anxiety

Intrusive thoughts can occur at any time and are just as they sound—intrusive! Intrusive thoughts are thoughts that come out of nowhere, are involuntary, and can be difficult to get rid of. Common examples of intrusive thoughts include wondering if the doors are locked, if the stove or curling iron is turned off, or if people like you.

Everyone experiences intrusive thoughts at some point in their lives. For most people, intrusive thoughts come into their mind and seem to leave almost as quickly as they arrived. They can recognize the presence of the intrusive thought, acknowledge it, and take care of it, whether that’s by cognitively or behaviorally disproving it. They may check to make sure the door is locked and then don’t give the thought any more attention. Or they may simply remind themselves that “of course the door’s locked” and focus their thoughts on other things. For most people, intrusive thoughts are nothing more than a huge annoyance.

For some people, however, intrusive thoughts can be a symptom of a deeper issue. Intrusive thoughts can be characteristic of several mental health conditions such as anxiety, depression, obsessive compulsive disorder (OCD), and post traumatic stress disorder (PTSD). In these cases, the intrusive thoughts are more than just annoying; they may cause severe emotional distress to the person or cause them to behave in erratic ways. For a person with OCD, for example, instead of dispelling the intrusive thought that the door is not locked by checking the door, the intrusive thought persists and can become a compulsion. For these individuals, the intrusive thoughts simply won’t go away.

Intrusive thoughts are different from hallucinations because they occur as thoughts and will typically present the way the person speaks. Hallucinations, on the other hand, sound as if someone else is speaking in your mind. Regardless of if you experience an occasional intrusive thought or experience them frequently as a symptom of a larger mental health issue, there are some things you can do:

• Acknowledge the thought and identify it as intrusive. When people try to ignore the thoughts or push them away, they typically occur more frequently. Has anyone ever told you not to think about something? I remember being told not to think about ice cream once. Suddenly, ice cream was all I could think about!
• Remember that you are “normal” and everyone has intrusive thoughts from time to time.
• Continue with your usual behavior.
• Practice mindfulness and meditation to help practice “refocusing” your thoughts. Many people find “grounding” – a therapeutic approach where you focus on connecting to the earth – helpful. This can be accomplished by simply looking around the environment for things you see, hear, feel, taste, and smell.
• Learn and practice Cognitive Behavior Therapy (CBT) or another approach to reframe distorted thoughts.
• Receive professional treatment if intrusive thoughts persist or become bothersome. During your initial meeting, the clinician will usually ask about the frequency and intensity of the intrusive thoughts. They will also ask other questions to determine if the intrusive thoughts are symptomatic of an undiagnosed mental health condition. Sometimes a clinician will decide that medication may be the most appropriate way to treat intrusive thoughts.

Written by Rayeann Milne, Counseling Intern. If you’d like to schedule an appointment with Rayeann, please call us at 412-322-2129.

Interested in Medication Management for Intrusive Thoughts?

If you’d like an assessment by our psychiatric mental health nurse practitioner, please call us at 412-322-2129 or fill out the form below.

References: 

Bilodeau, K. (2021). Managing intrusive thoughts. Harvard Health Publishing. 

https://www.health.harvard.edu/mind-and-mood/managing-intrusive-thoughts

Sreenivas, S. (2021). What are intrusive thoughts? WebMD. 

https://www.webmd.com/mental-health/intrusive-thoughts

In more recent years, studies have been emerging that focus on the possible connection between gut health and mental health disorders, including anxiety and depression. The microbiome makes up all microorganisms in the human body. The microbiota encompasses all the microorganisms in a particular location, such as the GI tract. These together are developed while in the womb. During this time, early nutrition can play a role in shaping the developing gut microbiota. This helps with the development of various healthy bacteria.

The Science Behind Gut Health and Mental Health

As solid foods are introduced to infants, the microbiome is exposed to many different energy substrates, creating and developing our metabolism along with new variations of bacteria that make up the gut. It is difficult to determine what a normal microbiome consists of given the environmental, seasonal, and health status of an individual. Although, what we eat can determine what type of bacteria are predominantly present. This can also be directly linked to inflammation of the GI tract, placing stress on the microbiome. This can result in the release of cytokines and neurotransmitters. Elevated blood levels of these pro-inflammatory markers increase the permeability of the blood-brain barrier. Their release influences brain function, leading to anxiety and depression.

Pro-inflammatory cytokines are also important stimulators of the hypothalamic-pituitary-adrenal axis (HPA). The hypothalamus releases various hormones, one in which stimulates the adrenal release of cortisol, a known stress hormone. Cortisol stimulates a pro-inflammatory response, leading to a dysregulation of the HPA axis, resulting in symptoms of depression and anxiety.

When the human microbiome is challenged with dietary changes, coupled by stress, or maybe a course of antibiotics, the physiology of the normal microbiome changes. When there is a loss of beneficial bacteria, this can trigger a pro-inflammatory response and weaken the intestine. This can lead to increased intestinal permeability and allow bacteria to leak through, leading to detrimental effects on our bodies, which can be demonstrated in diseases such as irritable bowel syndrome (IBS), and mental health disorders such as anxiety and depression.

Probiotics, living microorganisms of yeast and bacteria, have been utilized as supplements for aiding in reducing symptoms of anxiety and depression. Primarily, they have been studied in the suppression of cytokines, noting improved intestinal barrier integrity. This promotes a decrease in inflammatory response. As a result, adding a probiotic to your daily regimen could help reduce pro-inflammatory hormones, especially in individuals suffering from chronic inflammation.

Although, there is no FDA regulation pertaining specifically to probiotics, and ultimately, no dosage recommendations. Until more research behind the use of probiotics as therapy for anxiety and depressive disorders is available, probiotics cannot be considered a reliable treatment method as compared to psychiatric medications.

Anti-Inflammatory Foods

When it comes to diet, various components in food can help reduce inflammation. Consider foods that are high in fiber, omega-3s found in fish, oils, and leafy greens, polyphenols (plant chemicals) found in fruits such as berries, and unsaturated fats found in almonds and flaxseeds. All of these foods can be incorporated into your daily diet to help reduce inflammation and promote a healthy gut and microbiota!

1. Yogurt: containing live bacteria cultures, yogurt can help support a healthy gut by keeping the microbiome healthy. The probiotics in yogurt can help reduce inflammation and symptoms of bloating, gas, constipation or diarrhea. Many yogurt varieties contain added sugar, so look for plain options and add your own flavoring with fruit, nuts, and seeds to avoid excess sugar intake.
2. Fermented foods like Kombucha, kimchi, sauerkraut, kefir and miso are rich in probiotics. The good bacteria grow during the fermentation process. Add fermented foods to your diet for a healthy dose of probiotics.
3. Dark Green Leafy Vegetables: Packed full of vitamins like A, K and magnesium, dark green leafy vegetables, such as spinach, kale, bok choy, mustard greens, and collards, are crucial for brain function and gut health. Swiss chard is a great example of a food that is loaded with fiber, feeding the healthy bacteria in your gut, preventing inflammation.
4. Omega-3s: Omega-3 fatty acids also support brain health. Fatty fish such as salmon and tuna, are great sources of omega-3 fatty acids. Foods containing fatty acids can help reduce inflammation, and support healthy digestion. This can help you feel less bloated and sluggish.
5. Healthy Grains: Whole grain foods, such as oatmeal and bulgar wheat, are high in fiber, which plays an important role in stabilizing blood sugar levels. This helps restore a potential imbalance to the gut that can happen when blood sugar levels are challenged. Most whole grain products contain beneficial prebiotics that help increase healthy bacteria in the gut microbiome.
6. Berries: Berries are rich in antioxidants, which can help keep your gut healthy by reducing inflammation. They are also a great source of prebiotics, which promotes healthy gut motility. One of the highest vitamin C foods, which can improve the gut barrier and enhance nutrient absorption.

This article was written by our Registered Dietitian, Kali Alrutz

Get Started with Gut Health Nutrition Counseling

Call us at 412-322-2129 or fill out the form below to get started with Nutrition Counseling. Nutrition Counseling is covered by Insurance.

Every good parent knows that providing an enriching environment lays the foundation for future success. Or does it? From summer camp, to instrument lessons, and afterschool programs, how many extracurricular activities are too many and where do parents’ good intentions bleed into something less helpful and even have the unintentional consequence of creating a stressful and anxiety ridden environment for children?

Warning Signs Your Child Is Involved in Too Many Extracurricular Activities

1. Listen to your kids and teach your kids to listen to themselves, helping your child to understand and respond to their emotional cues might be more impactful for their future wellbeing than mastering their tennis swing or perfecting their smooth violin strokes.
2. Does your child have a lot of tummy aches, headaches, or have excuses when it is time to practice? According to the Centers for Disease Control, these things can be related to Anxiety. If you notice these patterns in your child, it might be time to have a discussion with your child about whether they want to continue to participate in this activity. any longer or a different variation that doesn’t stress outcome or skill.
3. Does the child have time to just be? Just be means having free time that is not structured. Overscheduled children also have overscheduled families, this a form of performance based obsessiveness being passed between generations. Does your child have time to themselves everyday? Do you have time together to be a family? Eat meals together? Have conversations or are your moments spent shuffling from one activity to another, eating in the car then heading to bed when you’re home?
4. Has your child verbalized that they don’t want to participate in a certain activity? Has this been a source of conflict between you? Many parents who want what’s best for their child insist that they should stick it out and encourage them to continue with the sport, activity, or instrument. The fine art of parenting is to know what is healthy stick-to-itiveness versus what is pushing past a child’s boundaries or neglecting their emotional needs.

What Parents Can Do When Extracurricular Activities Cause Your Child Anxiety?

1. Free play as opposed to goal oriented play activities. While goal oriented activities can help a child develop certain skills, when those skills are scrutinized by parents, coaches or teachers, it can lead to self esteem issues, stress, and anxiety. This is especially true around the age of 12 when kids start to compare themselves to their peers in the formation of identity and self concept.
2. Children should not have activities everyday or the week. Many people agree 3 is a maximum, if they want to add one activity then ensure that they drop one.
3. If you are going to be organized around a schedule, ensure that the schedule includes, downtime, family time (at least 20 minutes everyday) to play a game, sit and talk, draw or paint together.
4. When you are enjoying downtime, don’t make it another journey to a destination, don’t ask what they need to do today or tomorrow and pull your children back into planning and coordinating, instead, ask creative questions. Ie. If you were any animal which would you be? What do you think will make you happy in 5 years? Who is your favorite friend right now? What do you dream about at night?

Good behavior starts from the top down. Let your kids see you practicing the art of doing nothing and enjoying it!

Written by: Stephanie Wijkstrom, MS, LPC Founder of Counseling and Wellness Center of Pittsburgh

Interested in Family Counseling or Child Therapy?

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News Feature: Signs Your Child Is Involved in Too Many Extracurricular Activities

Teenagers often have worries and intrusive thoughts that can lead to ongoing anxiety. One of the most common types is Generalized Anxiety. The DSM-V explains Generalized Anxiety Disorder as, “excessive anxiety and worry  occurring more days than not for at least 6 months, about a number of events or activities such as work or school performance.” Anxiety can have physical and emotional effects that can feel like an endless burden. As adult mentors, educators, and caregivers, here are tips for how to help a teenager with anxiety.

Thoughts

The anxious brain is conflicted as the mind can race, but inversely “blank out.” The frustration of not having a clear mind can lead to poor performance in school. Teens can start to lose concentration after school during homework or at work. Validate some of their worried thoughts by using logical thinking such as separating facts from fiction. Encourage creative outlets after mentally draining tasks. Teens can use journaling and stream of consciousness type writing to free these intrusive thoughts. Make sure there is a safe place for creativity as expression can be personal. Respect the privacy of your teen, but encourage them to share if comfortable.

Anger & Tension

Anger and irritability can unfortunately arrive during anxiety as a result of frustration. As we feel tense with worry, our bodies follow suit. Find what works best for your teen in the realm of movement. Sports are an obvious go-to, but yoga, tai chi and even light stretching can help. Giving your teen a time and space to calm down when angry will benefit you both. Talking about the anger when clear headed will improve your connection.

Sleep & Rest

Since one purpose of anxiety is to keep the brain and body on alert, there is a restless component that comes with anxiety. Frequently one can feel hypervigilant, especially when racing thoughts are added.

As a result, teens with anxiety may feel more tired and lethargic. Sleep becomes more crucial as anxiousness is prone to poor sleep patterns. Teenagers also need more sleep than their adult counterparts. Make early mornings less stressful by sticking to a more relaxing “down time” routine before bed. Find what type of nightly routine and sleep schedule works best. Remember that rest isn’t always sleep; meditation and taking breaks when acceptable can refresh the mind. A “mental health day” off school or work when appropriate can rejuvenate the soul.

Feeling Safe

One of Maslow’s hierarchy of needs is a sense of safety. The recent pandemic drastically affected schooling and activities. As a result, teens have had to learn to adapt to change and deal with disappointment. Teens especially crave the consistency of routine. Knowing what to anticipate in advance can help calm the anxious brain. Try to be realistic with expectations and set rules together. If you are uncertain of plans, be honest with your teen and come up with alternatives so that they know what to expect.

Using the 5 senses can be grounding to calm the nerves. For example, making a favorite meal together is comforting and incorporates all senses. Carrying a rollerball scent to smell, a fidget spinner to touch or sour candy to taste can be quick remedies when anxiety starts. Small changes of surroundings can also be refreshing, such as letting your teen rearrange and redecorate their room. There has been a resurgence in sensory items among teenagers. Being playful and letting teens enjoy video games and toys from their younger years also creates a sense of comfort.

Emotional Awareness

There are many disorders that accompany anxious feelings such as Major Depressive Disorder, ADHD, and OCD. Anxiety can also be a result of traumatic events or major life changes.

Social anxiety (social phobia) is common among teens. Based on data from The National Comorbidity Survey Adolescent Supplement (NCS-A), an estimated 9.1% of adolescents have social anxiety disorder, with an estimated 1.3% causing severe impairment.

Therapy for teens with a licensed professional counselor gives space to divulge these complicated thoughts and emotions. Group Therapy for Teenagers is a unique opportunity to gain skills and new behaviors with the benefit of an expert-led experience while being accelerated through the lens of social learning that can only come from peer support. Group formats have been used to successfully manage a variety of mental health disorders such as depression and anxiety.

Remember to practice your own self care when anxious as we are a great influence in their lives. When children see us coping better, they experience positive results firsthand. Normalizing honest conversations about emotions will show teens how to develop into healthy adults.

Group Therapy for Teenagers: Teen Art Group

This in-person Group Therapy for Teenagers runs from September 26-November 14 at 6PM on Mondays. It takes place at our Monroeville location. The group will be led by Licensed Professional Counselor Rachel Taylor, author of this article.

Teen Group Therapy: Teen Art Group will help teens learn Social Skills, Depression Coping Skills, Anxiety Strategies, and How to Handle Anger all within the context of making art.

Sept 26: Intro to Group: Ice Breaker Activity, Review Rules and expectations
Oct 3: Social Skills: Healthy relationships and make bracelets for friends
Oct 10: Depression Coping Skills: Jeopardy game
Oct 17: Anxiety Strategies/Discuss Group Topic choice
Oct 24: *Group topic Choice and craft*
Oct 31: Halloween!-Mask Craft and discuss different “sides” of self
Nov 7: Anger: role plays
Nov 14: Closure *Apples to Apples type game to review Group Skills *discuss future groups

Written by Rachel Taylor, LPC. Rachel is accepting patients at our Monroeville location as well as online. She is leading Group Therapy for Teenagers: Teen Art Group.

Sources:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
Maslow, A. H. (1954). Motivation and personality ([1st ed.].). New York: Harper.
National Institute of Mental Health. (2021). Social Anxiety Disorder. Retrieved from: https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder

Our therapists are here to offer mental wellness support with specific interventions to treat all major mental health disorders including anxiety, depression, grief and trauma as well as relationship issues or any life stressors that you are dealing with.  We teach you new coping skills for a variety of relational, emotional, and psychological issues so that you can enjoy your life. 

While each counselor has their own specialties and approaches to therapy, there are several key things that most therapists want you to know.

Read on for 10 things your therapist wants you to know.

1. Talking to a friend is not a replacement for therapy—therapy is strategic, focused, and an application of scientific methods to heal.  Friends can offer support and connection but can’t replace therapy.
2. Therapy is a safe place where you can be yourself without feeling judged.  We won’t judge your story.
3. Healing doesn’t happen from attending a weekly appointment.  You heal by applying the skills, solutions and methods that you discuss in therapy during all of the hours in between sessions.
4. It is ok to tell us anything and everything you are experiencing or have experienced: feelings, thoughts, intentions, behaviors etc.  You’d be surprised that what you are sharing is something we have most likely heard many times before and it is not shocking. 
5. We’re not irritated by reviewing the same information over and over.  Change takes time and practice.
6. Setbacks are just learning opportunities — we won’t be disappointed in you.
7. It may get worse before it gets better.  Talking about tough emotions, situations and past traumatic experiences may be painful at first but is necessary in order to process them and change.
8. The opposite of depression isn’t happiness.  Often times folks who experience clinical depression make an assumption that they continue to be depressed or are not getting better even after symptoms decrease because they are “not happy” (with life/career/partner).  The marker they use to determine depression is happiness vs unhappiness.  When people learn that happiness takes work, it can be freeing for them and they have an easier time accepting their progress.
9. Therapy can be challenging.  It is not easy.  But first work on developing a therapeutic relationship with your therapist.  Once you have a solid foundation, you are able to work through so much.  Be patient with the process.
10. We won’t say hello in public unless you do first. 

It is an honor and privilege to be a part of this life journey with each and every client we see.

Interested in Starting Therapy?

If you are ready to start therapy, you can call us a 412-322-2129 or fill out the form below.

Holidays are steeped in traditions that are centered around the family and there is a hallmark sentiment that everyone is rejoicing in love with their near and dear during this most festive time of the year. The truth looks a bit different though. Family conflict, tension and even estrangement are more common than you may think. One study found more than 40% of participants had experienced family estrangement at some point.

But knowing you are not alone doesn’t make things happier or easier. The holidays are still hard and may bring up feelings of sadness, loneliness, jealousy, anger, shame or worthlessness. 

To help combat these feelings, here are therapist-verified tips to help beat the holiday blues:

1. Validate Your Feelings. If you fight the thoughts and feelings or judge yourself for having them, then you increase your emotional upset. Acknowledge that you feel sad and allow yourself to feel that sadness. This builds resiliency that you can be present with the uncomfortable feeling of sadness. It also increases self-trust that you can name and acknowledge the feelings you are having—this is especially helpful if your feelings were dismissed or not seen as a child. For example, “I’m feeling really sad and lonely that I am not on good terms with my family. This feeling is valid. I don’t have to pretend it’s not there. I can feel this sadness and use my coping skills to get through it.”
2. Pick a Coping Skill or Self Care Tool That is Most Useful for You. There are myriad coping strategies to deal with feelings of sadness, disappointment and loneliness. Pick a tool that best supports you and be sure to practice it throughout the holidays. Tools include journaling, focusing on what is right in your life and practicing gratitude for that, meditation, yoga, running, watching a funny show or movie, noticing your negative thoughts and reframing them. There is no one right tool so just pick one and try it out.
3. Set Boundaries for Topics of Conversation. To maintain your peace of mind during the holidays, set boundaries with your family on what you are and are not comfortable discussing. If your older brother always comments on your weight, simply tell him, “I am not interested in discussing my weight. I’d rather hear about my nephew’s soccer game.” If your grandmother always nags you about being single and childless, share that this isn’t something that you are open to discussing with her but you’d love to share about your lovely foster cat. Setting and keeping your boundaries will help you to feel empowered over your situation instead of feeling like you have no say in the conversations happening around the dinner table.
4. Temporarily Delete Social Media from Your Phone. For many people social media can be triggering. This is especially true during the holidays when your feed is filled with photos of other people connecting with their family around the dinner table or unwrapping presents in matching pajamas. This may make a person who is excluded from such family gatherings melancholy or jealous they aren’t having the same experience. Allow yourself to take a break from this type of content so you’re not adding on to your emotional burden. It can be as easy as deleting the app from your phone and reinstalling after the New Year.
5. Make a Plan for How You’ll Tackle the Day. Schedule a FaceTime check in with a friend. Enjoy a free yoga session on YouTube. Whatever you decide, make a plan ahead of time and stick with it. Literally put each activity in your calendar. This will keep you accountable and prevent you from having nothing to do and slipping into worsening feelings of loneliness or engaging in poor habits.
   
6. Schedule a Therapy Appointment. If you’re currently working with a therapist, be sure to schedule a session during this time. If you’re not in therapy yet, consider reaching out and getting additional professional support during the holidays.
7. Be of Service to Others. You can always be a support to others who are less fortunate than you by reaching out and volunteering. Clean out your coat closet and take your old coats to a local shelter, choose a child’s name off of a local Giving Tree program and go shopping for the gift, foster a homeless cat or dog through a local rescue group. You could even host a holiday dinner for others who are also alone. Be of service to others while being in service to yourself.
   

Only you can decide what is the best direction for you to maintain peace, mental wellness, and happiness during the holidays and the rest of the year and it is your sole job to protect your peace and wellbeing.

http://jpbsnet.com/journals/jpbs/Vol_3_No_2_December_2015/4.pdf