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Written by: Sonia Heidenreich, LGSW
In the days following the mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida, many people I work with have talked with me about the impact that this horrific event had on their sense of safety, their feelings of powerlessness, or their pervasive feeling of fear. It’s impossible, regardless of your beliefs about gun laws or mental health policies, to hear of this tragedy and not be affected. What follow is by no means an exhaustive list of ideas, but I wanted to share some thoughts about how to cope. Please know that all of us at Innovative Psychiatry are available for you to speak with if you need to. Parents:
Teens:
If you need more support, please reach out to your provider or any of us here. If you or someone you know is in immediate need of support, please call or text the crisis numbers here.
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Written by: Valerie Middleton, FNP
Many times patients will ask me what else they can do to feel better besides the medications they take. Or perhaps they are considering coming off of a medication because they have gone a year without feeling down and would like to try to wean off. Whatever the reason, there are a number of lifestyle interventions that one can pursue to set themselves up best for happiness and wellbeing. The following six things have been scientifically studied and are highly recommend both as adjunct treatment to reduce the symptoms of anxiety and depression as well as the prevention of the latter. Diet Eating right really does make you feel better! Studies have shown that there is a direct correlation between trans-fat intake and depressive symptoms. Conversely, there is a decreased rate of depression and anxiety when one increases good fats in the diet such as omega-3s. Eating foods rich in good fats such as salmon and nuts will make you feel better. Pursue a hobby Hobbies help us to get in to a “zone”. Meditation is a prime example because the focus is on clearing one's mind. It doesn’t have to be meditation to achieve the same effect though. Knitting, woodworking, painting, fishing and cooking are all examples of hobbies that clear the mind similar to meditating. The end result is increased wellbeing and decreased rumination. Rumination plays a large role in maintaining a depressed and or anxious state of being. Socialize Similar to the effect of a hobby, socializing helps keep us from ruminating. In addition, it has its own direct effect. Studies have shown increased levels of serotonin in both mice and humans that are present with others regardless of relation. So call up a friend or relative at least once a week and arrange to spend time. New to the area? Find a new “tribe” by looking online for groups that meet with similar interests. What do you have to lose? Exercise There are so many studies showing the benefits of exercise on so many levels, particularly if able to be done outdoors with others. Increased levels of feel good neurotransmitters result in feelings of wellbeing, increased attention and concentration, increased ability to learn new information, anti-aging effects on the brain and of course the numerous health benefits such as weight loss and decreased blood pressure. Sunlight Fifteen minutes of direct sunlight (preferably morning) a day has been associated with significant reduction in depressive symptoms. Makes sense if you think about seasonal affective disorder (SAD). A disorder in which a person finds that in the winter months they have decreased mood. A key contributor may be related to vitamin D. Vitamin D, a fat soluble vitamin, crosses the blood brain barrier and may play a role in the transmission of important neurotransmitters associated with depression. So if you cannot get in the sun, try a vitamin D supplement. Typical daily doses recommended are 2000 IU a day but always speak to your pcp about what is best for you. Sleep Of all of the above suggestions this one may be the hardest to do and may be the most important one to do. When you fail to get adequate rest your body goes in to fight or flight mode to a certain extent. This is not good on so many levels. First and foremost is the increased levels of cortisol in the body, the body’s natural steroid. What occurs in the short term with elevated cortisol is similar to if one were actually taking a steroid pill. You can become very irritable and or anxious, have sweet and salty junk food cravings, retain fluids and raise your heart rate and blood pressure levels. In the long term you are looking at decreased immunity to illness, depression, anxiety, heart disease, weight gain and diabetes to name a few. Many other neurotransmitters and hormones are affected by lack of sleep that result in deleterious health effects but I think you get the idea. Zzzzs are really, really important. Aim for 8 hours a night as this seems to be the magic number in terms of health benefits.  Written By: Lauren Barris, LCSW-C
Recently, I found myself faced with an incredibly painful and difficult decision. I was given a choice to make that would impact my life as well as another’s. In this moment, I felt so utterly and completely torn. I had limited time to make my decision, and the consequences of my choice would be permanent. There was no middle path, no painless alternative. I’ll be honest, in this moment I had to call upon every DBT coping skill I have ever taught to my clients. I was grasping at them, flipping through each one in my mind in a desperate attempt to get relief from emotional pain, a clear mind to make a decision -anything other than the suffering that I was experiencing. I tried Self-Validation --that helped me to stop judging my emotion. I reached out for support --that helped me feel like I was not alone. I tried Opposite Action to sadness --that helped, but the sadness (and tears, lets be honest) kept hitting me in waves, again and again. It kept using it, and it did offer intermittent relief, a sense of control, and the ability to function when I needed to. I thought about Radical Acceptance. But man, that felt very much out of reach. I whittled it down to just acceptance, whatever amount I could muster, and that felt possible. I was able to accept the situation that was in front of me, and accept that I had to make a choice. In this moment, I thought about Wise Mind. That elusive state of mind where you see the truth and value in both the emotions you are having, and the cognitive, factual pieces that cannot be ignored. I thought, if there was ever a moment where it was crucial to get into Wise Mind, this is it. The tricky thing is, finding Wise Mind is not as simple as just mashing together your emotions and your thoughts into a big sticky mess. It’s recognizing and lifting out the truth from each side, and making a choice that honors both. It’s listening to your intuition, and following your gut. For me, I imagined myself ten years older, looking back on this day, reflecting on my decision, and even letting it guide future decisions. Only when I imagined these things, did my choice become clear. I made the decision that was consistent with the person I would want to be; consistent with the values I would want that ideal self to have. Ten years from now, I could look back at this decision and be at peace with it; I could explain it to loved ones if I had to. The choice validated and honored my emotion, and also took stock of the factual information I was receiving. This decision was incredibly painful to make (far more painful in the short-term than my alternative would have been), and at the same time, it was followed by a deeper sense of calm, of “intuitive knowing,” and peace. Wise Mind is evasive. It is so hard to find, especially when we need it most. And in spite of, or perhaps because of its elusiveness, striving for it as often as possible helps us live more of our lives in that balanced, intuitive state, where nothing is shut out, and at the same time no one side has total control - we are “driving the bus,” not just our feelings, and not just our thoughts. Written by: Sonia Heidenreich, LGSW
I’m so often struck by the courage that people bring with them into the therapy room. It takes enormous bravery to be present with your own story, and then to tell that story out loud, in front of another person, and to remain open to the possibility of change and growth. I’ve been thinking recently about how often our own stories—and I think this is more universal than we sometimes believe—contain the overarching theme of not being enough. Whatever it is we tell ourselves—"I’m not good enough, I’m not strong enough, I’m not kind enough, I’m not ambitious enough, I’m not interesting enough, I’m not healed enough”—can provoke enormous sadness and fear in us. Of course, that’s a difficult emotional place to be. Of course, we want to avoid feeling those feelings and try to move away from them. It is exactly that moment when instead of instinctively moving away from those feelings of sadness, fear, or shame, we make the conscious choice to notice them, that we have an opportunity to practice courage, and to move towards growth. In my job, this is the moment when I hold the utmost admiration for the person brave enough to sit across from me and make this choice to stay. I’m reading Pema Chodron’s book, The Places that Scare You, and she has this to say: Tapping into that shaky and tender place has a transformative effect. Being in this place may feel uncertain and edgy but it’s also a big relief. Just to stay there, even for a moment, feels like a genuine act of kindness to ourselves. Being compassionate enough to accommodate our own fears takes courage, of course, and it definitely feels counter-intuitive. But it’s what we need to do. Why is this what we need to do, you might wonder? Your answer could be totally different from mine, but I think we need to stay and make space for our own fears so that we can develop a different relationship with them. Maybe we can notice these fears for what they are—just thoughts or feelings, not absolute truth. Maybe we can start to use these moments as opportunities to tap into our own sense of strength, or that sense of self that lives inside us (but that we sometimes lose track of). Maybe we use these moments as an opportunity to change our stories, or to tell ourselves something different. Rather than believing that we’re not enough, we can make the choice to practice telling a different story: I am enough. And you are. You are enough. If it’s helpful, use that as a mantra for your day. With time, you will be able to begin to broaden and expand the stories you tell about yourself. |
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March 2019
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