask another person and in fact, I may just start doing that for confusion’s purposes if nothing else and because I’m clearly an active troll. 

Part of what makes the topic of personal identity so difficult is there’s a cultural expectation for us dwellers stateside as to the areas we can place our identity within and thereby, the way we go about acknowledging our identity as a whole. More times than not, we can gravitate towards confusing what we do with who we are, effectively finding the source of our identity in the activities we engage in rather than the beliefs, values and overall content & context of the character that resides within our hearts. So where are a few common places we can house our identity? 

• Vocation/Job
• Relationships (marriage/dating/family)
• Finances

There’s an inescapable shortcoming though that occurs when we use any of the categories above as a means to fully encompass who we are. The challenge is that these things, while all positive in a sense, are temporary and unsustainable. Let’s test this out with the same categories to see if I’m just exhaling an overwhelming amount of hot air or if there’s merit to this: 

• Vocation/Job: this may be the most commonplace, as in the aforementioned example above of initially meeting someone, more times than not we’ll be led to explain the work that we do; “I’m a scientist,” or, “I’m an accountant,” can be familiar refrains but again, actually fails spectacularly to capture the very essence of WHO we are but explains well what we do. The challenge with putting our identity in our jobs? Well . . . layoffs, terminations, separation from employment, etc. If your identity is in the job you do, what happens should there be a day that emerges and you’re no longer doing that job? Essentially, a job is no longer a job but the very fabric of who an individual is while having the fragility to understand it could be gone in an instant.

• Relationships (marriage/dating/family): there’s going to be some overlapping concepts within this so I’ll attempt as best to use the very little brevity I’ve been naturally given to execute this like a blogging bank robbery: get in, get what you need and get out, don’t stand at the corner of the street waving around the money bags. Relationships though carry the same concept as there’s a temporary nature. Let’s say identity is located in being a partner in a relationship. This is all fine & good until that time emerges, barring a morbid Romeo & Juliet circumstance, where one person is going to have to function in the absence of the other. If identity is effectively wrapped up in the presence of that person, what’s one to do in said person’s absence? 

• Finances: Similar thought processes but bankruptcy, stock market crashing, ponzi schemes, etc. erase not only the financials but the very essence of who a person is when they identify with the zero’s in their bank account.

So at this point, this whole identity understanding is overwhelming & daunting, right? I’m sitting here basically saying in an elongated fashion, “don’t put your identity in anything that can be taken from you,” which carries an emotional gravity alongside it but also creates opportunity going forward. It’s basically creating the challenge of placing your identity in that which can’t be taken or stolen or lost or misplaced. All those aspects exist in the very fabric of who you are as a person; they’re your beliefs (spiritual & non-spiritual alike), your values, your hopes, your ambitions, your personality, your happiness, your sadness, your love, your joy and effectively, every wonderful thing that makes you the singular unique creation that you are. 

So here’s a thought process to explore within yourself that can help generate some personalized insight into this as it’s a simple question with a complex, nuanced answer: How would you describe yourself without describing anything that you do? 

The answers that are acquired from this introspection can be immeasurably valuable in helping to reshape or redirect identity from something that you do to everything that you are.