State of Anxiety

Providing humorous perspective during & after a breakup or divorce

help for depression

One of the Best Panic Books of All Time!

101 Ways to Conquer Teen Anxiety made it to the Best Panic Attack Books of All Time

I’m happy to announce that 101 Ways to Conquer Teen Anxiety: Simple Tips, Techniques and Strategies for Overcoming Anxiety, Worry and Panic Attacks, made it to BookAuthority’s Best Panic Attack Books of All Time.

BookAuthority collects and ranks the best books in the world, and it is a great honor to get this kind of recognition. Thank you for all your support.

The book is available for purchase on Amazon and everywhere the best books of all time are sold.  🙂

The Relationship Between Anxiety and Grief

It’s no surprise that levels of anxiety are surging right now. Repeated waves of COVID-19, and the lockdowns they bring in their wake, make this an incredibly difficult time for our mental health. There are many contributing factors to anxiety – with our lifestyle, environment, genetics, and even hormonal imbalances all having their part to play.

What’s not always acknowledged for its role in anxiety, however, is grief.

Discussions about grief tend to focus on the feelings of sadness, loss and desolation that can follow the death of a loved one. What they rarely touch upon is how anxiety and grief are intrinsically bound up with one another. Even someone who has previously enjoyed low-levels of anxiety can be hit with a sudden unexpected tsunami of worry as they come to terms with their loss. In fact, many grief counsellors suggest that anxiety should be included as one of the stages of grief that we all have to go through.

Why do anxiety and grief so often go hand in hand? There are many reasons behind this, of course, and it’s impossible to cover them all, but the following points are some of the most important.

  1. Bereavement is the most stressful event we will ever experience. Anxiety is exacerbated by stressful life events. These can be any number of things, with both marriage and divorce scoring highly as a potential stressor. Beating them all on the Holmes-Rahe Life Stress Inventory is the death of a spouse, with the death of a close family member a little further behind.
  1. The death of a loved one reminds us that we are mortal. When we lose someone we love, we’re reminded just how little control we have over our lives. We’re all going to die at some point, and this realisation hits particularly hard after our first significant bereavement. How we come to terms with the fact of our own mortality will play a key role in the future quality of our lives.

Credit: Sandy Millar

  1. We fear more loss. As well as bringing our own mortality into focus, grief reminds us that we may lose other people who are close to us. If we lose one parent, we may then be excessively anxious about losing the other. Intense anxiety may make it difficult to enjoy what time we have left with those we love.
  1. Trauma teaches us to be anxious. Traumatic events can lead to what’s known as classical conditioning. If the news of our loved one’s death came in a phone call, then every time the phone rings we may fear the worst.
  1. We may be anxious about our ability to cope. How will we manage without our loved one? We may fear that we won’t be able to take care of the practical and emotional challenges that we may face now that we’re on our own. In a particularly challenging year like 2020, these worries become even more pressing.

Credit: Thomas Bormans

  1. You fear the intensity of emotions that grief can bring. Grief is a deeply unpleasant state to be in, and it can be overwhelming. Going through it, however, is vital if we’re to move forward in life. Many people, particularly if it’s their first experience of grief, work hard to push it away and move on. This creates anxiety around their own emotional responses.
  1. You begin to overestimate the risk of negative life events. Before a significant loss, you might have had a generally benevolent view of life. Bereavement, particularly when you’ve lost someone who was relatively young or who died in tragic circumstances, can radically unsettle that world view. You may now overcompensate by overestimating the risk of accidents, serious illness or early death, leading to increased levels of anxiety.

Grief, whenever it comes, is a complex and, to a degree, mysterious state. It’s unavoidable for most of us, and how we respond to it can determine the future course of our lives as the pain starts to heal. Understanding the role our anxiety plays can be a valuable part of the grieving process. It can help us to accept, then begin to move through the painful emotions we are experiencing.

Myths We Tell Ourselves and Others to Ease Suffering

We tell people in the throes of adversity silly things in attempts to placate their angst. We also bask ourselves in a litany of clichés during stressful times to counter emotional suffering. We post them to social media, or tape them to our fridge next to that “Live, Love, Laugh” trope and the grocery list.

It’s not that we mean to be trite – it’s that we often don’t know what else to do or say to offer support.

Classic standby platitudes include the following:

  • God will never give you more than you can handle.
    God never actually said this. Just ask Moses or Job. But it sounds nice, while imparting just enough hope to accept that spilled $6 latte or another mass shooting.
  • What doesn’t kill you only makes you stronger.
    Tons of stuff can make you weaker … just before killing you. Have you ever seen someone bleed out?
  • Pain is weakness leaving the body.
    What a cute little absurdity. Excrement, sweat, and urea are weaknesses leaving the body. Pain can stick around indefinitely.
  • Opportunity often comes disguised as adversity.
    Opportunity doesn’t think this far in advance. Maybe it’s just shy, or likes surprising us. Either way, opportunity and adversity are as discernible as love and hate, or Michael Jackson skin tones through the decades.
  • The Serenity Prayer.
    Maybe this one helps, I don’t know. I can never remember the words.
  • We have nothing to fear by fear itself.
    FDR married his fifth cousin … do his mantras have any credibility? Also, there are plenty of things to fear, like dating apps, light beer, or former child actors. His point is moot.
  • God helps those who help themselves.
    I fell for this one too. Stand back, mere mortal – God doesn’t need our help.
  • In three words I can sum up everything I’ve learned about life. It goes on.
    I’m a rabid fan of Robert Frost, but his death in 1963 negates this proverbial gem.

There’s a reason canned, verbal peps don’t work: They’re simply not true. Can you think of a single instance of personal suffering where you recited anything similar, and felt a change in your emotions or mindset? We aren’t The Little Engine that Could.

When my grandmother, Hazel, my mom, and I were all diagnosed with cancers within the same year, I was emotionally spent and, honestly, pissed-off at the cosmos … or whoever made-up that “God will never give you more than you can handle” puff-slogan.

The topper of that time, however, was that from all the night-grinding of my teeth from stress, I had bone loss and gum recession in my lower jaw, requiring a $2,000 gum surgery. Human cadaver forearm skin was grafted to the inside of my lower gumline, while using growth factor from my own blood to lessen the tissue rejection. This prevented me from cursing aloud at life for wronging me, as I risked the piece of dead arm flying from my mouth.

No enemy is worse than bad advice.  – Sophocles

I can assure you that there were no cute motivational quips that could fix all that ailed me that year. Yet, friends would dispense asinine “pick-me-ups” while I fake smiled over gritted teeth and gums that weren’t mine.

Some of their trivial well-wishes included, “Just put one foot in front of the other;” “Tomorrow is a new day;” or “It’ll get better!” (the last person wasn’t even trying). The advice my friends gave me was as useless as the “ueue” in queue.

I knew they meant well, but had no offerings beyond the preceding hollow citations. And, I can’t blame them. I have a friend whom recently lost his mom to Covid in an ICU. I too struggled to placate his suffering with the right spoken Band-Aid.

It’s not that we don’t want to assuage the angst that we or someone we care about is feeling – it’s that doing so is a skill so few of us are trained to do.

So, What Can You Do For Someone (or, Yourself) Who is Going Through a Tough Time?

In absence of helping a friend sponge-bathe their infirmed parent, or donating your own arm skin for their mouth, there are simple but surprisingly helpful things you can do.

1. If it’s you going through a difficult time, radically accept what is happening to you. Radical acceptance doesn’t mean you have to agree with what’s happening or how you feel about it – but  you accept it as it is, no matter how painful or inconvenient it is. C’est la vie. Whatever will be, will be. It is so, so it is. There is incredible freedom in merely accepting how things are.

2. Regularly check-in with yourself and your feelings. If you’re feeling irritable, for example, take tangible steps to lessen your angst. This might include taking regular long walks or working-out, watching a comedy, turning-off your phone and reading some Dave Barry or David Letterman, or doing some guided meditations from YouTube.

3. If it’s a friend hurting, simply ask them how they are doing. Then be present and listen. You don’t need to offer nuggets of life-altering advice. It’s actually best that you don’t. Just listen.

4. Ask how you can best support them during this trying time. If it’s you who is hurting, how can you be your own best advocate? Hint: regular sleep, healthy eating, and not self-isolating.

5. Be consistent. Don’t check-in once and fade to black. Check-in regularly, even if via text.

6. Lastly, avoid the trite prose fails we often default upon. And, the next time someone gives you useless advice, convince them that having another baby will save their relationship.

Is that a Pachyderm On Your Chest?

We Are the Unhappiest We’ve Been in 50 Years…

Many of us are one wobbly-wheeled grocery cart encounter away from arm-barring someone’s maskless, selfish face. Especially here in California, where heat, wildfires, high Covid rates, and a hyper-contentious looming election add further anxiety, anarchy, and possibly more monster truck rallies into our collective future.

Like you, I’m facing notable levels of grief and apathy – as indicated by my 2 am binge-watching of Cobra Kai, eating weed gummies, and hitting snooze until lunchtime. Then taking a nap around 4:00. I even lack the energy to thumb scroll and judge people on social media. I’m filled with a general malaise where I can’t focus on anything beyond licking a stamp or overeating.

With over a month of West Coast wildfires, leaving the house means chewing through the chowder thick, carcinogenic air. It has even crept into the house where I have to regularly rinse my eyes with cold water. There is no escape beyond driving hundreds of miles east. Which I’m too apathetic to do. I often find myself standing in a window searching for the glowing orange orb of a sun through the claustrophobic haze. When I find it, I stare too long.

With all the adverse events unfolding, I’ve traded the great outdoors for brief, masked interactions at Trader Joe’s or Petco. My hikes replaced by long, boring spin bike rides and carpet push-ups.

I’m hearing a common theme about not just a general malaise, but something more concerning: An overall feeling of hopelessness. It’s not normal for so many Americans to feel this anxious or depressed.

A third of Americans are now showing signs of clinical anxiety or depression.

For every 100 American adults, 34 show symptoms of anxiety, depression … or, both. The data is directly from a Census study titled, Measuring Household Experiences during the Coronavirus (COVID-19) Pandemic.

Here’s the drop-kicker: Deep within that 20-minute survey, savvy U.S. officials included four questions taken from a form used by physicians to screen patients for depression and anxiety. The responses provide an alarming view into the country’s mental health after months of distress, seclusion, unemployment, and doubt.

The Census Bureau finding supports the mounting evidence of an increasing mental health crisis among Americans. Sadly, experts say that without intervention, the nation will experience a rise in suicides, substance abuse and overdose deaths.

And, what is our government’s response to this looming mental health catastrophe? Zero f#cks given. When asked how they would follow-up with respondents to the Census Bureau survey, the CDC said in an emailed statement:

“It is not feasible, nor would it be appropriate, to provide any health advice to respondents on the basis of their responses.”

The government actually has a responsibility to address the problems revealed by the survey. “If you measure a problem, presumably it’s because you want to do something about it,” said Maria A. Oquendo, former president of the American Psychiatric Association (APA). Doctors don’t diagnose patients with cancer only to send them back into the asbestos mine.

So, why should you feel hopeful?

Go easy on yourself. It would be weird for you to not feel jacked-up over all that’s happening. Current events are heavy and creating an unavoidable wake of despair for the majority.

Sonja Lyubomirsky, psychology professor at the University of California, Riverside, says that re-imagining happiness is almost hard-wired into Americans’ DNA. “Human beings are remarkably resilient. There’s lots and lots of evidence that we adapt to everything. We move forward.” 

Source the humor! It’s always there. As Erma Bombeck once said, “There is a thin line that separates laughter and pain, comedy and tragedy, humor and hurt.” It seems personally blasphemous to laugh at our current misfortunes. But sourcing the humor is precisely what we need to do in order to cope. When you are overwhelmed by tragic events, humor is a useful defense mechanism. Time may not enable us to laugh at everything. But, tragedies and humor go together like cashiers and plastic sneeze guards.

When facing adversity such as illness or even death, humor serves as a buffer. In fact, people who think about death are actually funnier. The notion is appropriately called Terror Management Theory. Studies suggest that humor functions as a natural and often effective means of down-regulating stressful or traumatic experiences

Humor is embedded in tragedy, pain and struggle in ways we cannot grasp. And possibly, humor is also what will save us in all this mess. If not, NASA said there’s a 1 in 240 chance that an asteroid the size of a small car will hit Earth the night before the election

**Anxiety Disclaimer: Don’t worry. Asteroids of this size burn-up in the atmosphere long before they hit our ground. This won’t be the thing that does us in.

There is No “New Normal” Because There Was Never a “Normal.”

If you were to ask the general public what specific outbreak might wreak mayhem within our lifetimes, you’d likely hear Flu, locusts, boils, frogs, politicians or something similar from social media prophetics or the Book of Revelations.

Even when news of another coronavirus hit, it was in a far away land impacting only “other peoples.” It would seem hyperbole that cruise ships would become the vector ferrying tiny, spiky, murder spheres to our own shores.

Our sole defense was keeping the potentially contagious temporarily adrift on floating petri dishes, while enjoying 24-hour buffets and sequined ABBA and NSYNC cover bands.

But we’d soon be worried over parents, grandparents, and ourselves as we came face-to-face with our vulnerability and the inter-connectedness of our Planet. Moreover, we realized that nothing was ever “under control” – an illusion we had believed and subscribed to for a generation. And we became angry at the thin veil through which life was sewn.

Didn’t Someone’s God assure us we’d never be given more than we can handle?

Actually, no. This guarantee isn’t in the Bible, Quran, Torah, Guru Granth Sahib, Vedas, Tripitaka, or Kojiki. It’s a motivational quip we like to keep next to those Live, Love, Laugh prints from Bed, Bath & Beyond.

The problem with living such a comfortable existence for so long, is the depth of the fall to a life of discomfort.

Thankfully, we’re buoyed by the frontline workers in healthcare, at nursing homes, behind badges, delivery personnel, pharmacists, grocery employees, and perhaps the most unexpected superheroes: undocumented agriculture workers – without whom we’d lose a vital tier of the food pyramid.

Mid 2020 has seen the indoctrination of millions of newcomers into the anxiety and depression clubs – the steep dues paid with inner chill and peace of mind. Though many of us (i.e., the anxious) have been mentally prepping for a lifetime, we too found ourselves ill-equipped for an epidemic. You can’t train for a contagion that exists only in one’s mind (another reason why worry is a useless endeavor). But suddenly it’s not so weird to clean an apple with a bleach wipe.

Find the humor, find the cure.

It’s always there. This might not be the best time to ponder Dostoyevsky’s Poor Folk or The House of the Dead – though I’m a huge proponent of the man otherwise. A pandemic calls for some light and cheery reading to facilitate levity and laughs. Consider anything from Dave Barry or Augustin Burroughs. And don’t overlook works by other great contributors like Erma Bombeck and Dorothy Parker.

Mark Twain knew it best: “The secret source of humor itself is not joy but sorrow.” Studies confirm that laughter lowers blood pressure and releases beta-endorphins, a chemical in the brain that creates a sense of joy. Moreover, humor is clinically validated to reduce stress long-term by improving the immune system through the release of neuropeptides, relieving pain, increasing personal satisfaction, and lessening depression and anxiety. The simple act of smiling causes the brain to release dopamine, which in turn makes us feel happy. But don’t worry about the science. Just YouTube “Sebastian Maniscalco”  or “cat videos” and away you go.

Humor = Calamity + Time.

Humor will change your relationship to the problem of stress, worry, or anxiety. It reduces stigma, promotes wellbeing, helps you to cope with difficult situations, reduces tension, discomfort and stress; and strengthens your immune system. It’s pretty much a miracle elixir.

Austrian neurologist, psychiatrist and Holocaust survivor, Viktor Frankl, sourced and used humor as one tactic to survive German concentration camps, and he highlighted humor as ‘another of the soul’s weapons in the fight for self-preservation.’ “The attempt to develop a sense of humor and to see things in a humorous light is some kind of a trick learned while mastering the art of living,” cited Frankl.

Humor produces endorphins that soothe the body and allows a responsive brain to take charge – like a legal massage somewhere with no blacked-out windows.

There cannot be a “normal” in an unpredictable world. We use terms like “new normal” to instill an element of control over things. Control is an illusion.

But radically accepting the randomness of life, while staying mindful in the present is damn liberating. We don’t like to admit that we actually have little control over anything – especially our own fates – yet we do things that impact our longevity.  You can now observe the rampant OCD taking place nearly everywhere by those not accustomed to proper OCD’ing. For example, shaking hands during Flu season (or otherwise) has always been an archaic practice in the transmission of filth. Have you seen what you do with your hands?! Despite lacking opposable thumbs, even dogs know that sniffing butts is a more hygienic “hello.”

And consider a University of Arizona study revealing that cellphones carry 10 times more bacteria than most toilet seats. Yet we don’t hesitate to pinch zoom a pic when someone hands us their toilet phone.

And, how many times have you eaten birthday cake blown on by someone you didn’t like or barely knew? Well, you might as well have them blow directly into your open mouth. A study in the Journal of Food Research determined that blowing out candles over that sweet, sticky icing resulted in 1,400% more bacteria compared to icing spared the puff (The study was aptly titled “Bacterial Transfer Associated with Blowing Out Candles on a Birthday Cake”).

Black-light most any hotel room and it will look like a Jackson Pollock painting.

Hotels will charge $250 for smoking in your room, but you can leave a bodily bio-hazard at no charge. This serves to heighten my perception of hotels as wildly filthy. And do you think the card keys ever get cleaned? I question the entire arrangement altogether. Most of us make that room as cozy as our own, in full denial that few people tip the maids upon checkout.

Hotels are where people go to cut their toenails, trim body hair, or bleed. The mattresses are literal smut sponges. But we gladly pay for the privilege of rubbing our faces into the pillows and bleach-infused towels.

Humor is ever present. You just gotta peek through the dank mental hues of your angst. Sourcing the lighter side of your emotions is vital – particularly when a third of Americans are now showing signs of clinical anxiety or depression.

Covid created a massive wake of anxiety and depression across the globe, along with budding terms like “immunity privileged” and “vaccine nationalism.”

Understandably, as most of us had not incurred a life disruption of this magnitude prior. During the initial stages of the pandemic, I spent most of my time hiding from humanity to avoid the contagion. My sole activity was sterilizing everything I ordered via Instacart and Amazon with disinfectant wipes. I wondered if anyone else was using hospital grade wipes on their organic lettuce.

There are a handful of things I’ve done to maintain internal peace and manage my anxiety during the quarantines and isolation. One of the most vital was distraction afforded by Netflix binges, naturally. But I also read a lot. At any given time during the pandemic, I’ve been concurrently reading five to six books depending on mood.

I also attend live or archived online church and devotional sessions to feel grounded. This is where I learned specific scriptures that also helped carry me through the salty times. Isaiah 41:10-13, Isaiah 53, Psalm 23, Psalm 40:1-3, Psalm 91, and particularly Philippians 4:6-8 were pivotal in smoothing the frays. Memorizing scripture is also a form of meditation. And it helps train the brain for other things – like remembering to brush your teeth or what day it is.

A good chunk of my Covid coping time was spent on building an in-home gym since my fitness center closed. This was exceptionally challenging as millions had the same idea, and every dumbbell, kettlebell, and old-school cement-filled, vinyl prison weight was sold-out everywhere.

Over weeks, I slowly accrued a Frankenstein gym of mismatched heavy things.

I converted my living room into a carpeted fitness studio where I performed calisthenic and plyometric feats of athleticism, such as 3,000 burpees and push-ups per month. I also fast-walked like a soccer mom late to A.A. 25 miles per week. Sadly, my ”nothing succeeds like excess” mindset and compromised shoulders reminded me why my body was made for writing in an ergonomic chair. I was soon too injured from one of the physical endeavors to do anything else, and I had to take two months off. But my anxiety did not.

Anxiety and depression can pique in the absence of coping skills. When we assign value or validity to intrusive thoughts and fears, it’s like mental Miracle-Gro. Talking to a therapist via phone or teletherapy is a measurably effective adjunct tool during stressful times.

There is a little-known dichotomy about mental health issues that makes seeking treatment difficult:

When you’re feeling anxious or depressed, it’s often hard to do what’s best for your welfare – this includes seeking help. My anxiety doesn’t want me to pay bills until I’m getting hate mail from creditors, fold laundry until I have no room on my bed to sleep, get groceries until I’m down to ramen and a jar of crusted mayo, or wash my car until stranger’s spell profanities on the windows.

 There are two incidences when you should seek out a professional.

  1. If you are in danger of hurting yourself or others, or if you are having passive thoughts about hurting yourself or others (even if you don’t have a plan or any real intent to follow through with these thoughts).
  2. If your symptoms are starting to interfere with your daily life. Such symptoms could include suddenly not getting along with friends or family, difficulty with sleep, problems eating, doing poorly in school or work, or starting to use alcohol or drugs to cope or feel better.
How to choose a therapist

There are many different types of talk therapies available, and many types of therapists to choose from. So which therapy and therapist is right for you? When it comes to treating all mental health issues, especially anxiety or depression, you want to make sure you chose a therapist that uses an approach that is evidence based or empirically validated. This means that they say and do things to treat your symptoms that have been proven by research to be effective. It doesn’t mean watching episodes of Dr. Phil or Dr. Oz.

Client: “What should I do?”
Therapist: “What do you think you should do?”
Client: “Alright then, keep your secrets.”

When choosing a therapist, there’s an array of therapy degrees that include psychiatrists (M.D.), psychologists (PsyD.), and masters level therapists (LCSW, MCSW, etc.). Don’t get hung-up on the pedigree. Just make sure the person is licensed – meaning s/he went to a school that was accredited, received training that was accredited, and have passed both a national and state licensing examination to prove they know what they are talking about.

Equally important, you want to see someone that you like. If you’re going to see a therapist, the type of degree is less important than making sure they are licensed, using techniques that are supported by research, and are someone you can trust and get along with. I personally know some smart but asshole jerk psychologists that shouldn’t be advising anyone on anything, despite their diplomas. Remember who’s paying whom, and hire/fire accordingly.

How long will you need to attend therapy?

The duration of therapy needed is unique for everyone. Many people experience improvement within only a few sessions, while others reap benefits through months or even years of seeing a professional. There’s no commitment required. The goal is simply helping you achieve measurable improvement.

You can also access the “Managing Covid-19 Anxiety” resource page by the reputable Anxiety & Depression Association of America (ADAA).

Just come away from this knowing that you never need to white-knuckle things alone. Your state-of-mind can make it hard to reach-out, which is precisely when you should.

How do You Know if You’re Depressed or Just Sad?

You might think you’re feeling lazy or unmotivated, but here are the signs that it’s something more serious

Is your two-day, Netflix binge of “Black Mirror” and “Stranger Things” a bout of laziness and apathy, a case of “the melancholies,” or … clinical depression?

Maybe you think you’re depressed, or you’re just using depression as an excuse to be lethargic – only to realize this itself might be a symptom of depression. It’s tough trying to figure-out your head with your own mind, right?

The brain is an organ that can malfunction like any organ. Mental illnesses are illnesses of that organ.

Brain scans show that there is a physical difference between a healthy brain and a sick brain. Telling someone with depression, “You don’t have an issue, it’s all in your head” is as inane as telling someone with diabetes, “You don’t have an issue, it’s all in your pancreas.” Any organ is susceptible to disease or disorder.

When you’re feeling down, it’s imperative to distinguish feelings of sadness versus depression because confusion can lead you to avoid evaluation and treatment of a serious condition. Alternatively, you might overreact to a normal emotional state of sadness.

“And, here’s why the distinction is crucial: If we (or a loved one) are depressed, it has huge implications for our long-term mental health, physical health, and longevity,” says NYC Psychologist and author Dr. Guy Winch. Sadness and apathy are normal emotions. “Sadness is usually triggered by a difficult, hurtful, challenging, or disappointing event, experience, or situation,” says Winch. This also means that when something shifts, or we’ve gotten over the hurt or event, the sadness also wanes.

“Whereas depression is an abnormal emotional state; a mental illness that affects our thinking, emotions, perceptions, and behaviors in pervasive and chronic ways,” says Winch. Depression can occur in absence of any of the triggers that cause sadness. Sadness is about something and depression is about … nothing.

Criteria for Depression

Depression is classified into different types using a book with diagnostic criteria for mental health disorders. Now in its fifth edition, the book is called the Diagnostic and Statistical Manual of Mental Health Disorders. But, everyone just calls it the DSM-5. Think of it as the owner’s manual for the brain but – like an iPhone user guide – you must make an appointment with an accredited genius to see one.

The DSM-5 outlines the following criterion to make a diagnosis of depression.

Note: These serve only as a guideline. You need to see a mental health professional for a conclusive diagnosis. The individual must be experiencing five or more of the following symptoms during the same 2-week period, and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

  1. Depressed mood most of the day, nearly every day.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
  5. Fatigue or loss of energy nearly every day.
  6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition. Afterall, a bottomless mimosa brunch or afternoon of beers is enough to spur a days-long depressive spell, as booze and other substances are known depressants.

Anxiety and depression disorders are often interlinked.

“It’s very hard to find patients who are depressed who don’t also have anxiety. It’s equally hard to find people with anxiety that don’t have some depression,” says Charles Goodstein, MD, a professor of psychiatry at New York University School of Medicine. So, don’t berate yourself if you’re feeling anxiety on top of everything else. It’s more likely than not to occur. And though signs of depression, anxiety disorder, and even bipolar disorder have similarities, each requires different treatments right down to the therapy and medications used. This is why a professional diagnosis is so important to obtain the correct treatment regimen.

A Quick Lesson in Sourcing the “Why” in Your Life…

One of the most poignant examples of suffering and sadness is the story of Viktor Frankl, a physician and psychiatrist who survived four Nazi concentration and death camps, including the infamous Auschwitz. Frankl epitomized the words of Nietzsche: “He who has a Why to live for can bear almost any How.” As a prisoner, Frankl kept himself and his hopes alive by a desire to see his wife again and one day teach about man’s quest for meaning.

Sadly, Frankl’s parents, brother, and pregnant wife were killed; but he was able to cope, source the importance of it all, and move forward with a renewed life purpose to include writing one of the most moving and significant books of our time, Man’s Search for Meaning. Frankl teaches us that “if there is a meaning in life at all, there must be a meaning in suffering. Suffering is an eradicable part of life, even as fate and death. Without suffering and death human life cannot be complete.”

We all face the opportunity to achieve something through our own suffering. Our unique opportunity lies in the way we bear our burden, and in our attitude toward difficulty while pondering our meaning. Make no mistake; you have a decisive and purposeful meaning in this world. For many of us – myself included – it takes suffering and hardship to find it.

We are supposed to feel like we can’t handle things alone sometimes. That’s when we find the grace or help through others. In times when life becomes unmanageable, we must be willing to ask for help and support one another. It’s by design. We can be with one another amid suffering, helping each other bear the weight. Part of life is the realization that sometimes we can’t make it on our own. For some, a spiritual leader is a person to whom you can turn and say, “I have a burden that I cannot bear.” All it takes is walking into a local church, mosque, synagogue, or temple and asking for help.

Live to the point of tears.  -Albert Camus

Conquering Teen Anxiety

In this excerpt from “101 Ways to Conquer Teen Anxiety,” learn the difference between “normal” anxious feelings and those that interfere with daily life

Am I Losing My Mind, or Is This That Anxiety Thing?

Anxiety can make you feel different. As a teen, I never knew why no one else seemed to struggle with life the way I did. And it wouldn’t have mattered what diagnosis or label was put on me because it would not have changed how I felt. Sadly, teenagers can let anxiety steer them through most life decisions. Left untethered, anxiety will drive every choice and action you take.

So how do you know if you’re experiencing anxiety or something more insidious with a Latin name in the Physician’s Desk Reference? The type of anxiety we address in this book is not the healthy, normal varietal that prompts you to get important stuff done, like studying for an exam or running from prom date requests. According to the National Institute of Mental Health (NIMH), “Severe anxiety that lasts at least six months is generally considered to be a problem that might benefit from evaluation and treatment.”

Rather than motivating you to act and get things done, anxiety at this level interferes with daily living, activities, and relationships.

The Accoutrement of Depression

Like a salad bar and sneeze guard go together, anxiety and depression disorders are often interlinked. So, don’t berate yourself if you’re feeling depressed on top of everything else. It’s more likely than not to occur. And though signs of depression, anxiety disorder, and even bipolar disorder have similarities, each requires different treatments right down to medications used. This is why a professional diagnosis is so important in order to obtain the correct treatment regimen. Having anxiety doesn’t have the social stigma it once did. It just means you’re really living.

But, there is a little-known dichotomy about anxiety that makes seeking treatment difficult: When you’re feeling anxious or depressed, it’s often hard to do what’s best for your welfare – this includes seeking help. Anxiety is a narcissist that wants you to focus on … anxiety. Anxiety will cloud your mind and fill your consciousness with a perverse volume of thoughts, noise, feelings, and stressors that have no validity. Next thing you know, you’re not turning in homework on time, missing chores, and arriving late to work or practice, and everyone’s wondering why you can’t get your act or matching socks together. If they saw the thought carnival in your mind, they’d surely understand.

No medication will cure anxiety. Medication treats the symptoms of anxiety.

Every case of anxiety is unique. Unfortunately, many anxiety sufferers use prescription medication when therapy, exercise, or self-help strategies such as those taught here would work just as well – if not better – because they are actual skills with no side effects. Therapy and skills usage include development of the necessary tools to beat anxiety.

The goal we’d like you to adopt from this book is not to remove anxiety, but to bring it down to more manageable levels. That means working with it directly, in a nonjudgmental way, and not avoiding it or thinking it’s bad or weak that you feel this way. We’ll talk specifically about how to do this in the book.

For more on 101 Ways to Conquer Teen Anxiety click here.

If You’ve Ever Thought These 7 Things, You Might Have Relationship OCD (as featured at YourTango.com July 2018)

And the 10 Steps to Take if You Do.

The power of the human mind is wonderful and boggling – except when it turns on you while peppering your psyche with a staccato of queries about your relationship. 

One minute your partner’s grandeur is so intense, it’s cartoonish. How did you ever land such a splendid fish? The next you’re spun into a vortex of doubt, placing them under intense analysis, and scrutinizing every nuance of the relationship, including their questionably thick eyebrows.

This barrage of errant thoughts and questions commonly arise in otherwise healthy relationships. The obsessions include judgments around their imperfections as a person and partner, or about the rightness of the relationship itself:

  1. Why can’t he get that huge mole on his back removed?
  2. Does her nose-have to whistle whenever she chews? Could I do better?
  3. I just saw a hot guy at Starbucks, so am I in the wrong relationship?
  4. Is he even smart enough for me?
  5. Why aren’t we shmoopy like other couples?
  6. There are times I’d rather look at Instagram than have sex with him. Am I staying in this relationship just to avoid hurting him?
  7. Why don’t I miss her even though I’ve been at Coachella for three days?

The form of anxiety that comes with liking someone is so common that it has its own acronym: ROCD (relationship obsessive compulsive disorder). The seemingly sublime onset of ROCD has led to many brain-worm Taylor Swift songs and vodka tonics pondering if you’re with the right person. You may avoid taking the next step in your relationship because you can’t get past their perceived flaws, or you might even quit dating altogether because no one seems good enough. You met them on a free dating app, after all.

ROCD has been receiving increasing research and clinical attention as a form of Obsessive Compulsive Disorder (OCD) in which the sufferer experiences intrusive, unwanted and distressing thoughts about the strength, quality, and nature of their love for their partner. As with other forms of OCD, the fixations in ROCD focus on issues of doubt and an intense discomfort with uncertainty.

These obsessions often contain responding compulsive behaviors to include seeking reassurances or gauging one’s own feelings, comparing characteristics of one’s partner with those of other potential mates, or avoidance actions. The compulsions, which are intended to lessen the distress caused by unwanted thoughts, can take forms such as regularly asking friends or family if you have made the “right” choice in your partner; comparing your relationship to a previous exciting (often unhealthy) relationship, Internet searches about “the one,” finding that sex is a chore or eating a sandwich during sex, while fixated on that back mole or eyebrow shrub.

Relationships in which one partner has ROCD can be chaotic, ending in the sad, ironic twist that the dread of hurting or losing one’s partner often results in both.

From Where Does ROCD Arise?

You position your companion against idealistic projections of “real” love from episodes of The Bachelor, royal weddings, or the seething sexual chemistry in Trojan™ personal lubricant commercials. This is exacerbated by dating apps like Tinder and OK Cupid which have created an atmosphere of seemingly endless options, short-attention-span-dating, and The BBD (bigger, better, deal). We have commoditized ourselves, and dating has become transactional. It’s no wonder that our anxiety surrounding relationships, commitment, and marriage has shot up, while the principles of love and marriage run askew.

Add to this the notion of “soulmates,” which further ups the relationship anxiety ante. There’s a fantasy that guides many into seeking idyllic partners or soulmates. If you could find that perfect match you’ll be guaranteed a lifetime of relationship bliss, right?

Nope.

Research by Aurora University psychologist Renae Franiuk who studies people’s beliefs about their intimate partnerships, called “Implicit Theories of Relationships,” says “People who believe in soul mates may be setting themselves up for a lifetime of heartache and failed relationships. If you operate according to the soulmate theory of relationships, you constantly evaluate your dating partners against the idealized image of the man or woman who will be the one true love of your life. Once you’re in a relationship, even without your knowing it, you perform constant comparisons between the actual person you’re with and that ideal one-true-love model in your mind.”

There is a persistent idea that when we choose someone to be a long-term partner, s/he will be an incredible lover, hold fireside chats about Tolstoy, and take long beach saunters while sharing kale smoothies. OCD demands that there be no doubt in a person’s mind whether s/he has chosen the right person. To the ROCD sufferer, their obsession is, “I must know unequivocally that my partner is the absolute one for me.” This belief is steeped in anxiety. The anxiety, in turn, compels the person to engage in the compulsive behaviors in a vain attempt to arrive at certainty.

How to Counter ROCD:

The goal is to reduce ROCD symptoms enough to reach an informed decision regarding your relationship. Implement any of the following skills to move toward inner peace:

1. Let go or be dragged.

Radically accept that there is no way to know with 100% certainty whether any relationship will work out for the long-haul. If they make you happy, and you share similar values and goals, then Yahtzee! We all have flaws, and no relationship is perfect.

2. Remember thoughts and feelings do not equal facts.

Remind yourself that all OCD is rooted in irrational fears and lies to you with baseless obsessions, rituals, and ruminations. Just because you think it or feel it, doesn’t mean it’s true. And, if you have experienced past OCD symptoms, a relationship can easily become the new focus.

3. Expose yourself.

The most effective form of treatment for ROCD is called Exposure and Response Prevention (ERP). This entails exposing yourself to the thoughts, images, objects, and situations that make you anxious and cue your obsessions, while not engaging in a compulsive behavior in attempts to alleviate the angst. For example, if you’re claustrophobic, take the elevator, not the stairs.

4. Daisy chain your obsessions.

If you mentally play-out the calamitous beliefs causing you distress, you will negate their power over you. For each obsession, ask “And what’s the worst that can happen?” until you get to the end and see that the worst result is not catastrophic. ROCD includes a gross overestimation of the negative consequences of staying in relationships or being alone.

5. Stop the comparisons.

Comparison is the fastest route to misery. Stop researching or collaborating with others about the fit of your partner. Check-in with yourself whenever you find you’re ruminating about the relationship. This includes comparing your real relationship with those nauseating social media versions that you can “thumbs-up” later when they inevitably split.

Attraction and arousal wax and wane. Expecting yourself to always find your partner attractive, or to always be interested in sex is setting yourself up for discontent.

6. Realize that risk is scary, but regret is scarier.

Be willing to sit with the anxiety caused by the thought that you may not be committing to the “right” person. To live life fully one must take risks, or face regrets. Once you stop pursuing a futile quest for certainty, you can move forward. Seeking assurances is a compulsion that increases OCD thinking patterns.

7. Give yourself the present of presence.

Mindfulness is a skill that is practiced and perfected little by little … like using chopsticks to eat a salad. Mindfulness meditation encourages the practitioner to observe wandering thoughts as they drift through the mind. The intention is not to get involved with the thoughts or to judge them, but simply to be aware of each mental note as it arises. With practice, an inner balance and peacefulness develops and you become Yoda-like.

Don’t worry — meditating is easier than you might think.

Sit or lie comfortably in a quiet setting. Close your eyes. Make no effort to control the breath; just breathe naturally. Maintain your focus and attention on your breath and on how your body moves with each inhalation and exhalation. Each time your mind drifts to your thoughts, refocus back to your breaths.

8. Grab a pen and get mighty.

Research has shown that journaling helps reduce stress, solve problems more effectively and even improve your health. University of Texas at Austin psychologist and researcher James Pennebaker found that regular journaling strengthens immune cells, called T-lymphocytes. Writing about stressful events helps you accept them, thereby reducing the impact of the stressors on your mental and physical health.

9. Remember that you cannot control your thoughts.

And that’s okay! It may appear that you can, but it only backfires with more obsessions and compulsions. What matters is what we do with our thoughts. Pay attention to your breathing and notice where in your body you are feeling the melee. Stay with that for a few minutes. Then notice where you feel the most comfortable. Then stay with that. Shift back and forth slowly for about 15 minutes. Do this every day.

10. Get by with a little help.

Notice your past relationships. How often have similar doubts shown up in your life? If there is a pattern, do not break off the relationship until you have practiced these skills, or consulted with a professional therapist. Like other OCD symptoms, relationship OCD symptoms require psychological intervention if causing significant distress.

If you’re in a place where you’re ready to reach out for help, consider online therapy.

What’s Under His Suit? Depression and Anxiety (as featured at PsychCentral.com)

Let’s get candid about male mental health.

Men don’t get a lot of compassion — not as a gender, not toward one another, and not toward ourselves. We are the more impulsive, less refined gender that has not progressed much since our cave-dwelling days. We’ve learned to use a salad fork since then, however, and we pretend to enjoy chivalry.

Sadly — and perhaps due to our ruffian status — men are often perceived as an expendable lot, regularly sent to do life’s dirty work like unclogging municipal sewers, diffusing IEDs, repossessing tractors, or mining for coal and ore miles below Earth’s surface. When duty calls, somewhere a willing man answers.

It is our own culture that depicts men as the stronger sex.

This might be true when it comes to opening new bottles of ketchup, or scaling a tree to save a kitten. But when it comes to our mental health, men are subjected to a culture where the standards of masculinity are literally making us sick. Men make up most suicides, and the minority of mental health service users.

It’s a misnomer that men have only two feelings: hungry and horny. Male anxiety, depression, and suicide has become a silent crisis, and one of the biggest challenges in combating mental health disorders in men is that they are difficult to reach through traditional methods, like physicians or mental health programs. Moreover, the condition is often masked by risky behaviors, self-harm, and substance abuse.

Anxiety and depression run feral and cloaked within men everywhere. Most just channel or compartmentalize it while it individually displays as forms of fatigue or apathy; insomnia or lethargy; substance abuse; irritability; conflict and anger; isolation; impulsivity and risky behaviors; mood swings; relationship and job problems; denial; self-criticism; aches, pains, or digestive problems; indecision; and suicidal thoughts.

I personally distracted from my anxiety and depression with feats of athleticism and binge drinking, resulting in 13 orthopedic surgeries and countless broken bones. I had no choice but to become a writer. My hands were the only thing not in a cast or physical therapy.

Emotions have no gender.

Most men are too obstinate or ashamed to seek help for anything involving our head except a nail from a pneumatic gun or balding. Sadly, men must hide behind the facades they feel pressed to create. Men have come to accept many things, but being considered weak isn’t one of them. Yet forms of anxiety like PTSD are diseases of the tough-minded.

Mental disorders and illness don’t care if you’re a war vet, foreman, or florist. They’re an indiscriminate mind sweeper. It can happen to anyone, any age and any gender. And it’s not just “all in your head.” It’s a medical problem that can wreak havoc 24/7 like any other ailment on any other organ.

How to Mind Your Mind:

JUST DO IT … LATER. Mental breaks increase productivity, replenish attention, solidify memories and encourage creativity. Schedule downtime to do nothing. Consider practicing some relaxation techniques. This can include simple meditative breathing exercises, or guided meditations available on YouTube or via smartphone apps. The best way to get your brain and body to work at their peak is to take rest breaks.

RADICAL ACCEPTANCE IS THE NEW DENIAL. One option you have for any problem is Radical Acceptance (Linehan, 1993). Radical acceptance is about radically accepting life on life’s terms and not resisting what you cannot change. Radically and mindfully accept that you cannot control everything, and let life live you.

COFFEE AND BOOZE LIE TO YOU. Caffeine sets unrealistic expectations of your daily productivity and can spike anxiety. Though low doses (200 mg) of caffeine is known to improve cognitive performance, studies revealhigher anxiety levels in moderate and high caffeine consumers versus abstainers.

On the other hand, alcohol is a depressant which slows down the brain and the central nervous system’s processes. Alcohol may help deal with stress in the short term, but long term it can contribute to feelings of depression and anxiety and make stress harder to deal with.

LET ME HEAR YOUR BODY TALK. Exercise is a phenomenal antidepressant and anti-anxiety tool. Channel nervous energy, stress, and even depression into a regular exercise program. More than the physical upside, there is the social aspect in structure, and seeing regulars and friends. Exercise improves mental health by reducing anxiety, depression, and stress, while improving self-esteem and cognitive functioning (Richardson CR, Faulkner G, and McDevitt J. Et al. Psychiatric Serv. 2005 56:324–331).

YOUR BED IS A TIME MACHINE TO PANCAKES. Serial killers are just regular people on too little sleep. Promote good sleep hygiene. Get to bed early and at the same time each night. Turn off the electronics to turn off your brain. Sleep problems greatly exacerbate stress and anxiety. Research indicates that REM sleep may play an especially significant role in maintaining emotional well-being and psychological balance.

YOUR CHEAT MEAL SHOULDN’T BE A MONTH LONG. Some say that you can’t spell “salad” without “sad.” But there is a direct correlation between a healthy diet and a positive mindset. During times of stress, we often turn to traditional “comfort” foods like fast food, pizza, and ice cream, which make us feel sluggish and less able to deal with stress. Brain food such as the antioxidants in fruits and vegetables, is thought to improve cognitive function, and can be used at preventing or treating many stress-related mental disorders (The Journal of Medical Investigation, Vol. 51, 2004).

PLUG YOUR BEAK. By controlling your breathing, you will slow your heartbeat and eliminate anxiety and panic. Try alternate nostril breathing (aka, yogic breathing). This is a simple, natural breathing technique from Ayurvedic medicine that brings the body and mind into a state of balance and neutrality. Close one nostril by placing your thumb gently over it. Exhale; then inhale through the uncovered nostril. After each inhale/exhale (a breath cycle), switch sides. Then, leading with your out-breath, do one out-breath followed by one in-breath through each nostril. Repeat this series, alternating nostrils after each inhalation. It will likely be easier to breathe through one nostril than the other. You’re not deformed. It’s normal.

I WILL FIND YOU, AND I WILL THANK YOU. Being grateful by focusing on gratitude improves physical health. According to a 2012 study published in Personality and Individual Differences, grateful people experience fewer aches and pains and report feeling healthier. Not only does gratitude do the obvious work of increasing how much positive emotion we feel, it just as importantly robs the negative energy that is the driving force of why we feel so bad. Cite three things for which you are grateful each day, no matter how small.

BECOME A FREAK OF NATURE. A 2015 Stanford study found quantifiable evidence that walking in nature can reduce stress and lead to a lower risk of depression. By 2050, 70% of people will live in urban areas. Urbanization is associated with increased levels of mental illness, but it’s not yet clear why.

PHONE A FREUD. There is no shame in seeking help. If stress, anxiety, or depression disrupts your life or daily activities, get a mental spotter. It is imperative to know when to seek professional help. The easiest index to use is if your emotions are starting to interfere with daily life functioning. Make an appointment with your doctor or a mental health provider because you may need treatment to get better. Cognitive Behavioral Therapy (CBT) is an effective treatment for anxiety. Self-medicating is not. You can find a trustworthy mental health professional HERE.

Don’t believe everything your mind tells you.