FYI- Many insurance companies are waiving copayments for their clients who would like to receive online counseling at this time. Please connect with your mental health insurance provider to see if you are eligible.
Have you ever spoken to a friend on FaceTime? Participated in a Zoom meeting for work? Chances are you have virtually connected with someone via video at some point. The world is becoming more virtual as technology improves and many have smartphones that allow you to reach out to someone quite easily.
Now that much of the nation is practicing social distancing or are in places that many non-essential services are shut down due to COVID-19, we are staying home to flatten the curve and protect those who are more vulnerable to the virus. In the past, this could mean weeks of skipped therapy or inability to access help when we all need it the most. Online therapy can provide treatment while also addressing the anxieties, stressors, and fears this pandemic has caused.
Recent research reflects that online therapy can be just as effective and sometimes, more convenient in our busy lives. Also, virtual therapy can feel more comfortable for some as it is conducted while you are in your own environment. As with traditional therapy, you receive the same treatment and can discuss what you need to with your therapist as if you were face to face.
Let’s talk about the benefits of online therapy
1 It doesn’t just have to be on video
If you aren’t comfortable with video, online therapy offers other methods. Some therapists offer text-based therapy and allow you to contact them throughout the week. This can be especially useful for those with social anxiety, panic and agoraphobia. Second, there is audio therapy – in this method, you and your therapist will meet on Zoom or the telephone.
2 No commute
Commuting for therapy appointments can be cumbersome. Add the costs associated (transportation, parking, childcare and missing work for appointments) it can become a financial and scheduling burden. Many people don’t begin therapy or stop going because of the difficulties in traveling to their therapist. Online therapy removes these hindrances and makes it easier to find a time that is convenient for yourself and your therapist.
3 Great if you are uniquely abled
If you have accessibility issues or physical limitations including being housebound, online therapy is an excellent choice for you.
4 Still covered by insurance
Many insurances cover online therapy sessions, however, it always good to contact your healthcare insurance to see if they are covered under your policy.
5 As always, it is confidential
As with your visits to your therapist are private and confidential, so are your online visits! Online therapy is completely confidential and the same rules that apply offline are still applied online. The therapy itself can sometimes cause stigma around mental health; online therapy reduces this. That way you are more comfortable with the sessions and your communication during them.
Also, communication online is encrypted through an HIPAA compliant platform called VSee. VSee is free for the you and can be downloaded onto your phone or computer.
6 Your therapist must be licensed in the state you live in
Some may be licensed in more than one state. So, you know you are getting quality healthcare by a reputable and credited provider to meet your mental health needs. This also means they are aware and comply with all Health Insurance Portability and Accountability Act (HIPAA), ethic and legal practices.
7 You can have access to a specialist that you cannot find locally
You may want a certain type of therapy such as cognitive-behavioral therapy (CBT), dialectical behavioral therapy or other evidence-based treatment. Oftentimes, therapists formally trained and specialized in these modalities for panic, anxiety, and other diagnoses are much easier accessed virtually. You may more likely to find a suitable and qualified therapist if you go beyond the location you would stay in to visit a therapist in an office.
Online therapy isn’t the best choice for everyone, and some mental health disorders may be better treated in person. Clients who are actively at risk of harm to self or others are not suitable for teletherapy services. If you are feeling suicidal, it is better to be seen in person. That said, during the quarantine many therapists are allowing for online sessions regardless.
Many of my clients are finding that treatment for their anxiety and worry during this time of uncertainty has been surprisingly easy, and it is a great way for your counselor to see where you live, meet your pets and maybe even family members. If you’re interested in learning more- please don’t hesitate to reach out!
Here’s to all of us taking great care of ourselves, and making it through to the other side stronger and thriving!
Ambiguity, a sense of uncertainty about what’s going on or what might happen, is part of life. This blog post explores dealing with the unknowns in life and how to handle them.
When Your Environment is Unpredictable
Wow, what a week. Coronavirus or COVID-19 is all over the news and it seems that panic has set in. It is understandable to be anxious when uncertainty is all around us. Our world has been thrown off, and a new normal is here for the near future.
Human distaste for the unknown is well-grounded in experimental psychology, and research has shown that when given the choice, most of us feel calmer knowing that something bad will happen in the near future vs. it possibly happening. This phenomenon is apparent even if it causes us intense stress. Daniel Gilbert, author of the best-selling book Stumbling on Happiness writes:
“Consider an experiment by researchers at Maastricht University in the Netherlands who gave subjects a series of 20 electric shocks. Some subjects knew they would receive an intense shock on every trial. Others knew they would receive 17 mild shocks and 3 intense shocks, but they didn’t know which of the 20 trials the intense shocks would come. The results showed that subjects who thought there was a small chance of receiving an intense shock were more afraid — they sweated more profusely, their hearts beat faster than subjects who knew for sure that they’d receive an intense shock”.
WAYS TO HANDLE ANXIETY
We can’t eliminate uncertainty in our lives, but we can manage our reactions to the unknown in healthy ways using one technique that the best cognitive behavioral therapists employ:
REST Technique or Radical Acceptance
When you become overwhelmed or feel anxious, your first instinct may be to act impulsively or panic. There is a healthier method – Take a REST.
Set an intention
Step one is to literally freeze and stop whatever you are doing. Breathe. Step away from the situation for a few seconds. Try to find a different perspective on what is happening and create a space between yourself and the impulsiveness you may feel. You can even tell yourself out loud to “Relax” or “Rest”. Slow your breathing down and calm down before you decide on another course of action.
Ask yourself what is going on – what are the facts in the situation? You don’t need to solve an ambiguous problem or discover any answers right now. You only have to evaluate what is happening to your physical, mental, and emotional self. Move on to looking at other people around you. At this point ask yourself “How do I feel?” and “Are the people around me in immediate danger?” Think right here, right now.
Set an Intention
“Step three is to set an intention to do something.” You can also treat an intention as a goal or plan. Decide what you will do, pick a distraction or self-soothing skill and ask yourself “What do I need right now?” Whatever you choose isn’t permanent, it is only for right now.
Distractors and soothers that help get you out of the uncertainty trap do not have to be expensive or time-intensive. Good examples of immediate coping skills are:
Count all the greens or blues in your vision.
Describe a wall or other item in detail.
Alphabetize movies, songs, cities, etc. in your head or on a sheet of paper.
Breathe 4 seconds in, hold for 4 seconds, and out for 6.
Pay close attention to the living things around you
Clean, fix something, do anything where you move your body for 5 minutes.
Lastly, take action. Mindfully move ahead slowly and meaningfully toward what you are doing. Slow and deliberate often helps us get what we want to be done faster than rushing through. Even if this is not the final solution to your problem, it is a healthy and effective way to thwart any impulsive behaviors or panic that may set in when uncertain.
Once you start getting used to using the REST technique, you will begin to identify when you are distress and can implement these steps in a few seconds. You will be ready to spring your new habit into motion and “REST” when you feel like you are in a similar situation again.
QUIZ: HOW WELL DO YOU MANAGE UNCERTAINTY?
Everyone has a different level of tolerance for ambiguity. Wondering how good you are at tolerating ambiguity? There is an easy way to find out. The Tolerance for Ambiguity scale will tell you. You will respond to a set of 16 statements about your attitudes and behaviors. Whether your score is particularly high, or lower than you expected, it is interesting to know where you stand. This information might also be helpful to a therapist who you consult to help you manage anxiety.
Of course, if you follow the directions given by healthcare professionals for the coronavirus, you will feel like you have some control and they are good precautionary habits to have in our current environment.
Also, make sure you stay connected with your support system via phone and video and limit your use of social media, which is less interactive and in turn, increases our anxieties.
Matthew McKay Ph.D., Jeffrey C. Wood PsyD, et al… The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, … (A New Harbinger Self-Help Workbook) New Harbinger Publications; Second Edition, Revised edition (October 1, 2019) Print.
As the world has been inundated with news of the coronavirus, I want to share this great post by fellow therapist and gifted writer, Brianne Rehac, LMHC in how we all are coping with anxiety differently. Take good care of yourself and your loved ones this weekend! Warmly- Karen
“This week, I have spoken to many people about their heightened emotions since the outbreak of coronavirus disease 2019 (COVID-19).
Everyone has a definition of what is a stressful event for them. And everyone reacts to those events differently. If you find that you have not felt impacted at all by reports of the coronavirus outbreak, that is a perfectly okay response. If you find that you have been more anxious, sad, irritable or angry lately, that is completely normal, too. Our reaction to stressful events is a product of a multitude of factors including, our proximity to the event, socioeconomic status, personal history, and personality. Some people who may respond more strongly include individuals who are managing a mental health condition (like anxiety), children, and first responders/healthcare professionals.
Sometimes responses to a stressful event don’t present as emotions. Instead, you may notice a change in sleep patterns; change in appetite; difficulty concentrating; worsening of a chronic health problem (like GERD or chronic pain); change in behavior (stocking up on essentials or changing your routine); or increased use of alcohol or other drugs.
It is really important that during stressful times, you continue to take care of your physical and mental health. That means sticking to your treatment plan, including taking medications as prescribed; attending routine appointments; adhering to any special diet you may have. It also means reaching out to your supports—family, friends, doctors, therapists, and support groups. You’re connecting to them not just for yourself, but for them, too. Let’s all check in with each other on this, okay?”
SAMHSA’s Disaster Distress Helpline
Toll-Free: 1-800-985-5990 (English and español)
SMS: Text TalkWithUs to 66746
SMS (español): “Hablanos” al 66746
National Suicide Prevention Lifeline
Nacional de Prevención del Suicidio
Options For Deaf + Hard of Hearing
Veterans Crisis Line
Your mental health is important, why mental health apps? Sometimes you cannot afford to see a therapist, do not have time to go to one, or one isn’t accessible where you live. Perhaps you aren’t ready to see one but would like to see what therapy all is about. Maybe you see a therapist, but need help to put the helpful techniques they have given you into practice. Mental health apps can be very beneficial, free, low-cost or affordably priced, and offer a way to help give you therapeutic help on the go. So which ones are best? There are so many out there!
Mental health apps that I recommend:
Headspace is an app that just about anyone can use, whether you are dealing with stress, anxiety, lack of focus, or sleeping difficulties. It teaches you to “meditate and live mindfully”. Meditation has been shown to reduce stress, lessens anxiety, support emotional health, and enhances self-awareness. This app provides small meditation modules to accommodate people’s busy schedules and “SOS exercises in case of sudden meltdowns.” You can take advantage of their free trial and if you like it, you can make the jump to a monthly subscription.
Youper is an app that is powered by AI – “your emotional health assistant”. This app allows you to have conversations, guidance through meditations that are personalized for you and trackers that help you monitor your emotional health and mood. This technology created by doctors, scientists and engineers;focuses on the science and pursuit of happiness – helping those with depression and anxiety live happier lives with treatments personalized for them. This app also works in conjunction with seeing a therapist, as you can ‘share’ your information. Many of my clients use this app as complements many of the CBT techniques we use right in session.
Youper is free to download and have some free features; more advanced features are based on a subscription plan.
This app offers meditation training as part of a “mental fitness” approach. FitMind uses traditional techniques used since ancient times with western science. Using daily challenges, along with access to meditation instructors; FitMind can help you learn to meditate in a way that works for you. Again, meditation is a useful tool for improving mental health because of all of the health benefits you get from practicing it. This app is free and offers in-app purchases.
Sanvello is an app designed for stress, anxiety, and depression using strategies and resources that can help you with the symptoms and situations you are dealing with at the moment. You can customize goals; like mindfulness, building confidence and thinking positively. Based on clinically proven techniques, this app offers tracking for mood and sleep, tools for relaxation and meditation and you can connect to a group of your peers for further support. Free to sign up and install.
This mental health app uses four tools that are designed to enhance your mood, identify and change unhealthy thinking, track mood, and create journal entries. Managing negative feelings thoughts by identifying situations that cause stress, changing how you think, monitoring your mood through tracking, and developing self-awareness through writing is all of the ways MoodKit is designed to help you improve your mood and mental health. This app is only available on the iPhone and iPad, but is just $4.99.
Mental health treatment is no longer limited to the office and self-help books. Whether you are on the road, want quick help, or establish a daily cognitive behaviorally based self-care routine, there has never been so many options on how to start. It’s good for you, and most apps have a free trial! Jump in and let us know how it goes.
The extra demands combined with the typical stress around the holidays can cause most of us to fall into the trap rigid thinking and the belief that life should be idyllic. If you struggle with anxiety, this season can be an especially difficult time. Perfectionism is something cognitive behavioral therapists see often. Here are some good CBT-based tips on how to help yourself during the rest of 2017
Do Not Strive For Perfect
Perfectionism is a self-imposed unrealistic expectation and the subsequent stringent judgments on you, others, or a situation. You are with yourself every day and you see every mistake you make, so we tend to have quite a long checklist of our real and perceived mishaps. When you focus on self-defeating thoughts, you become hypercritical and begin to put more weight on the negative aspects of oneself. Inevitably, this leads to depression, low-self esteem, and a sense of frustration. Of course, this isn’t beneficial to you and the people who love you. When you find yourself revisiting that list of mistakes, it’s time to combat them by a CBT technique termed a ‘positive data log’. Write down events that were ‘good enough’, or events that were just fine in spite of being imperfect you begin to be more flexible, and your all or nothing mindset can be reduced.
With so many social media apps, unrealistic advertising, and other messages promoting perfectionism, it’s impossible to not compare your life with an idealized sample of others. For perfectionists, it’s not easy to remember to take a step back and assess reality. When we engage in perfectionistic comparison, we typically measure ourselves next to someone we already think is ‘better’ in some way. However, all that time comparing can have real consequences. A recent study among Facebook and Twitter users showed 62% feel inadequate and 60% feel jealous when using social media. The same study found half of participants from 18-34 felt ugly due after time online.
Are co-workers, ex’s, or family on social media fueling your feelings of inadequacy and stress? If you want to kick perfectionism to the curb, un-follow your “competition”, and kindly remind yourself that social media is not a representation of reality, even if just over the holidays.
Temper Family Expectations
Family can cause a lot of distress around the holidays, and even more so when you have lofty expectations. There is already enough pressure around this time of the year without adding perfectionism to the mix. Remember, you can’t control the actions of your family, but you can control your own. Part of walking the walk is that you can identify and reduce acting and thinking in ways that are not productive.
Trying to change others can be akin to entering a faulty debit card pin at checkout. You are in a hurry, and your code won’t work. Instead of admitting defeat, you continue to enter the same thing with growing frustration. Your blood pressure is rising, as is that of the cashier and the people behind you in line. All of this stress and anxiety could have been avoided if you simply stopped repeating the same unproductive habits and expectations.
Beat Perfectionism by Shifting Perspectives- An Experiment in CBT
On days when everything goes wrong, take a minute to consider how much worse things could be to shift your negative perspective. The following are three other tricks to engage your positive lens.
1.Incorporate a daily gratitude practice. According to CBT research, gratitude improves mental health, emotional health, sleep, and self-esteem. Each morning, night, or both write down 5 things you are grateful for, and that is all.
2. Acknowledge Your Power. Cognitive behavioral therapists emphasize that it’s vital to recognize that we all have control to choose our perspectives. We choose which thoughts to pay attention. Reorienting yourself to the positive can add more value and warmth to the way you experience your life.
In Part 3, I’ll be discussing cognitive-behavioral approaches to coping with loneliness over the holidays. As always, please let me know how these tips work for you. Other ideas? Please share. Enjoy the rest of your month and experiment with your new tools. What to know more about cognitive behavioral therapy? Click here for an FAQ: Cognitive Behavioral Therapy/CBT in San Diego
Positive psychologists and cognitive behavioral therapists promote certain behaviors that prime the brain for happiness.
Shawn Achor is one of my personal heroes- you may have heard of him as the author of ‘The Happiness Advantage’ or through his infamous TED Talk which you can find here. After almost a half a century in the making, positive psychology is sweeping the mental health landscape and I couldn’t be more thrilled. Cognitive behavioral therapists, educators and behavioral scientists are adopting techniques, such as the ‘happiness advantage’ to help people shift their mindset towards the good.
A Cognitive Therapist’s Answer to “Why Can’t I Find Happiness?”
‘Happiness’ makes many think of smiles, the sunshine, material acquisitions, and absolute bliss. People often perceive ‘happy’ as being beyond our control, that it has to do with external factors or some level of intangible success. However, when you depend on external factors to reach this mysterious state, you set yourself up for fleeting joy but also long-term disappointment, which can lead to depression and anxiety.
Contentment does not have to be controlled by external factors, what you have achieved, or what you or someone else consider the ultimate success. Rather than telling yourself that happiness is something to wait for, or believing that a partner, weight loss, or more money will lead you there, you can train your brain to be positive in the here and now. According to Shawn, if your brain is focused on positivity, it performs 31% more productively than when it is negative, neutral, or stressed. With the happiness advantage, your intelligence, creativity, and energy levels rise. That said, it makes much more sense to focus on how happiness leads to success, instead of the other way around.
It makes sense that managing depression and anxiety can be approached in a different and more effective way- by creating a new internal reality. As you learn how to become more positive in the present, the solution may not seem as hard to achieve. Training your brain to be more positive is something you’ve already taught it to do other tasks until it becomes automatic. Have you ever catch your fingers hitting the ‘F’ for Facebook without even noticing? Reaching for the snooze button? These are both common examples of automatic thoughts.
Over time, reversing your formula for happiness in the now and leading your brain to focus on the present and the positive aspects is a mighty force. The trick is to act differently right now, and your brain will begin to become primed for success, which means that you will be able to work harder, faster, and more intelligently in the moment as well as long-term. One of the ways that your brain can be trained is to encourage the release of dopamine, which is a vital ‘feel good’ hormone. Dopamine has two functions: first, to make you happier and second, to trigger all of your learning centers in your brain- of course, you’ve already watched Shawn Achor’s TED Talk and know this, right?
When I work with clients who are looking for solutions to anxiety or depression, I make sure I focus on behaviors instead of feelings. There are several actions that can train your brain to produce more of that precious dopamine. Shawn asserts that if you practice a positive habit daily for 21 days in a row, you can build a habit and train your brain to be more positive. Three ways to achieve this are to:
Journaling- Write down one positive experience in the past 24-hours, so that your brain can relive that experience and start focusing on it. This habit teaches your brain that what you do and what actions you take each day matter.
Meditation- Take the time to slow down and meditate, giving your brain a chance to stop multitasking and to focus more on one task, such as the matter at hand. Opportunites to meditate are everywhere and are easier that you may think, as this article by Temma Ehrenfeld discusses.
Random act of kindness- Completing a conscious act of kindness can increase the dopamine levels in your brain, such as writing a positive email to a friend, praising a friend for something they accomplished, thanking someone for their support, or simply complimenting someone on their clothes or hair. Personally, this is one of my favorites. A few years ago I published an article on how volunteering can battle a sour mood. Do you live in my town of San Diego? Volunteer Match is a super way to get on it!
As the exercises above reflect, CBT helps you learn skills needed to be happier and more content. Behavioral interventions can be simple and if practiced every day, these types of activities help improve depressed moods and how to be happier in the present!
Happiness is within your control and is attainable with daily practice. Building some simple habits into your daily life will help you create that positivity and happiness that you desire. If you’ve already been influenced by Shawn Achor’s work, please comment below- I’d love to hear from you!