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  1. Today
  2. Zoe

    Progress Tracking

    Day 20: Drove around the block again! This time the light was a little tricky, right at eye level, but it went just fine. I'm feeling psyched to be at 20 days of being behind the wheel Can't wait to start taking on more practical routes, like the grocery store or pet store.
  3. Yesterday
  4. Zoe

    Progress Tracking

    Day 19: Felt less resistance to going out and driving a little (very little-- I pulled out into the ally and right back into the parking spot). It was dark out, but hey I know where the lights are now.
  5. Last week
  6. Zoe

    Progress Tracking

    Day 18: Went with the easiest version that's still keeping up the habit, so sitting in the driver's seat with the engine on for a bit. I feel like in general, I'm less pessimistic and discouraged about driving, even if I wish I could do more. It's seeming more possible in general that I could get better at this in the long term.
  7. Zoe

    Progress Tracking

    Day 17: Had another driving lesson with my friend. It went okay, though I forgot to breathe as much and as a result felt a little more stressed out than last time. I also felt like things weren't super "smooth". Lots of jerky motions, which contributed to feeling a bit out of control. I did get to practice making 3-point turns out of dead ends a few times, which was helpful. I did also want to stop a fair bit, just because my stress level was a little high, but still drove for about 1.5 hours.
  8. Phobiasupportforum

    Psychology Around the Net: January 25, 2020

    Greetings this lovely January day! Hope everyone is staying warm and well. This week’s Psychology Around the Net dives into perfecting the art of small talk, why working from home may have its cons, how depression and anxiety can affect a young person’s first job, and how a student’s poor mental health can lead to peer exclusion, and more. How Brandon Learned to Small Talk and Why It Transformed All His Relationships: Do you struggle with making small talk? If so, you’re not alone. Many people dread the prospect of chatting it up with strangers. In this article, psychologist Jonice Webb PhD, explains how to get better at small talk by asking vertical (rather than horizontal) questions. That Cushy Work-at-Home Job Can Lead to Social Isolation, Mental and Physical Health Risks: Do you work from home? Or wish you did? A new report finds that people who work from home may be at greater risk for loneliness, especially those in entertainment jobs such as music, publishing, film and sports. This article details more of the report’s findings. Mental Health at Work: How It Affected My First Job: Young employees are the most vulnerable for experiencing poor mental health on the job, according to research. For some, making the transition from school to a first job can be particularly daunting. This article highlights two young employees and their struggles with mental health issues. Getting Mental Health Care Can Be Hard Enough. Then Comes Paying for It: Have you ever had to fight an insurance company to get mental health coverage? Joe and Enita Dugan know this battle well, as their son has long struggled with behavioral and mental health issues. “A psychiatrist said kids like him become addicted, detained, or dead,” Joe said. Unfortunately, the Dugan’s insurance company insists their son can get by with a much lower level of care than his doctors think he needs. This article tells the Dugan’s story as they fight to get proper mental health care for their child. Poor Mental Health Both ‘Cause and Effect’ of School Exclusion: A new study provides further evidence that poor mental health in students can lead to peer exclusion and vice versa. Professor Tamsin Ford from the University of Exeter says, “These children are often facing a wide range of challenges, and need both education and mental health practitioners to act quickly and effectively to prevent exclusion and improve both educational and health outcomes in later life.” New Generation Pushes Hmong Mental Health Concerns Into the Light: Large numbers of the Hmong people, primarily from isolated mountain villages in Southeast Asia, have immigrated to the U.S. in recent years. Trauma from war and migration and the stress of adapting to a new culture have contributed to the high mental health problems and suicide rates among this population. This article highlights Project Tshav Ntuj, an advocacy group that aims to break the silence on mental health and suicide in the community. View the full article
  9. Greetings this lovely January day! Hope everyone is staying warm and well. This week’s Psychology Around the Net dives into perfecting the art of small talk, why working from home may have its cons, how depression and anxiety can affect a young person’s first job, and how a student’s poor mental health can lead to peer exclusion, and more. How Brandon Learned to Small Talk and Why It Transformed All His Relationships: Do you struggle with making small talk? If so, you’re not alone. Many people dread the prospect of chatting it up with strangers. In this article, psychologist Jonice Webb PhD, explains how to get better at small talk by asking vertical (rather than horizontal) questions. That Cushy Work-at-Home Job Can Lead to Social Isolation, Mental and Physical Health Risks: Do you work from home? Or wish you did? A new report finds that people who work from home may be at greater risk for loneliness, especially those in entertainment jobs such as music, publishing, film and sports. This article details more of the report’s findings. Mental Health at Work: How It Affected My First Job: Young employees are the most vulnerable for experiencing poor mental health on the job, according to research. For some, making the transition from school to a first job can be particularly daunting. This article highlights two young employees and their struggles with mental health issues. Getting Mental Health Care Can Be Hard Enough. Then Comes Paying for It: Have you ever had to fight an insurance company to get mental health coverage? Joe and Enita Dugan know this battle well, as their son has long struggled with behavioral and mental health issues. “A psychiatrist said kids like him become addicted, detained, or dead,” Joe said. Unfortunately, the Dugan’s insurance company insists their son can get by with a much lower level of care than his doctors think he needs. This article tells the Dugan’s story as they fight to get proper mental health care for their child. Poor Mental Health Both ‘Cause and Effect’ of School Exclusion: A new study provides further evidence that poor mental health in students can lead to peer exclusion and vice versa. Professor Tamsin Ford from the University of Exeter says, “These children are often facing a wide range of challenges, and need both education and mental health practitioners to act quickly and effectively to prevent exclusion and improve both educational and health outcomes in later life.” New Generation Pushes Hmong Mental Health Concerns Into the Light: Large numbers of the Hmong people, primarily from isolated mountain villages in Southeast Asia, have immigrated to the U.S. in recent years. Trauma from war and migration and the stress of adapting to a new culture have contributed to the high mental health problems and suicide rates among this population. This article highlights Project Tshav Ntuj, an advocacy group that aims to break the silence on mental health and suicide in the community. View the full article
  10. Zoe

    Progress Tracking

    Day 16: Went all around the block this time. And I went ahead at the four-way stop instead of having to be waved through! Feeling pretty good about it. I still notice that I feel the worst about it before getting in the car. Once it's started it feels okay, but thinking about driving fills me with dread! Hopefully the more events I experience of positive driving, the less that feeling of dread will happen.
  11. Phobiasupportforum

    Ten Tips for Aging with Depression

    Major Depression — the clinical type — is not a normal part of aging. Though it can appear at any age, older adults are at an increased risk. The Centers for Disease Control and Prevention (CDC) distinguishes this condition from having “the blues” and likens it to other medical illnesses that are treatable, like diabetes or hypertension. Overwhelming sadness and anxiety can last for weeks at a time or much longer, with a wide range of other discouraging symptoms. Yet, there are things that can help. Statistics tell us that later in life, at least one chronic disease will affect 80 percent of us. It naturally follows that having other illnesses, like heart disease or cancer or dealing with slow-downs in social, cognitive, or mobility functions make it likely that depression might be more common. Retirement is often a huge change in lifestyle and, while it may seem attractive to dream of the freedom to do whatever one choses, the reality may be quite different as finances, structure, and productivity limit the desire of some to do anything at all. Long-term struggles with depression, if those have been present, exhaust a person’s resources and strength. Fatigue is a major indicator of depression though the right doctor can make the diagnosis and separate symptoms from the true cause or causes. Misdiagnoses or reluctance about seeking treatment might mask what is going on, especially if a patient is not completely truthful with his or her doctor because of fear or shame, both of which are undeserved. Tips for coping with depression include a variety of options. At one time or another you may need all of these, but assessing immediate needs is key to understanding which to complete first. Depression can cause suicidal thoughts. If you or someone you care about is in crisis, call 911. Do not leave a person in this state alone. Visit the emergency room of a nearby hospital. Call your healthcare provider or the National Suicide Prevention Lifeline (1-800-273-TALK). Keep this number with you. Be honest with your healthcare provider (and your family) and take any medications on time. Report side effects that bother you. Learn all you can about depression (and any other conditions you may be dealing with). Remind yourself that depression is a treatable illness and not a weakness or character flaw. Keep moving. Plenty of exercise, like walking, along with a healthy diet and adequate water intake, can help fight both fatigue and depression. An example of adequate water intake is drinking a glass of water every hour during the eight hours you are busiest. Water can promote a feeling of calmness and diminish anxiety. Understand that anxiety and other symptoms can be caused by depression. Consider counseling. Stay productive. Volunteer, do things you enjoy, and help other people. All of these cause reactions within your body that fight depression. According to the American Psychological Association, there is evidence that body changes associated with aging may increase a person’s risk of experiencing depression. Lower concentrations of folate in the blood and nervous system, for example, may contribute to depression, mental impairment and dementia. Researchers are looking into a possible link between the onset of late-life depression and Alzheimer’s disease. Lower quality of life, increased mortality rate, and decreased desire and ability to care for oneself that are related to depression are serious issues, but even seemingly unrelated symptoms such as insomnia and memory loss can be caused by this illness. There are different types of depression with different causes and risk factors. The National Institute on Aging lists major depression but also persistent depressive disorder, psychotic depression, postpartum depression, and seasonal affective disorder. There is a lot to learn about managing related illnesses and disorders. Being a detective can yield many rewards. That is why it is so important to receive competent care. A doctor will take into account less obvious symptoms like confusion or attention problems, other medical conditions, even grumpiness or trouble sleeping. Equally as confusing but no less important is determining the cause. Genes, personal history (including episodes of depression in early life), brain chemistry, and stress may trigger depression as can restricted blood flow (ischemia). Symptoms, treatment, and therapy can add up to successful management of depression. There is no need to fight this battle alone. Doing that can have grave consequences. Enlist others to help you. Family members, friends, your medical team, support groups that can provide information and encouragement as you interact with others who are like you and who will help you are all vital elements of reclaiming the life you want. While reading about depression is a good option, writing your own story can help you and those you love understand what you are dealing with and can communicate your wishes and progress. Track your medications so you won’t forget to take them, make a list of the symptoms you know indicate a decline for you, and empower those around you by giving them the steps they can take to assist you. View the full article
  12. Zoe

    Progress Tracking

    Day 15: Today I went with the easier version of just pulling out of the drive and back. Found out how to turn on the lights, too! Scheduled another driving lesson for the weekend.
  13. Zoe

    Progress Tracking

    Day 14: Drove around the block the other direction (this one is all left turns across traffic rather than all right turns). Had an unexpected event occur, in that someone was trying to leave the alleyway I wanted to get back to, and there wasn't enough room for us both, so instead of trying to force it, I made the trip around again (this time the right-turns version) and got back. It felt pretty good. I had to be waved through that four-way stop again. I always think the cross traffic has right-of-way and forget to go! But overall I'm pleased; this is the farthest I've gotten by myself so far.
  14. Earlier
  15. Zoe

    Progress Tracking

    Day 13: Drove around the block by myself again. Felt more confident, thinking back to the lesson yesterday definitely helped me feel more comfortable, even with other cars around. Funnily, it felt super impossible before I got in the car, but then it was fine.
  16. Separation Anxiety occurs, particularly in children, during times of stress or change. It is characterized by symptoms of insecurity and anxiety when a child must separate from a particular caregiver. Symptoms can intensify well after the initial point of separation and can become very disruptive for both child and parent. Symptoms might manifest as sleep disturbances, tantrums, withdrawal, or other behaviors otherwise atypical of the child. Having worked in the childcare industry myself, I had seen this difficult and emotional scenario play out firsthand. I had watched many a mama linger tearfully in the doorway, wringing her hands together in certain agony, while her child struggled dramatically over the separation, causing a great internal debate between if it would be better to just quit her job and stay home full time or if it was just time to give her baby bird a big shove out of the nest. Every child and every family dynamic is different, but here are some simple ways to help a child cope with feelings of separation anxiety: Empathy Sometimes when struggling with anxiety, we only need to be heard. Children are no different in this regard. They need to have mirrored back to them that their emotions are normal and important, but also passing. Empathizing with our children instead of trying to convince them everything is okay also removes the potential for argument and power struggle, which is a cycle that only prolongs feelings of anxiety. Instead of saying, “It’s okay,” try making simple observations about what your child may be feeling. Sometimes just giving them the vocabulary to express their feelings is enough to quell their fears. “I understand. I know it feels sad. It’s a lot of new things to take in. Making new friends can be scary.” Quick Separation The quicker you make the separation, the better. If you hang around, waiting for your child to get used to the idea of your leaving, then it’s likely you’ll never leave. Children respond more to our energy, body language, and nonverbal cues, than any words we could ever muster. If your desire is to convey confidence and trust in where you are leaving your child, then display just that. Give a big, deliberate hug, turn around and leave, and do not look back. It should be said that for a brand new environment and depending on the age of your child, a phase in process may be necessary for your child to gain an initial orientation. But if you’ve been acquainted with this situation already and your separation seems to be getting more and more drawn out by your child’s anxiety, it may be time to practice making your separation short and sweet. Connecting to New People Once you learn some names of your child’s peers and teachers or other people in their environment, start talking about them a lot at home. Not just in the context of the new environment, but in terms of who they are. “Do you think Mary Ann likes riding bicycles, too?” “What do you think Ms. Amber’s favorite color is?” Thinking of new friends this way helps familiarize them, bring them into the fold of trust, and helps your child accept and take ownership of this group as his or her “people.” Planning a play date with new friends while you can still be present is another great way to build your child’s confidence in being with others while separate from you. The more experiences you can give your child will increase their adaptability and flexibility for new situations. Transitional Objects Sometimes a transitional object such as a favorite stuffed animal or toy can be helpful for a child to retain a since of security after separation. Young children are actively building scaffolding for how the entire world works and it can be disorienting when things change suddenly. Having an object that stays with them after having to separate from their caregiver can help establish a consistent feeling of safety. It is likely this special object will only be needed in this way for a short time, overall, as your child gains new skills and abilities to cope with change. As with anything your child may be struggling with, it is important for the caregiver to maintain an attunement to what to is working and what is not for your individual situation and adapt from there. View the full article
  17. Zoe

    Progress Tracking

    Day 12: Did another driving lesson with my friend. About two hours worth of driving around parking lots and less busy streets. It was good! A little stressful at times when I was going pretty fast, but it helped when I realized I wasn't breathing (I was holding my breath a bunch) and focused on remembering to breathe when I turned, or when I switched from gas to brake.
  18. Zoe

    Progress Tracking

    Day 11: Drove around the block again, by myself, and there were a few other cars on the road. Limbs are pretty shaky but I'm also psyched to be making more progress. Scheduled another driving lesson with my friend tomorrow.
  19. Zoe

    Progress Tracking

    Day 10: Went to a mall parking lot and drove around for about an hour. The first rotation was more stressful than the second few rotations... But I got some good practice driving around other cars, parking, and driving around pedestrians. I'd say overall good!
  20. Phobiasupportforum

    Psychology Around the Net: January 18, 2020

    This week’s Psychology Around the Net explores how anxiety looks in children, how managers can work with employees dealing with depression, why young girls are struggling more with mental health issues than their male counterparts, a new bill that would make mental health a priority for first responders, and more. Anxiety is Different for Kids: Do you have a child who struggles with anxiety? Would you even recognize it? According to the author, anxiety disorders in children can manifest in a variety of ways, and kids typically don’t display symptoms in the same way that adults do. Michigan-based therapist Carrie Krawiec, LMFT, offers specific advice parents can use to identify anxiety symptoms in their kids and help them work through them successfully. How to Manage an Employee With Depression: Depression is the leading cause of disability worldwide. In the workforce, the disorder is estimated to cost $44 billion a year in lost productivity in the U.S. alone. Here is an excellent guide for managers on how to negotiate work arrangements for employees struggling with depression. Girls at Center of Teen Mental Health Crisis: Rates of major depression among teen girls in the U.S. rose from 12% in 2011 to 20% in 2017. According to the article, rates of depression started to tick up just as smartphones became popular, suggesting that digital media may play a role. But both boys and girls started using smartphones around the same time, so why are girls experiencing more mental health issues? The author examines three surveys of more than 200,000 teens in the U.S. and U.K. in an attempt to find some answers. Mental Health in First Responders Becoming a Priority: In 2017, more firefighters and police officers died by suicide than in the line of duty. In addition, rates of post-traumatic stress disorder and depression are five times higher in firefighters and police officers than in the general public. A new bi-partisan bill going through the Wisconsin legislature, Assembly Bill 569, would give firefighters and police officers up to 32 weeks of workers’ compensation, if they are diagnosed with PTSD by a licensed doctor. Childhood Trauma and Your Inner Critic–And What to Do: Do you have an inner critic? That part of yourself that constantly berates and criticizes your own thoughts, feelings and actions? Maybe your inner critic says something like this: “Why would you even say that? Now the person thinks you’re a moron. You’re so dumb.” In this article, the author shares several approaches to help you silence your inner critic. Rethinking Interactions With Mental Health Patients: A new Australian study refutes the idea that people with severe mental illness are incapable of effective communication with their psychiatrist. Professor Cherrie Galletly from the Adelaide Medical School, University of Adelaide says that patients can be “positioned as active participants by psychiatrists who adopt a non-confrontational, non-judgemental approach, conveying support and safety, and ask open ended questions which allows the patient to engage, feel listened to, and work with the psychiatrist to achieve a shared understanding.” View the full article
  21. This week’s Psychology Around the Net explores how anxiety looks in children, how managers can work with employees dealing with depression, why young girls are struggling more with mental health issues than their male counterparts, a new bill that would make mental health a priority for first responders, and more. Anxiety is Different for Kids: Do you have a child who struggles with anxiety? Would you even recognize it? According to the author, anxiety disorders in children can manifest in a variety of ways, and kids typically don’t display symptoms in the same way that adults do. Michigan-based therapist Carrie Krawiec, LMFT, offers specific advice parents can use to identify anxiety symptoms in their kids and help them work through them successfully. How to Manage an Employee With Depression: Depression is the leading cause of disability worldwide. In the workforce, the disorder is estimated to cost $44 billion a year in lost productivity in the U.S. alone. Here is an excellent guide for managers on how to negotiate work arrangements for employees struggling with depression. Girls at Center of Teen Mental Health Crisis: Rates of major depression among teen girls in the U.S. rose from 12% in 2011 to 20% in 2017. According to the article, rates of depression started to tick up just as smartphones became popular, suggesting that digital media may play a role. But both boys and girls started using smartphones around the same time, so why are girls experiencing more mental health issues? The author examines three surveys of more than 200,000 teens in the U.S. and U.K. in an attempt to find some answers. Mental Health in First Responders Becoming a Priority: In 2017, more firefighters and police officers died by suicide than in the line of duty. In addition, rates of post-traumatic stress disorder and depression are five times higher in firefighters and police officers than in the general public. A new bi-partisan bill going through the Wisconsin legislature, Assembly Bill 569, would give firefighters and police officers up to 32 weeks of workers’ compensation, if they are diagnosed with PTSD by a licensed doctor. Childhood Trauma and Your Inner Critic–And What to Do: Do you have an inner critic? That part of yourself that constantly berates and criticizes your own thoughts, feelings and actions? Maybe your inner critic says something like this: “Why would you even say that? Now the person thinks you’re a moron. You’re so dumb.” In this article, the author shares several approaches to help you silence your inner critic. Rethinking Interactions With Mental Health Patients: A new Australian study refutes the idea that people with severe mental illness are incapable of effective communication with their psychiatrist. Professor Cherrie Galletly from the Adelaide Medical School, University of Adelaide says that patients can be “positioned as active participants by psychiatrists who adopt a non-confrontational, non-judgemental approach, conveying support and safety, and ask open ended questions which allows the patient to engage, feel listened to, and work with the psychiatrist to achieve a shared understanding.” View the full article
  22. Zoe

    Progress Tracking

    Day 9: went out late this time, after it was already dark. Sat for about a song's worth of time, realized I don't know how to turn on the lights! So that's next for tomorrow haha. Got a couple e-books on driving phobia and looked through one of them today. Tomorrow a friend of mine is going to give me a driving lesson, so that'll be nice.
  23. Zoe

    Progress Tracking

    Day 8: It was snowing like crazy when I got home, but I turned on the car, found the windshield wiper controls, listened to a song in there on the radio with the engine going. It's less than previous days, but I'm happy that I'm not losing overall momentum. I think as long as I do something towards this every day, I'll still be making progress ultimately.
  24. Phobiasupportforum

    What You Need to Know About Suicidal Behavior

    The number one thing I’ve learned in my more than 20 years of experience in the mental health space is that there is always more to be learned. Suicidal behavior and prevention are complex. Just as there is not one single thing leading to suicidal behaviors, there is also not one single thing that will prevent them from occurring. In order to provide exceptional care and support to individuals with lived experience, friends, family members and co-workers, we must continue to learn about mental health. With that in mind, let’s review the latest trends, warning signs and some key resources that everyone should be aware of: Suicidal Behavior Trends Suicidal behavior does not discriminate — it is a national and global issue touching all populations. To fully understand the impact of suicidal behavior it’s vital to be aware of key trends. Suicide is the 10th leading cause of death in the U.S. with nearly 45,000 Americans aged 10 or older dying from suicide in 2017. Suicide rates have been rising in nearly every state from 1999 to 2016, with over 25 states experiencing increases of over 30%. Suicide has become a public health crisis, ranking as the tenth leading cause of death in the U.S. Suicide is the second leading cause of death in individuals aged 10-34. While suicide rates have increased in the U.S., they have decreased in other countries, such as Japan and Canada, proving that we can bend the curve of the suicide crisis in the other direction. The Warning Signs Every single person can help save a life. With suicide rates continuing to rise, it has become even more important for people to be aware of the common signs and symptoms of suicidal behavior including: Extreme mood swings Showing rage Withdrawing or isolating from others Sleeping too little or too much Acting anxious or agitated Substance abuse Talking about feeling hopeless or trapped Talking about wanting to die Feeling like a burden Life stressors can include: Relationship struggles Legal issues Financial struggles The warning signs of suicidal behavior have not changed over the years, but due to technological advancements, the way in which people make others aware has changed slightly. For example, individuals who may be struggling with suicidal behaviors are now likely to use outlets such as social media and gaming to share their feelings. Resources: Now is the best time to start building a collection of resources that you may need one day for yourself or a loved one. Suicidal behaviors can happen at any moment, so instead of waiting until you truly need them, I recommend finding some trusted resources now to become familiar with. Resources to save: MHAScreening.org: Offers free, confidential, and secure mental health screens. Taking a mental health screening is one of the quickest and easiest ways to determine whether you are experiencing symptoms of a mental health condition. Suicide Prevention Resource Center: Offers resources including webinars and online courses. American Foundation for Suicide Prevention: Advocates for suicide prevention research and funding. Psych Hub: An online platform providing free, engaging videos for individuals and healthcare providers about mental health, substance use, and suicide prevention. PsychArmor: Provides resources to Americans so they can effectively engage with and support military service members, veterans, and their families. American Association of Suicidology– Offers free resources and information on national programs to support suicide prevention. With the knowledge of these topics, we can all be better mental health advocates and support systems for a loved one who may be struggling with suicidal behavior. Continue to arm yourself with knowledge because you may never know when you’ll need it and every single person has the ability to save a life. If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-8255 to connect to a local crisis center or text MHA to 741741 to connect to a trained Crisis Counselor 24/7. This post courtesy of Mental Health America. View the full article
  25. It’s completely normal to feel anxious in social situations. Be it giving a speech or talking on the phone, social anxiety affects a surprisingly large percentage of the population. However, when one experiences considerable distress and an impaired ability to function in parts of their daily life, it is likely they will be diagnosed as social anxiety disorder.1 Many people with social anxiety disorder do not know that they have it. They may recognize that there is something “wrong,” but do not know what it is or what to do about it. This is where mindfulness can help. By being mindful, aware of the present moment, one can identify that they feel “some kind of way.” Through practice, rather than being self-critical, or judgmental of the anxiety-provoking situation, one can learn to accept things as they are rather than the way they “ought to be.” This, in turn, can lead to an increase in self-compassion and the reduction of social anxiety symptoms. What is Social Anxiety Disorder? Social anxiety disorder is generally understood to be characterized by a marked fear of situations in which there is potential for embarrassment or humiliation in front of others. It is important to note, it is merely the ‘potential’ for embarrassment or humiliation, not necessarily any actual negative experience. It is this fear that makes social anxiety disorder so insidious. Social Anxiety Disorder Symptoms The symptoms of social anxiety disorder are generally triggered by two main social categories: performance situations and interpersonal interactions. Performance situations are where people feel they are being observed by others. Situations such as public speaking, eating in front of others, and using a public washroom can all be triggering to someone who suffers from social anxiety disorder. Interpersonal interactions are those where people are interacting with another person. Interactions such as talking to friends or co-workers, dating or even ordering food at a restaurant can also be extremely triggering. When triggered by one of these social situations, an individual with social anxiety disorder may experience physical, emotional, and behavioral symptoms. Physical symptoms may include rapid heartbeat, stomach issues, shaking or trembling, excessive sweating and blushing. Emotional symptoms may include extreme fear and anxiety, nervousness, panic attacks and body dysmorphia (particularly concerning the face). Behavioral symptoms include avoidance of social situations, refraining from social activities due to fear of potential embarrassment, isolating oneself and excessive alcohol and substance abuse. Age of Onset Social anxiety disorder has a relatively early age of onset. Symptoms generally manifest at around 13 years of age.2 A significant number of people who develop social anxiety disorder in adolescence recover before reaching adulthood. That being said, only about half of those with the disorder ever seek treatment. Moreover, those who do seek treatment, generally only do so after experiencing symptoms for 15-20 years. There are several explanations for an individual to not seek professional help: feelings of embarrassment or fear, a feeling that their shyness is part of their personality, or ironically, a function of the disorder itself.3 Prevalence of Social Anxiety Disorder Social anxiety disorder is one of the most common anxiety disorders in Canada.4 About 7.1% of adults in the U.S. had social anxiety disorder in the past year, according to the National Institute of Mental Health. Lifetime prevalence rates of up to 12% have been reported, compared to lifetime prevalence estimates of 6% for generalized anxiety disorder, 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive-compulsive disorder (OCD).3 What is Mindfulness? Mindfulness is a mental state achieved by focusing one’s moment-by-moment awareness, while calmly acknowledging and accepting one’s thoughts, feelings, physical sensations and surrounding environment, in a gentle, non-judgmental way. It is important to note, that mindfulness involves a sense of acceptance. That is, paying attention to thoughts and feelings without judging them — without believing, for instance, that there’s a “right” or “wrong”, “good” or “bad” way to think or feel in a given moment. Though mindfulness has its roots in Buddhism, secular mindfulness has become popular in the West due in part to the work of Jon Kabat-Zinn and his Mindfulness-Based Stress Reduction (MBSR) program developed during the late-1970s. How to Practice Mindfulness? The practice of mindfulness is not overly difficult. The real work is remembering to practice. There are many ways to practice mindfulness, and below is a short practice to help get you started. Take a seat – Find a place to sit that feels safe, calm and quiet. Set a time limit – It can help to choose a short time, such as 5 or 10 minutes. Notice your body – Notice how your body feels against the chair or cushion. Notice any aches or pains. Notice any need to fidget. Follow your breath – Follow the sensation of your breath as it goes out and as it goes in. Notice when your mind has wandered – Your mind will wander; it’s what minds do. Your attention will leave the sensations of the breath and wander to other places. When you notice this, in a few seconds or a few minutes, simply return your attention to the breath. Be kind to your wandering mind – Try not to judge yourself or obsess over the content of the thoughts you find yourself lost in. Just come back to the breath and start again. Mindfulness is essentially the practice of paying attention to the present moment — thoughts, feelings and physical sensations. With practice, one can learn to gain psychological “distance” from their worries and negative emotions, seeing them as an observer, rather than being engrossed with them.1 As one gets better at recognizing unhelpful thoughts, uncomfortable emotions and/or sensations as they arise, they will also get better at choosing how they react, or not react, to said thoughts and sensations. How can Mindfulness be Used to Treat Social Anxiety Disorder? Through the practice of mindfulness, one can learn to notice their “social” discomfort arising. For example, in a social situation, someone with social anxiety may be reluctant to join a conversation or make a phone call for fear of being judged or criticized. They may begin thinking, “Everyone thinks I’m stupid.” Their heart rate may increase and they may begin to sweat. Through the practice of mindfulness, the person may be able to recognize these thoughts as unhelpful and as merely thoughts, which may or may not be true. With practice, the person may be able to accept these thoughts as fleeting, return to the breath and try to calm down. At this point, the person may be able to join the conversation or make the phone call. It must be emphasized that mindfulness is practice. The same way one cannot expect themselves to be able to play Mozart’s Symphony No. 5 on their first try, it is the same with using mindfulness to treat social anxiety disorder. Mindfulness needs to be practiced to become well-versed at the practice. Accepting the fact that overcoming social anxiety is hard, and will probably be hard for a while, is part of the practice. Through acceptance, a sense of self-compassion may also arise — “I have these negative thoughts about myself. I may not like them, but for now, it is part of me, my experience. I am okay, experiencing social anxiety doesn’t lessen my self-worth.” Social anxiety disorder is a very common anxiety disorder that affects approximately 7% of Canadians as well as 7% of Americans every year. It can be treated using a variety of methods. Mindfulness is one of the most efficacious. It is essentially paying attention to present moment thoughts and sensations. By practicing mindfulness regularly, one can begin to reduce the anxiety felt in social environments, be it in performance situations or interpersonal interactions. The practice itself is not difficult, however, remembering to do so can be. This is a good reason why it is important to establish a regular practice: notice the discouraging thought, accepting that one is experiencing social anxiety, coming back to the breath, letting go of the discouraged, starting again. This is the practice. References: National Collaborating Centre for Mental Health (UK). Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society; 2013. (NICE Clinical Guidelines, No. 159.) 2, SOCIAL ANXIETY DISORDER. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK327674/ Introduction: Social anxiety disorder: recognition, assessment and treatment: Guidance. (n.d.). Retrieved from https://www.nice.org.uk/guidance/cg159/chapter/Introduction. Section B – Anxiety disorders. (2015) Retrieved from https://www150.statcan.gc.ca/n1/pub/82-619-m/2012004/sections/sectionb-eng.htm The Human Face of Mental Health and Mental Illness in Canada, Chapter 5. (2006). Retrieved from https://mdsc.ca/documents/Consumer%20and%20Family%20Support/Anxiety%20disorders_EN.pdf View the full article
  26. Zoe

    Progress Tracking

    Day 7: this time I drove in the afternoon and was feeling stressed about the other cars on the road, so I just pulled out into the alley, then back into the drive like yesterday. It always seems so intimidating and impossible before I actually get in the car, and it's really stressful to think that maybe this day is the one where I give up and stop trying to improve at this. I did ask a friend of mine to drive with me this weekend, so I'm hoping that will help me keep moving forward. Even though I wish my progress were more linear and smooth, I'm really glad I am at least getting behind the wheel every day, even if only for a minute or two. Something is better than nothing, and I can build on the comfort and familiarity as time goes on.
  27. Zoe

    Progress Tracking

    Day 6: All day I felt really drained, so I put off driving until about 3:30 pm this time. I went easy on myself and just did what I did on Day 1 (pull out of the driveway and recenter, then park again). Admittedly it's a little disappointing not to surpass yesterday's driving 'level', but I think it'll ultimately be more sustainable if I focus on just being consistent, not expecting more than just to build my comfort level with driving and do it every day. I realized that if I knew there would never be another driver on the road, I don't think I'd fear driving at all! But trying to figure out the social rules and expectations of driving around other people really stresses me out. Annoying strangers is probably pretty risk-free like 95% of the time, but it is still hard for me to stomach. Add to that the very real concerns about dangerous and costly accidents, and it's not surprising that dealing with this fear is pretty exhausting.
  28. As I’ve discussed previously, drug-gene testing, also referred to as pharmacogenomics or pharmacogenetics, doesn’t really yet work for psychiatric drugs and disorders. People are buying a promise that’s not backed up by the research. Recently, one company in this space published a followup study to a large outpatient study of patients with clinical depression. Since the first study did not show any statistical significance in the study’s primary outcome measure, the company decided to simply re-crunch the data with another measure. Voila! Significance found. In early 2019, Myriad Genetics, makers of the GeneSight Psychotropic test, had the results of a study they funded published (Greden et al., 2019). This is referred to as the GUIDED study — Genomics Used to Improve DEpression Decisions. The primary measure used in that study — the Hamilton Depression Rating Scale-17 (HAM-D17) — showed no statistical significance between a group of patients using treatment guided by the drug-gene test to a group that had treatment as usual. This scale is commonly used in depression drug trials as a “gold standard” for measuring the effectiveness of depression treatment. The difference in symptom improvement scores between the two groups was 2.8%, with the “guided care” (the drug-gene testing) group experiencing slightly better symptom improvement. This difference, however, was not statistically significant. The study also found that the guided-care group experienced significantly improvements in response and remission rates. I guess the lack of statistical significance on the HAM-D17 was bothersome to the company, as it undermines their marketing message about the superiority of their drug-gene test. After all, the HAM-D17 was listed as the only primary outcome measure in the Clinical Trials database. Since that outcome measure did not show statistical — much less clinical — significance, that suggested the GeneSight test perhaps wasn’t as helpful as the company claimed. Twenty-five additional secondary measures were also listed. Of the ones actually reported in the study, these measures also demonstrated mixed statistical significance for the guided-care group. Let’s “Re-Analyze”! So the company decided to re-evaluate the data from the GUIDED study by looking at another measure — the HAM-D6. As you can likely guess, the HAM-D6 is a subset of the HAM-D17, consisting of just 6 of the 17 questions found on the longer measure. The HAM-D6 was developed to cut down on the time needed to administer the test. It also purports to more closely measure the symptoms related to the DSM-IV diagnostic criteria for clinical depression — e.g., it is more sensitive to detect depressive symptoms that are used in diagnosis. This reanalysis could be done since they had all the data from the HAM-D17. All they had to do was just look at those 6 questions used on the shorter measure to see what they might find. Here’s what the lead researcher of the new study claims in the company’s press release: “The HAM-D6 scale has been shown to be a better measure of core depressive symptoms than the HAM-D17 scale,” said Boadie W. Dunlop, M.D., one of the study investigators and associate professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine. “This post hoc analysis provides further evidence that the GeneSight test led to significant and clinically meaningful improvements in clinical outcomes for patients with major depressive disorder relative to treatment-as-usual care.” Now, honestly, this is just BS. If the original study had found statistical significance with the HAM-D17, there’s no way the same set of researchers would then go on to conduct what amounts to a big ol’ fishing expedition, in my opinion. In fact, it begs the obvious question — if the HAM-D6 is such a superior measure, why wasn’t it used (even as a secondary measure) in the original study? The new study found that patients in the guided-care group experienced a 4.4% greater difference in symptom improvement vs treatment-as-usual group. Voila again! Since that difference is statistically significant, it now allows the researchers to claim that the GeneSight test is superior to treatment as usual according to a widely-accepted depression measure. The researchers nicely milked that 1.6% difference between the two studies — the amount apparently needed to claim statistical significance. Does It Matter to Patients Clinically? Researchers can babble all day long about data and statistical significance. It means little to most people. And it’s no wonder, because statistical significance in the data doesn’t automatically translate into clinical significance in a doctor’s office. In short, do patients subjectively feel that 4.4% difference in symptom improvement in their lives? Arguably, the answer in this case is a firm “maybe.” The response and remission rates found in the study speak more strongly to the possible impact that the guided-care arm had in treatment, since those in that group seemed to have a quicker response to the treatment they were prescribed, and were able to keep the depression symptoms at bay more often than those in standard care. But in terms of the actual subjective feeling of symptom improvement, I believe the results are decidedly less clear. I don’t believe that most patients would experience much of a subjective difference in their symptoms in the guided-care group versus the treatment-as-usual group. Keep in mind that both groups studied had less depression symptoms over time. It’s just that in the GeneSight group, those patients reported a slightly greater improvement in their symptoms. If Myriad Genetics was looking for a grand-slam in terms of evidence clearly demonstrating the efficacy of their drug-gene test, I don’t think they found it in either of these studies. What the studies demonstrate instead, in my opinion, is a slightly better outcome for some patients who take the GeneSight test. It is not an outcome that I believe to be clinically significant, nor justifies the widespread use of any GeneSight test for psychiatric disorders at this time. References Bech, P. (2006). Rating scales in depression: limitations and pitfalls. Dialogies in Clinical Neuroscience, 8(2), 207-215. Dunlop BW, Parikh SV, Rothschild AJ, Thase ME, DeBattista C, Conway CR, Forester BP, Mondimore FM, Shelton RC, Macaluso M, Logan J, Traxler P, Li J, Johnson H, Greden JF. (2019). Comparing sensitivity to change using the 6-item versus the 17-item Hamilton depression rating scale in the GUIDED randomized controlled trial. BMC Psychiatry, 19(1):420. doi: 10.1186/s12888-019-2410-2. Greden JF, Parikh SV, Rothschild AJ, Thase ME, Dunlop BW, DeBattista C, Conway CR, Forester BP, Mondimore FM, Shelton RC, Macaluso M, Li J, Brown K, Gilbert A, Burns L, Jablonski MR, Dechairo B. (2019). Impact of pharmacogenomics on clinical outcomes in major depressive disorder in the GUIDED trial: A large, patient- and rater-blinded, randomized, controlled study. J Psychiatr Res., 111:59-67. doi: 10.1016/j.jpsychires.2019.01.003. Epub 2019 Jan 4. Thase ME, Parikh SV, Rothschild AJ, Dunlop BW, DeBattista C, Conway CR, Forester BP, Mondimore FM, Shelton RC, Macaluso M, Li J, Brown K, Jablonski MR, Greden JF. (2019). Impact of Pharmacogenomics on Clinical Outcomes for Patients Taking Medications With Gene-Drug Interactions in a Randomized Controlled Trial. J Clin Psychiatry, 80(6). pii: 19m12910. doi: 10.4088/JCP.19m12910. View the full article
  29. The past few years I have become increasingly aware that I should feel free and brave by now with my continuous journey of self-discovery and openness to dive deep into my story and find out what makes me who I am. Four years ago, I boldly took off my armor temporarily and stood naked, so to speak, for the first time in many years, as I came out of the mental health closet. Maybe, it was really for the first time ever. As the unraveling began, I didn’t find myself living with adventure and growing into my gifts, feeling an abundant sense of relief and joy. I tried. Goddammit, I tried. So, when I didn’t feel that way I reverted to armoring up to safety. “Midlife is not a crisis. Midlife is an unraveling. Midlife is when the universe gently places her hands upon your shoulders, pulls you close, and whispers in your ear: I’m not screwing around. All of this pretending and performing – these coping mechanisms that you’ve developed to protect yourself from feeling inadequate and getting hurt – has to go. Your armor is preventing you from growing into your gifts. I understand that you needed these protections when you were small. I understand that you believed your armor could help you secure all of the things you needed to feel worthy and lovable, but you’re still searching and you’re more lost than ever. Time is growing short. There are unexplored adventures ahead of you. You can’t live the rest of your life worried about what other people think. You were born worthy of love and belonging. Courage and daring are coursing through your veins. You were made to live and love with your whole heart. It’s time to show up and be seen.” – Brené Brown Here I am teetering on the outskirts of midlife, and I sometimes still feel more lost than I have ever been. The idea that the truth shall set you free, and being vulnerable is the starting place of healing and change, is something I have learned and preached to others. My ongoing struggle of self-exposure lingers between the shame that still tries to weigh me down, and the continuous comparing myself to others. This can make it difficult to practice what I preach sometimes. So, as this midlife status lingers, I am bombarded with the reality that time is running out. I panic and think, how will I feel about my life when I am the age my dad was when he died? Will I have regret that I let anxiety rule much of my life? Will I feel like a failure from walking away from my career in 2008 and never quite being able to find my place in the world since? Will the feelings of inadequacy still be there? Will I feel proud that I armored up to protect my heart and soul at the expense of an adventurous and carefree life? Or will I feel shame that I worried too much what other people thought? I don’t know. I only know that time feels like it’s creeping up on me. I don’t know if it’s because this past year has been a very grief- and death-intensive year and the reality of the life cycle is sinking in, or that when I get up off the floor my hips remind me, I am not 25 anymore. I have had a few close calls with death, and I am not ignorant to the fact that I am lucky to be alive. I used to think midlife was all about the struggle and fear of getting older that could be resolved by buying a sports car, finding a younger man or going hiking in the mountains, but here I am at midlife and none of those things ever cross my mind or appeal to me. If midlife is about questioning where you have been, where you are going and deciding if you are going to be you or the facade you have been portraying for years, then I am definitely at midlife. I am at that place of questioning everything. I am at that place where my coping mechanisms and armoring up are starting to piss me off, even though it’s been a knee-jerk reaction in life that I’ve gotten used to. I feel the universe’s hands upon my shoulder as she whispers in my ear “I’m not screwing around.” And, if I have learned anything in life, it is that if you ignore the universe’s whisper to smarten up, she will try louder until you can no longer ignore her. View the full article
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