by Counseling and Wellness Center of PittsburghNovember 28, 2019 gratitude, gratitude challenge, reframing cognitive distortions, thanksgiving0 comments
The Real Gratitude Challenge
It’s Thanksgiving and everyone wants to talk about turkey and gratitude. Newsfeeds and flyers encourage us to take the ‘gratitude challenge’ by sharing how happy we are for our kids, our marriage, families, our job, our house. Nowonder, according to the National Institute of Health, gratitude can help us increase our life satisfaction and mental health! Oh, how nice that is! Things really are so well and good through the lens of this gratitude, but isn’t it almost too easy when we simply share what is great? I want to talk about a different kind of gratitude, the dark side of gratitude if you will, this is what I call a gratitude challenge. It is not the shiny happiness and gloating we feel when everything works out just the way we want it, but instead, this gratitude challenge, is the kind of gratitude that we can choose to cultivate when we are sitting on a big tall mountain of suck. In this vast beautiful adventure of life, reality more often than not smacks us in the face, universal are the experiences of hurt, loss, and grief. Yet, even more important than making a mental note of gratitude for all of the ways that we are blessed, our mindset truly evolves when we deliberately choose to frame our losses in one beset by gratitude.
Of course on the day that you get the job, and then again when you land the promotion, you are elated, but can you be grateful for those years of success and comradery even when you get the news that company is downsizing and you are handed your severance? Of course, you are beaming at the altar on the day that you say “I do” to the love of your life, but can you still find gratitude when you are headed to marriage counseling because you’re in conflict and bickering about who is doing more cleaning around hte house? Of course, you will be joyful on the day when you learn that you have finally conceived the child you have been yearning for but can you still be grateful that it has happened when their little heart stops beating in utero? Of course, you are thrilled when you finish the marathon in 2nd place, but what can you choose to be grateful for when you have knee replacement surgery from all of that running?
Choosing gratitude amidst the sucky moments of life doesn’t mean that we pretend it’s all ok. Instead, we do not try to block the hurt of our losses, we feel the devastation and despair deeply because let’s be honest here, we have no choice! Some things in life will rip the wind right out of our lungs and bring such agonizing hurt that we will fall to our knees in the pain of it. Yet, the difference is that we choose to live in the memory of the joy that they brought us, we choose to be grateful that the wonders in life have happened no-matter how long or short they stay with us. Cognitive behavioral therapy instructs us to reframe the despair of our cognitive distortions, we do not allow misery or grief to frame the pictures of our memories or the loss in our life. The gratitude challenge is to be penetrated by the suffering of a life well lived but then to hunt like a little scavenger for every little bit of joy, peace, and hope that our experiences have shown to us. Some days that might mean that we are grateful to know that they pain won’t last forever and allow ourselves to contemplate the gratitude for that. When you get here and can nurture this sort of perspective, you take a little bit of power and direction back to your life. On Thanksgiving and every day, the decision to live a life peppered in gratitude is yours. So go ahead, take the challenge, how grateful can you be, what about your pile of suck can you be grateful for?
by Counseling and Wellness Center of PittsburghNovember 11, 2019 panic disorder, signs of panic attack0 comments
According to the Amercian Psychological Association, 1 out of 75 people will experience a panic attack at some point in their life. Yet the term is used very commonly in pop culture. There are major differences between a panic attack and anxiety or stress. The most common signs of a panic attack are a racing heart, sweating, pupil dilation, chest pain, dizziness or faintness, tingling in the arms, hands, or fingers, a feeling of dread, feeling like you’re dying, difficulty breathing, and feeling a loss of control. Of course everyone experiences these symptoms differently, it is common for a person experiencing a panic attack to go to the hospital thinking that they are having a heart attack or other cardiac event.
According to the Association for Depression and Anxiety, triggers for a panic attack are varied but often a panic attack has no known trigger or precipitating event which makes it even more confusing for the person experiencing the panic attack. A person can have one single panic attack without having a panic disorder or anxiety disorder. Other times, the panic disorder which is hallmarked by frequent panic attacks and particularly a pattern of avoiding situations to prevent the possibility of a future panic attack, this could be an indicator that the panic attack is evolving into a mental health disorder. Stress, medication withdrawal, caffeine, loss/grief, major life events like a wedding or divorce can also be triggers for a panic attack. There is also an important relationship between mitro-valve prolapse and panic attacks and anxiety disorders, those with mitro valve prolapse do experience higher than normal rates of panic disorder.
If a person is experiencing a full panic attack it may be difficult to resist the urge to run to the hospital, if a person who is sure that it is a panic attack, they can label the sensation as panic, and remember that it lasts for 10 minutes to 30 minutes. A person with panic disorder should be working with a mental health counselor on developing a plan for when their panic attack comes on, some people write that plan down and carry it with them everywhere to remind themselves of how to work through their crises management steps. Some people do deep breathing, take a walk, use grounding techniques, trace the outline of the room with their eyes, stretch, yet a mental health counselor is the best person to help a person come up with an individualized plan based on their strengths, needs, and overall context.
A panic attack is very different from anxiety or stress, although the term panic attack has made its way into popular language most of what people call a panic attack is really stress, worry, or panics little sister- anxiety. A full panic attack can sometimes be described as life changing because it has startling intensity. Anxiety is a state of worry or fear that can generally be managed or serve as pesky background noise in the sound reel of our minds. Panic is all consuming with spikes of heart rate and a feeling of total loss of control. If you are experiencing more than one panic attack, you should seek medical and mental health support immediately to rule out underlying conditions and prevent the panic attack from evolving into a full panic disorder.
This is not intended to treat or diagnose a mental health disorder, if you suspect that you are suffering from a mental health disorder seek a medical or mental health professional.
by Counseling and Wellness Center of PittsburghJanuary 25, 2019 best counselor for me, what is an lpc vs lmhc vs lcsw, what is lcsw, what is lpc0 comments
If you are trying to find a counselor or therapist, you might start to become overwhelmed with options and confused by all of the abbreviations for credentials. Or maybe you are considering furthering your education in the mental health field but are not sure which degree is the best for you. Allow this helpful guide to take you through the various meanings which make up those abbreviations and this helpful guide will unveil what they all mean.
ACA The American Counseling Association, this is the governing board, they over see the education and the field of counseling on the national level.
APA American Psychological Association oversees the field of psychology and ensures quality and consistency in learning and licensing requirements.
LPC Licensed professional counselor, this person has a masters degree in professional counseling which covers behavioral psychology and the theories of behavioral change as well as many other theoretical approaches. After completing their universities course work, a counselor has completed thousands of hours of supervised counseling, rigorous screening processes and background checks by licensing boards to become licensed. An LPC is often considered a general practitioner who can take up further study to specialize in a variety of topics from addiction, to trauma, anxiety, depression, and relationships to name just a few.
MSPC This is a master of science in professional counseling. This is a person who has graduated with a degree in professional counseling but has not yet completed their supervision hours to become licensed. A person can practice in a variety of settings with a master’s degree, some people do not pursue a license and continue their career with their masters degree. A MS or MA can be used somewhat interchangeably and the difference is only in the amount of math and statistics that are required for the particular program they studied.
LMFT Licensed marriage and family therapist specialized in relationships and family dynamics and typically offers marriage counseling. This is a particular track which focuses on interactions between people and the theories which allow the therapist to help those people in the relationship to become well.
LCSW Licensed clinical social worker, is a person who has graduated with a masters degree in clinical social work and then went on to do supervised hours which gain them a professional license. A licensed clinical social worker is able to manage a variety of mental health issues from anxiety and depression to relationship issues.
MSW This person holds a master’s degree in social work and they may or may not have done any clinical supervision hours. They have graduated from a university after studying a variety of clinical theories on counseling. Social work also provides a comprehensive study of social systems which can offer support and assistance for a variety of issues.
LMHC This describes a person who has a masters degree in counseling and is also licensed, this degree does not exist in Pennsylvania but is the equivalent of an LPC.
PsyD This person holds a doctoral level of study in a given field, for our purposes that will be psychology, this person has studied a university program which emphasized clinical experience instead of research experience. A psychologist can provide therapy or a number of assessments. They also might be active in teaching at the university level or doing research.
PhD This person holds a doctoral level degree, for our purposes we will focus on a person with a PhD in psychology who is refereed to a psychologist, this person has defended a thesis, psychologists have a strong background in research on any number of topics. They may provide therapy and any number of mental health assessments, they can be found working in many kinds of places from hospitals, to clinics, universities, as well as private practice settings.
Psychiatrist This person is generally involved in medication management, they may work in inpatient settings or out patient settings. Other specialized roles might involve sub-specialties such as neuroanatomy and traumatic brain injury recovery.
Other Helpful Terms
LGBTQIA- Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Ally refers to this entire of cluster of people who may identify as one of the above and most newly, identify as an ally with promoting the rights and awareness of equality.
AASECT-American Association of Sexual Educators, Counselors, and Therapists. An certifying institution which educates counselors and therapists on sex therapy and sex positive practices.
CAADC–Certified advanced drug and alcohol counselor has achieved a higher level or educational and clinical learning that allows them to offer clinical treatment for substance abuse disorder.
In good health and wellness,
Counseling and Wellness Center of PittsburghLearn More
by Counseling and Wellness Center of PittsburghJuly 31, 2018 food for anxiety, food for depression, food for mood0 comments
28 Foods to Decrease Anxiety and Depression and Enhance Positive Moods
Food & Mood Series by Liz Mckinney, CNS, Board Certified Nutritionist
“It is both compelling and daunting to consider that dietary intervention at an individual or population level could reduce rates of psychiatric disorders. There are exciting implications for clinical care, public health, and research” – editorial in the American Journal of Psychiatry https://doi.org/10.1176/appi.ajp.2009.09060881
Mood imbalances like depression and anxiety are on the rise in the U.S. In 2016, the National Institute for Mental Health estimated that 16.2 million Americans have experienced at least one major depressive episode and 42 million have an anxiety disorder of some kind. https://www.nimh.nih.gov/health/topics/depression/index.shtml Additionally, depression is the leading cause of disability globally. Traditionally, depression and anxiety are viewed as being caused by chemical imbalances, due to under production of our feel good neurotransmitters like dopamine, GABA, and serotonin. Lets explore how food is related to emotional health and how we can put ourselves at risk for developing anxiety or depression with our diet, as well as the good news of how diet can increase of mood, energy, and all around wellness.
So what factors contribute to a drop in the production of neurotransmitters? Biologically, this question has a multi-tiered answer. First, genetics and epigenetics (namely, how our environmental exposures affect which of our genes become activated) certainly play a role in a person’s proclivity towards depression and anxiety. For example, a common genetic mutation called MTHFR has a big impact in how we activate the B vitamin folate in our cells. Those with this genetic mutation are more prone to depression because of folate’s role in making serotonin. But, we know that our genetics don’t tell the whole story. The second factor influencing the expression of our genes, are our mental and emotional stressors or triggers, this is the part that can be effected by our social supports and reduced with therapy. Social factors and cognitive perceptions contribute significantly to the onset of these common mood disorders.
The Standard American Diet, which is low in fiber, healthy fats and protein and packed full of cheap, convenient sugar laden foods means we have less of the amino acid building blocks we need to make GABA, serotonin, and dopamine. A second issue to consider is that poor gut health is directly linked to worsened mood disorders thanks to the two-way gut-brain connection. Intake of processed snack foods packed with sugar, flour, and trans fat are like pouring gasoline on the fire and promote overgrowth of pathogenic bacteria and yeast in our gut where up to 80% of our body’s serotonin is produced. Eating poor quality proteins or simply not enough further compound the issue because proteins are the building blocks for these important compounds that keep our moods stable. Grain fed, factory farmed eggs and meats and genetically modified crops are not only loaded with toxins and pesticides that alter our microbiomes, they serve to ramp up that low grade chronic inflammation. Finally, fiber intake has never been lower thanks to the standard American diet. Fiber rich foods serve as probiotics that feed the beneficial bacteria in our large intestine. Without fuel, the good “bugs” are more likely to die off, leaving room for the pathogenic species to flourish. Our bacteria send signals to our brains, so we want our good bacteria to dominate and send signals that promote brain health, not cause further chemical imbalances and inflammation.
Now time for the empowering news! The food we eat can also improve mood, and decrease symptoms of depression and anxiety. Food can be a kind of internal therapy, by nourishing organs, healing of stomach linings and then increasing energy and brain health, they have a huge impact on decreasing ones susceptibility to relapsing from mental health disorders.
- High quality proteins
- Cage-free Eggs
- Grass-fed Beef and
- Chicken raised without growth hormones or antibiotics.
Vegan or vegetarian
- Non-GMO soy
- Vegetable proteins like legumes, pea chia, or hemp.
- Fermented foods like kefir, kombucha, or sauerkraut which contain live organisms that populate the microbiome with beneficial bacteria.
The above mentioned foods promote emotional and physical health by keeping the gut happy and healthy. As a word of caution, avoid processed, packaged snack foods at all costs and focus on whole, unprocessed foods like promote a good mood. Here are some more delicious options to add to your daily diet that calm inflammation and support mood:
- Dark Chocolate (70% or darker)
- Vitamin B rich foods – eggs, raw dairy, grass fed beef, and organic chicken and turkey, leafy greens like kale or Swiss chard, and bananas
- Red, Purple, and Blue Berries – Contain Vitamin C and other antioxidants
- Omega 3s – wild caught fatty fish (2 servings weekly), walnuts and flax seed
- Coconut oil
As a final note, understanding mood disorders is complex and the underlying factors multi-tiered. Everyone is unique and requires and individualized approach that takes into account genetics and epigenetics, mental and emotional health and diet and lifestyle. When all three are addressed, we are better able to address mood disorders and provide the best outcomes. If you want to learn more about health enhancing diets and what foods can support emotional and physical health, meet with a board certified and licensed nutritionist, our nutritionist, Liz Mckinney, CNS accepts Aetna and Blue Cross Blue Shield insurance as well as self paying clients.
by Counseling and Wellness Center of PittsburghMarch 16, 2018 anxiety, anxiety therapy pittsburgh, cognitive behavioral therapy, counseling, counseling for anxiety, counseling pittsburgh, generalized anxiety disorder therapy pittsburgh, licensed therapist monroeville, licensed therapist pittsburgh, searching for a therapist in monroeville, searching for a therapist pittsburgh, therapist, therapy, therapy for anxiety, therapy pittsburgh, wellness, wellness center monroeville, wellness pittsburgh0 comments
Panic Attacks and Panic Disorder
As many as 4.7% of people will experience a panic attack at some point in their lives, panic disorder is a form of anxiety disorder which can be extremely intense, many times individuals who have a panic attack end up going to the emergency room imagining that the rapid heart beat and dizziness are a heart attack. Symptoms and features of anxiety disorder according to the Diagnostic and Statistical Manual IV, laid forth by the American Psychiatric Association are as follows: To have experienced at least 4 of the following 13 symptoms;
A feeling of smothering
Feeling of Choking
Discomfort or Pain in the chest
Abdominal distress including a heightened need to urinate or defecate
Dizziness or Lightheadedness
Derealization or Depersonalization
Fear of losing control or a feeling that you are “going crazy”
Sweating, Chills or Hot Flashes
The symptoms of a panic attack are hallmarked by their sudden onset and intensity, unusually a panic attack has an onset in as little as 10 minutes. In example a person who has experienced a panic attack may say “I was sitting on the bus when all of the sudden I felt like I couldn’t breathe, it was like my throat closed up and I was choking but there was nothing in my mouth. I became dizzy and my heart felt like it was beating out of my chest, I started looking around and was going to cry for help. My fingers and toes felt numb and tingling, in a few minutes my heart slowed down a little bit but my stomach was really tight for hours after.”
As you can imagine someone who is experiencing a panic attack is suffering greatly. There are several different types of Panic disorder according to whether they are caused by a specific cue, such as public speaking or encountering an enclosed space such as the panic that can happen with claustrophobia. In other instances, panic attacks can be un-cued or non-specifically cued, this means that sometimes a person who has a panic attack may not understand what the trigger for their panic is until they seek treatment for the panic and uncover the deeper fears and how to manage the panic with their therapist. A panic attack is differentiated from having a panic disorder which is to have had recurrent and unexpected panic attacks for a period of one month or more. Treatment for panic disorder are therapy, often most effectively Cognitive Behavioral Therapy, with a licensed professional counselor and also medication is sometimes the best treatment. Usually it is a combination of these two treatments which best helps to manage panic disorder. Untreated panic disorder can greatly reduce quality of life, leading to long standing feelings of guilt and shame and even agoraphobia.Learn More
by Stephanie McCrackenJanuary 8, 2015 counseling, feminist, mindfulness, personal growth, psychotherapy, wisdom0 comments
We raise them to be good girls, to nod politely during fine conversation strung on during respectable hours with respectable people. We raise them to be pillars of hope, encouraging others in their struggles, we hug them and cradle them from the womb to teach them that they too should hug others, pearls of sweat always wiped away before becoming visible, to be the tirelessly devoted caretaker. We raise them with their kitchen play sets and plastic burgers and fries to prepare, toil, to serve those near and dear, insistently offering heaps and dollops of crème fraichely flavored affectionate nurturance. We raise them to banter upon the midnight keys of the baby grand, to cajole the audience with a fine melody, high five you little entertainer, pat, pat upon your severely strewn locks all wrapped up in an impeccable bow, “you are such a good girl.”. Oh, indeed, she hears you, her tiny countenance aglow with your praises, forming a map, a how-to manual which will beckon the praises of all of the others, a lifetime of others. A heavily laden back drop of nodding, and “yes sir” and “yes ma’am”, discipline and structure abounds her omnipresent formative years, she will please and she will shine.
This little essay is for all of those good little girls, turned to women that must learn how to say “no sir” “no ma’am” here is the boundary that draws the distinction between you and between me. Sometimes she must say “no” and nod “no” for nobody else other than her, and her own self-interest, and sometimes she must walk away still being a “good girl” because as she is learning her obligation is to nurture herself, too. Here is to the good girls who have traded in their bright-eyed baby dolls and longed instead to sit in solitude, sometimes for hours on end, to strewn together words upon words which offer semblance to their own pale logic. This is for the good little girls who leave those plastic frying pans, those dull golden rubber buns left to acquire a lifetime of mold. This is for the little girls that are too busy collecting grasshoppers and salamanders, head to toe crusted in mud, smelling not like perfume and soap but like straw and finely decomposing fall leaves, yes little girl “we love you too”. This is for the little girl come lady who screeches out an alarming melody, a protestation, a vigorous “No! I don’t want to wear your dresses, I won’t be a good little girl, I want to listen to crickets and cicadas and feed the goats in my denim jean coveralls, someday I want to be the CEO and walk about with ease in a simple pair of flat shoes meant for utility!” For the little girl that doesn’t want to smile and nod, on some days she wants to stomp and to curse a big “fuck you world!” She wants to say it and not fall from her imagined place of grace, clinging to all of this sturdy awareness, panicking that she has careened over the invisible line, teetering on becoming a very bad girl indeed. Yes, good and bad and all of these startling dichotomies, black and white pervade in a world of pastels, blues and greys, there must be something beyond the stark definition, the deft appraisal, and no girl wants to be tossed to the bad girl side when it comes to such grossly serious matters. Even with messy hair, smeared mascara, no mascara, when we have stayed up too late, when we can’t wake up in the morning, when we have allowed cruel words and actions to rush passed angrily contorted lips, we still want your love. When we have shattered our picture perfect with heaps and doses of vapid reality, we still want your love, we still want to be a good-girl turned woman, a woman worth loving, to you, and we want to fill up our own hole that reeks of neediness, the irrational desire for your love which we know needs to be sustained by our own self-love, a love that remains beyond these tendencies of fluctuating moods, beyond good-girl and bad-girls, the place of total acceptance, the point of compassion for our own humanness, yes, right there, that space of self-nurturance, maybe we are good-girls turned woman after all.
In care and warmth,
Stephanie McCracken MSPC
Psychotherapist ; Reviving Minds Therapy
1010 Western Avenue Pittsburgh Pa 15233 Suite 100
by Stephanie McCrackenApril 30, 2014 counseling, mindfulness, personal growth, psychology, psychotherapy0 comments
Who among us has not suffered from feelings of anxiety at some point in his or her life, it is common enough to be among the more often seen symptoms which bring an individual into a therapist’s office. Even for the most staunchly healthy psyches anxiety is a typical benchmark which exists in a range of degrees within the human emotive process. Depending upon you as the individual and the technical approach of your clinician you may be offered a multitude of conflicting remedies to intervene upon that which is ailing you.
There are the wildly popular pharmacological interventions such as Xanax or Valium, while widely popular these interventions do nothing to examine the “how’s” or “why’s” of an anxious feeling. These interventions assume that an increased cardiovascular response, heightened worry, tense muscles, sleepless nights, feelings of agitation are all in the physical realm yet quite mysterious. Indeed anxiety in its more insidious form is a grave health concern so it is with accolades that I note the vast number of humans seeking treatment to escape its grips. There is something inexplicably disconcerting about the hyper arousal of anxiety which compels one towards a greater risk for many other issues health issues such as addictions, depression, coronary heart disease, even eroding the erectile function of both the male and female, to name but a few.
Most of us recognize that there are yet other forms of anxiety which are our “bon amie,” the kind which compels our actions for good causes such as self and social betterment. Without a touch of anxiety one may hit the snooze button each and every morning and drop out of society all together. Yet for our purposes we will consider the more sinister form with its wanton undesirability which causes many to seek its avoidance at all costs. There are vastly varied approaches within the medical community in terms of treatment of anxiety, there are folk remedies, homeopathic remedies, new age methods, each with their unique utility. Yet most all of these interventions lavish attention upon the amelioration of physical symptoms but may from sheer neglect, fail to examine the psychological underpinnings of anxiety itself. For those who do experience the necessity of utilizing anti-anxiety medication it is an empirically validated fact that the best therapeutic outcomes exists for individuals who make use of psychotherapeutic settings simultaneously. It is within the psychotherapeutic setting that the focus is cast specifically upon the unique psychology which may be breeding and offering sustenance to an overabundance of anxiety. Allow the remainder of this small essay to offer a rudimentary overview of some of the more typical sources of psychological anxiety.
Significant Life Changes
This form of anxiety is a reaction to some looming occurrence which has skated its way across your horizon, it may be adaptive and is completely natural. Many of us thrive upon constancy, as much as this tendency is at odds with the nature of the universe, inevitably we experience some anxiety while changing jobs, graduating, marrying, divorcing etc. While it is normal to exhibit some emotional reaction to such transitions be mindful to give extra care to yourself even during those joyous transitions. For any anxious feeling that continues to gnaw at your innards, give yourself some time to thoroughly examine all of your thoughts surrounding the (fill in blank) transition. This reflection affords the opportunity to hone in on any ways your emotional self may be beckoning you towards a closer look at something that your conscious awareness is not seeing completely.
The more that we attempt to repress our emotional experience the more that they tend to rupture forth in greatly unmanageable ways. Perhaps you are a product of early learning which valued emotional repression and lack of expressiveness. In some way you may have learned early or later in life that it is dangerous or taboo to talk about feelings or even notice that they exist for you, yet the vast and unstoppable torrent of the feeling state will not be escaped. This form of anxiety or panic urges the person towards understanding and experiencing of inner awareness and emotional expression.
The exactitude and finite nature of time is stated by some to be the source of all anxiety. What is it that you will you do with your precious earthly allowance? By becoming more aware of lapsing time, acknowledging that life proffers beauteous opportunity, love, and abundance still too, how will you cope with mounting defeats, losses, and unrealized potentials? Ones highest hope is to make father time ones friend, utilizing our human energies to compel feats which contribute to human progress. For you that may mean many things, to raise a family, build computer software, tend the forest, love deeply, the myriad meanings for the human riddle.
For some of us it is alarming to consider doing something that risks ones perceived control over ones surroundings. That could mean riding in an airplane, making interpersonal changes like developing new relationships, people are the ultimate unknown variables full of competing needs and possibilities. Will you be able to extend the risk of letting go of the known order to enjoy the potentials?
While this is in no way an exhaustive exploration of that powerful human indicator named anxiety it is something that may compel one to begin to relate to it in a slightly different manner. Perhaps it is time to consider its possibilities, its latent messages, it may one with greater respect for behoove one to not simply extinguish an anxious feeling with a pill or an exercise but to sit with it, even for just a moment, entering its heart palpating, dizzying sensation, in reverential respect for its utility and possibility as an psychic indicator. There is an understanding that in most cases, under the layers of any symptom are a fortunate beckoning towards the best version of yourself, the unrelinquishable layers of consciousness which insist that ideals will be felt and known.
In good health and energy,
Stephanie McCracken MSPC
Reviving Minds Therapy
1010 Western Ave
Pittsburgh Pa 15233
*This article does not intend to diagnose, treat, or in any way address an anxiety disorder or supplant psychological or medical advice. This is intended for your consideration only.