by Counseling and Wellness Center of PittsburghDecember 11, 2019 addiction, addiction recovery, how to say no, quitting alcohol0 comments
Do you have a problem with alcohol? Substance Abuse Treatment
Drinking problems affect a staggering 15 million Americans according to the 2018 National Survey on Drug Use and Health.
People are less likely to seek help for alcohol use addiction as there is little social stigma attached to alcohol consumption. Our culture tells us our alcohol use isn’t that bad. It is inaccurate to believe that someone with a problem with alcohol has to be living under a bridge, without a job, and drinking a bottle from a brown paper bag. You also do not have to be daily drinker of alcohol. Since men and women have different metabolic rates, the definition of binge drinking for men is consuming five alcoholic beverages within two hours, and for women, it is four drinks in two hours.
Ninety percent of adults with addictions began to use drugs or alcohol before age 18.
Alcohol Use Disorder (AUD) is a substance use disorder, is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild, to severe, and recovery is possible regardless of severity”.
Some questions you may want to ask yourself if you think you have a problem with alcohol.
- Had times when you ended up drinking alcohol more or longer than intended?
- More than once wanted or tried to reduce or stop drinking but couldn’t?
- Spent a lot of time drinking or being sick from the after effects?
- Wanted a drink so badly you couldn’t think of anything else?
- Continued to drink alcohol even though it was causing trouble with your family or friends?
- • Given up or cut back on activities that were important, interesting or pleasurable to you in order to drink?
- • More than once gotten into situations while or after consuming alcohol that increased your chances of getting hurt (such as swimming, driving, using machinery, walking in a dangerous area or having unsafe sex)?
- • Continued to drink alcohol even though it was making you feel depressed, anxious or adding to another health problem? Or after having had a memory blackout?
- • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, racing heart or a seizure?
- The National Council on Alcoholism and Drug Dependence points out that dangerous drinking can cause a number of other health issues and not just for the person doing the drinking. There are 100,000 people who die every year as a result of drinking and driving, other accidents, falls, fires, suicides, and homicides related to alcohol consumption.
- Alcohol and other substance abuse disorders commonly occur with other mental health disorders such as anxiety, depression, bipolar disorder, and borderline personality disorder to name a few.
There are treatment options available, such as an intensive outpatient program, 12 step support groups, and individual counseling. Treating addiction is not a one size fits all.
But know that here is hope for living a life without using alcohol.
*The criteria come from an authoritative handbook known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (or DSM-5).
Counseling and Wellness Center of Pittsburgh
4108 Monroeville BLVD Monroeville PA 15146Learn More
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 PittsburghJuly 10, 2019 why its important to take care of your mental health0 comments
This Is Why its important to take care of your mental health
By: Melissa Howard
One in five American adults experiences some form of a mental disorder each year, yet only 25 percent feel that others show them any compassion due to the negative stereotypes often associated with mental health disorders. Sadly, this can prevent individuals from getting proper treatment, or disclosing their condition in the workplace for fear of losing their job. Matters can become even more complicated if someone is dealing with persistent and irrational fears, otherwise known as paranoia, or general anxiety disorder (GAD). GAD is like a proverbial vice in that it causes stress and prevents one from carrying on with daily activities. To an outsider, these individuals appear high-strung, neurotic, and perfectionist because of their anxious personalities. Researchers have concluded that this behavior is caused by a dysfunction in parts of the brain responsible for dealing with fear, emotion, and memory.
While medication and psychotherapy are two of the top ways to control the side effects, self-care is equally as important for maintaining mental and physical health in the present and in the future. Here are some ways to make conscious, daily efforts to nurture your own well-being.
Banish Any Bad Habits
Whether it’s cigarettes, binge drinking, or experimenting with drugs, your entire being is compromised by bad habits. It’s only logical, as when you’re feeling poor physically, it’s going to affect the way you feel mentally, too. First, determine whether the monkey on your back is too heavy for you to lift off on your own. If so, seek the necessary treatment, such as rehab or a nicotine patch. Of course, this is easier said than done, but in many cases, it’s a matter of life or death. Consider confiding in a trusted friend or family member if you’re scared about next steps — it’s likely that they’ve already noticed something is wrong.
Learn To Become More Present
Being paranoid can conjure up irrational thoughts like thinking about dying in a natural disaster or losing a job. Taking up yoga can help you be more present while feeling grounded and getting a grasp on reality. In fact, doctors are actually recommending it as a complementary, holistic therapy. The gentle poses and breathwork from a vinyassa yoga class have been known to improve sleep, and reduce panic attacks and overall anxiety levels, not to mention it’s a great practice for building strength, increasing flexibility, and improving balance. The average cost of a yoga class ranges from $12 to $16, but prices go down if you pay for multiple sessions.
Set Aside Time to Get Organized
Getting organized and keeping your house clean, believe it or not, can go a long way toward improving your mental health. Not only can organizing your possessions help reduce stress and improve the quality of sleep you get each night, but it can also reduce the symptoms of depression and help you become more productive. Once you have everything organized, consider bringing in a maid service to give your home a good deep cleaning, which is a surprisingly affordable option. For example, in Pittsburgh, a one-time cleaning will run you between $93 and $204, depending on the size of your property.
Embrace Alone Time
While you don’t want to isolate yourself, taking advantage of having ‘alone time’ can be beneficial for one’s mental health. Not only can it help you to focus on self-help, but it also boosts creativity, increases productivity, allows you to explore personal interests, and provides a sense of empowerment. Taking time for yourself also makes it easier to take care of yourself by getting enough sleep, preparing a healthy meal, and exercising. When you learn how to be comfortable with yourself, the easier it is to be confident in social situations.
Don’t worry about the stigmas surrounding mental illness. Instead, establish a supportive network who understands that life can sometimes be challenging for you. For some, family and friends are enough of a support system, but others may be more comfortable adding a network of like-minded individuals into the mix. Talk to your doctor about getting a referral for a local support group in your area — you may need to try a couple of different ones out to find the right fit. You need not feel the pressure to participate. Sometimes, just listening to others share similar stories, concerns, and successes are enough.
Photo Credit: PixabayLearn More
by Counseling and Wellness Center of PittsburghJuly 8, 2019 meaning of rituals, rituals for self care, rituals for tranformation, rituals to reduce stress0 comments
Rituals, reducing stress and adding joyful meaning to life
5 Rituals You Should Try For transformation and wellness
Ever wonder why Michael Jordan wore his North Carolina shorts under his Chicago Bulls shorts every game? Rituals have enormous power to sooth and inspire as well as bring back balance to mental health by reducing anxiety and increasing confidence. According to the National Institute of Health, there are 3 primary functions of rituals, to manage emotions, to work towards goals, and to connect with others. From an evolutionary perspective we are creatures who have evolved to perform rituals including those of meditation or contemplation and group rituals. Have you ever knocked over a salt shaker and thrown some over your back? Do you attend church on Sunday? Do you pray? Have feast for the Easter holiday? These are all rituals. Flashback to the biblical era everything from attending Sunday worship, to praying for rain and lighting candles for the deceased, its clear that having a close relationship to spiritual rituals is very much a part of our cultural history. Still, whether we are referring to managing the emotional impact of times of stress, to ignite our faith, or to enhance wellness, many successful and happy people rely on rituals. The science behind why rituals work is compelling according to Scientific America. With some many different kinds of rituals we should really define that there is a difference in the Sunday beer drinking ritual, an obsessive hand washing ritual, versus a morning meditation ritual or a communication ritual with our partner. A ritual should be one that we complete with full attention and the deliberate effort to set an intention, reduce stress, or experience a divine aspect to ourselves, or foster our relationship to the spiritual realm.
Rituals can become a reliable tool for manifesting of our goal’s and enhancing our wonder, rituals have deeper embedded meaning. A beneficial ritual should be life sustaining and it is also true that the repetitive behavior of addiction and psychiatric obsessive-compulsive disorder both have the component of rituals built into them. When performing a ritual we are completing an act that becomes instinctive, our brains go into a flow state that doesn’t require higher order processing, the automatic nature of this state which can reduce our anxiety and promote calm. When we examine singing a hymn in a church, this is group ritual that can promote a sense of unity or connection among group members and with a deeper feeling of connection, these emotional components have clinically been show to reduced expression of aggression.
With so much to gain from incorporating rituals into your life, we are brought to the great burning questions, how do we incorporate more of them into our life? Start small and incrementally by adding a ritual component to something you already do, if you have never prayed or meditated it might be a large leap to attempt that everyday. A more manageable step might is to create a weekly goal. Some couples have a weekly ritual around problem solving and talking through emotional issues at the end of the week. Even meal-time can be a ritual when we bless our food or offer a moment of gratitude for the abundance on our plate. Others find that monthly rituals that set an intention with the full or new moon are the perfect time and space to set a goal for the month. Ultimately, we need to create rituals that are meaningful and manageable for you as an individual.
Meditation Ritual- whether daily, weekly, or monthly, meditation has a massive impact on wellbeing, stress reduction, and positive mood. Even 5 to 10 minutes daily makes a difference.
Love Ritual- Happy Couples have ways to celebrate the passage of time, they have yearly traditions that allow them to connect with the growth and change of their relationship over the years. It is also recommended that couples have a weekly communication ritual to release any residual emotional reactions and better connect.
Meal time ritual- Nourishing our bodies with life sustaining foods in a quiet and comfortable distraction free zone is a great way to enjoy eating. Eating has historically been an activity that is a part of ritual, think of the foods that surround every major holiday. It is also a time where families can connect to each other.
Self Care ritual- Whether it is journaling, fitness, using essential oils, or gardening, doing small things daily is important for your vitality and stress management.
Full Moon ritual- The full moon is the perfect time to release negative thought patterns and the new moon is a time for us to create new goals. Making time for a meditation under the moon light syncs us in to time and space and the greater cosmos. Regardless of your spiritual beliefs, there is something sacred that we experience when we cast out focus on something as grand and magical as the world around us.Learn More
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 PittsburghJanuary 17, 2019 addiction recovery, counseling wexford, digital detox0 comments
‘5 Awesome and Up-worthy Benefits of A Digital Detox’
Mental clutter, anxiety, ‘fubbing’ and stress related disease are just a few of the human spoils which we can estimate are at least in some part perpetuated by our over-reliance on cell phones and digital solutions. The technology era is here and the evidence is within our aching and gnarled fingers, computer blurred-out hyper-focused eyes, our text neck, and cluttered minds. In fact, cell phones have become a newly added to the expanse of potential behavioral addictions. The more we tune into our personal devices the more we tune out all that is around us. Digital detox is the new mental colonic but with perhaps even greater results and significance. When was the last time that you unplugged? What do you imagine would happen if you tried. We have heard of some texters and cell phone obsessed say that they even get full blown anxiety attacks if they leave their phone at home accidentally. We encourage you to take the digital detox challenge and see for how long you can not use your phone. Even for a few hours a day can make a difference. Here are some of the benefits you will notice fairly quickly.
- Thoughts and feelings become much more calm. Much like a turbulent bay on a stormy afternoon, our thoughts get churned up when we are constantly bouncing from one email, to our search engine, and then to social media. When we step away for a few days, our consciousness and the direction of our thoughts have a chance to become still and reflective.
- Enjoy better concentration with internal stillness. Sometimes we multitask to our own detriment, in an attentionally scattered frenzy we try to do too many things at once and fall short everywhere. Yet, when we are unplugged, we can tune our attention in any direction we chose. There are limitations to our ability to think and pay attention and we deplete those resources shuffling between 10 screens. Yet when we focus on things more deeply we become more aware and productive.
- We see what is around us, for real!! Of course when we are scrolling and trolling we are not very good company and we are missing a lot of the scenery. The people we care about may even become hurt or feel rejected by our obsession with our phone. In fact, cell phone overuse wrecks relationships and even brings many couples into counseling. Sometimes we unconsciously use our devices to avoid who and what is happening around us. When we put down our phone and step away from the screen we become much more aware of the people around us, the raw beauty of the skyline, the gray tinged clouds that roll in before the storm, we are ‘in the now’ and living it all.
- Sleeping more deeply. There is much compelling research from the National Institute of Health that logs the correlation between screen time and disrupted sleep wake cycle. The statistics are so compelling that we can safely suggest that we leave behind our personal devices for at least one hour before hitting the sack. The benefits really peak after several days disconnected, this is when our internal clocks have a chance to reset, the benefits multiply as there are few things which are better for our wellness than a solid nights slumber .
- Higher energy and creativity. When we are sleeping well and tuning into the environment, the next natural result is greater energy and even creativity. Want to finish an important project or just feel more vital? Try a digital detox for a few days and see what happens.
How ready are you to try something new today? If you would like further reading on how to make emotional, or physical changes, read our article ‘How to Slay Anything in 2019.’
With energy and clarity,
The Counseling and Wellness Center of Pittsburgh
Pittsburgh, Monroeville, and Wexford.
by Counseling and Wellness Center of PittsburghOctober 30, 2018 compassion, pittsburgh, positive psychology, resilience to trauma0 comments
Trauma; Honor For Your Healing Journey
The four things your therapist wants you to know about your healing journey. When you’re healing from a grief, trauma, or resultant PTSD, you must be thinking about ‘how will I ever move on from this horrible, unexpected, agonizing reaction to the traumatic situation that I have experienced?’ Remember, PTSD is a reaction to witnessing or experiencing a sudden and unexpected event which caused one to feel powerless by delivering, threatening, or witnessing harm. How can I rise above these feelings and thoughts and create meaningful and complete healing? Maybe you want to go backwards in time and undo all of the harm that you have experienced. A common and reasonable response to all of these above disorders, particularly PTSD, is to try to avoid all triggers associated with the situation which evoked the trauma, hypervigilance, intrusive memories, nightmares, flashbacks and an increased risk for anxiety and depression. This disorder presents a mountain to ascend, and whether you have spend years in therapy or are only beginning to acknowledge the depth of the effects this has had on you, these are some points to keep in mind. These are the 4 things that your therapist wants you to know about healing that are not immediately evident.
Healed but not Forgotten
Some people have the unrealistic expectation that when they reach the end of their healing journey they shouldn’t have any emotional reaction to their memories of the traumatic event which led to grief and loss. That is not how healing works. It is quite likely that you will always have some sort of reaction to the memories and thoughts associated with your grief or trauma. In fact, according to a 2011 study published in NIH by Sherin and Nemeroff, and according to all of science and psychology support the fact that there is potential for long term neuroanatomical and neurochemical changes to the central nervous system resulting from trauma. These changes are especially evident in the way we respond to triggers or trauma associated stimuli. What we should be striving for in the healing from trauma is a ‘new normal.’ Healing means that you are able to function in professional or personal settings and that you are practicing resilience and positive coping when waves of thought and emotion do come.
Healing means Acknowledging Feelings
One of the ways that therapy works is by creating an intentional space for healing warriors to be honest with themselves, to create an understanding of their emotions. After an awareness has been formed adaptive responses to feelings and thoughts can be generated. We create psychopathology by being critical and attempting to repress our internal honest responses. For some people like first responders, police, and paramedics, there may be an extra layer of difficulty and stigma attached to acknowledging ones feelings and seeking mental health support to manage trauma. This can cause further damaging denial of the effects of traumatic experiences, One of the core tenets of psychological theory present in every form of therapy is that the more we repress, judge or avoid our feelings, the more we cause problems. Repression elicits tangled feeling constellations, blocked energies, incomplete and unintegrated shadows. Mindfulness based stress reduction, EMDR, and Cognitive Behavioral Therapy, and Exposure Therapy, have shown efficacy in treating PTSD. Our feelings can turn into psychopathology that are bigger and sometimes socially unacceptable forms of the original emotional response.
Healing Happens in Relationships. Find your Healing Tribe
It is especially true for trauma that happens in relationships, that this same trauma is healed in relationships. When trauma survivors open up to those people who they consider to be safe, there is an incredible potential for healing to happen. Healing relationships are those that resonate compassion, gentle acceptance, warmth, and non-judgement. Think about it, we become close to those who we can be really honest with, those who ask about our feelings and can share in a compassionate interchange, (Mgrath, 2001). Sharing trauma should be exercised with caution. However well-intentioned our healing tribe may be, its members may inadvertently respond in less constructive ways that judge, shame, or put down the survivor for having the pain or scars of trauma. Another risk is not being able to hear or understand what is being shared. What is really needed is non-judgmental acceptance, understanding, and compassionate warmth.
Positive Psychology, Pop Culture and Non-Reality
You may have survived a trauma
but that doesn’t mean you have to fall victim to meme reality. Scroll through a social media forum and you will see many posts and memes which declare that everyone should be happy all the time. That isn’t honest or possible. The healthiest among us are those who are honest with themselves about what they experience and then respond to their vulnerable reality in a constructive way. According to a 2016 study by Elizabeth Kneeland,pop cultures layman positive psychology is damaging. When pop culture got its hands on positive psychology its representatives distorted the message, and now laymen perpetuate unrealistic and uninformed messages which imply that we can think our way into a good mood. It suggests that if we blink our eyes we can make trauma and psychological distress evaporate. Your therapist knows differently. Its ok to be outraged, disgusted, sad, hurt, angry, confused, and it is important to acknowledge where you are in your healing journey today.
No matter where you are today, the best we can do is to risk opening to ourselves, to create an honest internal dialogue that we are eventually able to share with others. We should unabashedly honor our own processes, giving relentless permission to feel, think and be; in reverence of joy, in honor of glorious fury, to the fullest expression of gaiety, to the utterance of insuperable hurt, to fully hone in on repugnant disgust. Keep developing your divine awareness, and eventually you will have created the unique meaning which understands with a lens of compassion, acceptance, and self love all that has happened to you.
With love and hope for resilience,
Stephanie Wijkstrom, MS, LPC, NCC
- Counseling and Wellness Center of Pittsburgh
830 Western Avenue Pittsburgh PA 15233
- Counseling and Wellness Center of Pittsburgh
4108 Monroeville BLVD, Monroeville PA 15146
Accepting new clients, our therapists accept UPMC, Highmark BCBS, United, Cigna, Magellan, Aetna, HSA, Self Paying and Sliding Scale.
Thank you to our Editor, Dr. Stellan Wijkstrom for his ever helpful alterations and contributions.
For More Reading
Kneeland, Elizabeth et al, Positive thinking Newsweek, 2016
McGrath, Ellen. Psychology Today, published November 1, 2001
Sherin, Jonathan E, Charles B. Nemeroff
Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278.Learn More
by Counseling and Wellness Center of PittsburghSeptember 30, 2018 counseling for anxiety, counseling for PTSD, psychotherapist, touch, yoga for trauma0 comments
Hands off-Please Do Not Touch My Body.
Closeness is sacred and powerful, and we should share it however we would like with a partner or partners with whom we have provided consent. Personally, I am a ‘toucher’, meaning I am a person who enjoys touch with my partner, someone who hugs family and friends and genuinely savors safe closeness. As we all know, touch can feasibly happen in many contexts. A recent trip to a local yoga studio has spurned some inspiration for considering consent and what exactly that means within the context of yoga. Consent is one of the topics of the century, the importance of asking for it, and heeding to it are championed issues with personal, psychological, and legal context. When we are on our yoga mat, we are presumably in a safe zone, we practice yoga to be well, to relax, to be inside of our bodies, to give life and expression to what our physical selves need in the moment to create our highest expression of safety, openness, and comfort. We rely upon the professionalism, understanding, and care of our yoga instructors while we are on the mat. When others take liberties with our bodies, reactions can range from uncomfortable to traumatic, yet we shouldn’t need to rely upon trauma informed yoga instructors to be the only providers who can offer a style of instruction which provides opportunity to say “No thank you, please do not touch my body.’ From chaturanga to shavasana, we find our bodies configuration of the posture as the yoga instructor cues. Without making space for hands off adjustments, one well-intentioned yoga instructor can inadvertently have a negative impact upon his or her student’s practice, day, overall wellness by taking liberties with his or her student’s bodies.
Consent means that one has asked for permission to approach another person in any way, whether that be to touch, to enter an intimate encounter, or even to provide unsolicited verbal feedback, we should always ask before encroaching upon others. After asking for consent, we wait and pause for that person to respond with their response of approach or avoid. A key component of consent is that the other person is truly able to say ‘no,’ if we are in a position of power, or if we are asking a person who is intoxicated, a minor, or incapacitated in any way, then the other can not provide for their own consent. Under normal circumstances, then, if and after we have been given permission to ‘approach’ we take it a step further to check in to be completely sure that non-verbal permission has been granted to continue or deepen the exchange. Physical space, proximity, and closeness are very special, they are exchanges which can lead to bliss, warmth, bonding, relaxation and even orgasm in the right time. When touch is used subversively, to coerce, to control, to harm, physical connection can become shrouded in horror, it also has the potential to instill anxiety, fear, terror, panic, and pain.
Consensual sexual intimacy is the gold standard, we should always be sure that we are well within the green zone of any boundaries of any person who we are touching and to also always note that we are creating safety for others as we strive for mutual enjoyment and pleasure. There are many contexts or situations where touch happens from fitness instruction, personal training, yoga instruction, little league coaching, physical therapy, massage, and medical settings. While there are many of the medical and physical instructors listed above who do check in and ask, ‘is it ok for me to adjust you.’ The best ones who follow this question by ‘does this feel ok for you’ and to them I applaud their insight and wisdom to always, in all settings, to ask first and wait for an enthusiastic ‘yes’ or a clear non-verbal head nod which unambiguously encouraging procession. For other yoga and fitness instructors, it may be less obvious that they should ask for consent before breaking the touch barrier with students. Let us examine consent from a trauma informed perspective and look at some ways that we can be sure we are always providing supportive and caring touch.
Regardless of the setting or context, we do not have permission to touch another person until we have asked for it and they have given it. For a trauma survivor it can be very triggering and alarming to feel a person, even a coach or instructor grabbing at them, or tapping on their body, for another person to move ones legs or touch ones hands. Feeling safe and giving permission for these things to happen is vital and walking into a yoga studio to practice does not provide consent for one’s physical boundaries to be violated. Just as walking into a bar or nightclub in a low-cut blouse is not the same as providing consent for someone to touch our breasts. Being a woman out late having drinks is not an invitation to have sex, we need a society which is built upon making space for ‘Yes’, or ‘No’ by always ask first. Yoga and fitness instructors, we are here, we want to participate in a fun and fulfilling way but ask before touching please. Additionally, for some instructors who may have a style of delivering their teaching that is very directive and assertive, it may feel punitive to some students.
Recently, in an all levels class, the instructor was someone I had never practiced with before. The class was much less than an all level class, it was more of an intro in my experience, we were cued to move into postures without much attention to how we flow through the sequencing. In any event, after 15 minutes or so warming up, we were cued to do some Sun A’s. When forward folding the instructor told everyone to grab a two blocks in anticipation of their hands not hitting the ground. I have long arms, and have been doing forward folds for many, many, years, it does not tax my body to fold forward and I find it delicious and restorative. The teacher stomped back to me and said ‘No! get your blocks, do not go into your deepest fold!’ In knowing my body, and knowing that I did not need the blocks I started to reach for them to appease her as she began grabbing my leg and tapping rapidly and harshly onto the front of my quad with her pointed finger tips and squinted eyes, ‘Move! Move! Move!’ she commanded. What started as a day of wellness, mindfulness, and an attempt to let myself feel peace, quickly became a source of discomfort and anxiety.
Being a yoga instructor is a big responsibility, it is a pathway to open ones consciousness, those blissed out happy vibes and chakras can really open up and make others aware of themselves, their feelings as well as anything happening with the instructor. We should encourage yoga instructors to have a higher level of insight into their style of relating to others so that the instructor is not unconsciously projecting their own unmet needs or style onto all of those who they come into contact with. The yoga instructor should be very aware of how of tone and content of speech particularly as adjustments are being made. If an instructor is simultaneously speaking in a critical or cold tone ‘move!’ ‘faster!’ ‘in, in, in;’ in a style that feels like they are spitting commands to the students, if the instructors speak this way while grabbing at a students body, it may become even more likely that they are making others feel tense, uncomfortable for anyone, and furthermore this kind of tone and motion can even be panic inducing for some trauma survivors.
More than ever, we must seek to create safety, to speak with love, to be sure that we are providing physical touch which is tender, and warm, and supportive or not tender and warm, if that is the kind of touch which is consensual and agreed upon by those who can legally and actually provide consent. Speak and act with awareness and care for other people’s feelings, doing fitness, pilates, doing a forward fold or downward facing dog, or even having a suspicious mole removed from our bodies are things that must happen peacefully and respectfully, and always with particular attention to any person’s ability to state, ‘No thank you- please do not touch my body’.
Stephanie Wijkstrom, MS, LPC, NBCC
830 Western Avenue Pittsburgh Pa
4108 Monroeville Blvd Monroeville Pa 15146
For more reading on the ethics of touch in yoga;
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 PittsburghJune 21, 2018 counseling for PTSD, psychology, psychotherapy, ptsd, trauma, trauma informed care, trauma therapy0 comments
We have fantastic and astonishing memory abilities, the human mind and its processes, particularly in the way we store and retrieve the effective memories which then effect the way that we store and respond to our other memories and sensory input. Evolutionary psychology examines the way some things that can be problematic are often helpful to us in the past and as we evolved. This is especially true for trauma survivors. According to the American Psychological Association, Trauma is an emotional response to a event like an accident, rape, or natural disaster, abuse or assault. Immediately after the event, shock, emotional upheaval, loss of ability to function, and denial are typical. Trauma is especially present in situations where a person feels powerless and their sense of control are taken. Long term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea, nightmares, inability to rest or calm down, feeling tearful, experiencing fear and heightened startle response. While these feelings are very universal response to the paralyzing fear that is associated with trauma even if the survivor reports feeling neutral in the moment. Biology offers some rational for how we can feel afraid but work through it in the moment of the traumatic situation, but it is later when we are safe and comfortable that the panic can emerge, generally emotions are something that can be seen and felt most when everything is alright around us, meaning the traumatic event is over and we are safe. Some people have difficulty moving on with their lives because trauma can result in long term effects such as post traumatic stress disorder, acute stress disorder, anxiety, depression, and addiction.
There are so many events that we experience which are traumatic, whether these develop into the more complex constellation of behaviors which we identify as PTSD, really depends on an interplay of biological, social, and other environmental factors. Some of the situations which can cause a trauma response include, domestic violence, sexual violence or assault, car accidents, national tragedies, serving in war, robberies. It is possible that we can experience a traumatic response my witnessing these events even if we are not the direct recipient of the threatening attack.
People who later feel the emotional and physical effects of trauma may wonder, what is wrong with me? Also, even if the event seemed manageable in the moment, it seems bizarre that they keep seeing flashes of it months or years later. The answer is while the effects of trauma can be debilitating, our cognitive processes are primed to be traumatized. Evolution explains that we and our ancestors are wired to hold tight to frightening or threatening experiences, imagine what happened to all of the humans who did not startle and produce massive amounts of cortisol and adrenaline at the sight of the saber toothed tiger just through the northern passage on the savannah. They died and did not evolve to have offspring in our gene pool. Having memory of dangerous events, people, situations, and gearing up to flee or protect one’s self is a sign of an evolutionarily healthy adaptation, it allows us to stay safe by avoiding possibly dire situations. In fact, our Vagal nerve which communicates directly to our bodies, without having to yield the advice of our logic, there are long term changes in the way that our Vagal nerve responds to triggers after we have experienced trauma. The vagal nerve is what allows healthy people to experience the ‘startle response’ for example when someone sneaks up behind you, usually we respond with a physical jerking motion in our bodies, and literally jumping. In domestic violence survivors, being ‘jumping’ and easily startled when a person raises their hand, is a well noted phenomenon that may last an entire lifetime.
We are wired to remember traumatic events. Survivors of trauma know that the sight of the perpetrator of their violence, even a coat that’s the same color as the one their attacker had worn can evoke the fear response. ‘Triggers’ are any stimuli which we associate with the traumatic event. These triggers and their associated memories can and do produce a jolt to the vagal nerve resulting in heightened, panicked, and anxious response in the person who is perceiving them. The biological response when we encounter a trigger are a plenty, our bodies enter a state of hyper-arousal, respiration becomes more shallow, heart beat rises, and fear settles in, even cognitive function is impaired as our higher order reasoning is impeded and all neurological resources are yielded to the hind brain and its motor and autonomic functions. The one and only thought becomes fight, flight, survive, and in some cases freeze. Remember, just like on the savannah in the seat of civilization, the extra energy our bodies create allow us to escape danger.
Cognitive behavioral therapy, systematic desensitization, and exposure therapy, and some therapies which aim to change the tone of the vagal nerve are recommended ways to work through the trauma and empower the survivor to be able to withstand exposure to triggers and regain emotional wellness. It is recommended that trauma survivors do their best to limit exposure to triggers as they heal from the event and associated memories. If you feel that you may be experiencing long term effects from a traumatic situation, it is recommended that you work with a therapist who is specifically trained in trauma informed care. Healing will allow the processing of the entire event, client and therapist will identify triggers, developing the capacity to respond to triggers with mindful balance, and work through the effects of any other psychological effects from the trauma.
Counseling and Wellness Center of Pittsburgh, Serving Western Pennsylvania with Individual Therapy, Couples Therapy, Family Therapy and Wellness Services.