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I remember spotting a woman at the grocery store not too long ago, wearing a shirt that read, “Will Work Out for Fries.” The problem with this sentiment, along with similar ones, is that it posits physical activity as compensation, or penance, for consumption, a problematic belief that can trigger disordered behavior. When we believe that fries must be “burned off” through physical activity, we up the ante at the gym, a slippery slope toward compulsive exercise, or toward creating a dangerous pairing between eating and compensatory behaviors.

So, what is the link between exercise and eating fries – or cheesecake or pizza or anything else that diet culture tells you not to eat?

Engaging in physical activity is a health-promoting behavior. We know that movement improves our physical and mental health. Exercising might clear your mind, create a challenge for you, distract you from your daily stressors, or provide you some much-deserved “me time.” A flexible relationship with food, one that allows us to satisfy cravings and engage with food socially, naturally, and spontaneously, is also a health-promoting behavior. It results in reduced binge/emotional eating, reduces obsessive thinking about food, and increases the ability to relate to food easily and non-emotionally – all of which promote general well-being.

Also, eating intuitively and in response to particular cravings at times is fun. It’s enjoyable. It’s what gives life flavor and spark. Moving our bodies, if done intuitively and non-punitively can serve a similar function. Physical activity is innately rewarding, unless we devise a set of rules or expectations that rob it of its inborn joy. Spend some time watching children move to remind yourself that this is true.

So, eat the fries and go for that walk or run – not because you have to “burn them off” – but because both are examples of healthy and life-affirming being in this world.

Meet Jia Jang. He’s an entrepeneur, author, and TED Talker. He’s also the owner of Rejection Therapy, a game designed to help people overcome their fears of rejection.

A couple of years back, Jia sought to conquer these same fears by participating in a 100-Day Rejection Therapy Challenge. According to his TED Talk, Jang endured early experiences of rejection and shame that led him to fear any future rejection. As any student of behavioral psychology would do, he decided to address his anxiety via desensitization – or exposure to the feared stimulus – in this case, rejection. Jang took on 100 rejection exposure challenges, anything from asking his local Domino’s if he could deliver their next pizza to asking President Obama for an interview.

Cognitive-behavioral therapy (CBT) suggests that the more you engage in something you fear, the less you will fear it over time. As Jang experienced rejection after rejection, he started to become desensitized to the experience – to dread it less. He even made rejection his business. Jang shares on his website: “My journey has revealed that the stings and slights of rejection are universal among us as humans, but that with conscious intent we can turn rejection into enterprise, insult into ambition, and regret into courage.”

Fear of rejection is a hallmark symptom of Social Anxiety Disorder (SAD), sometimes referred to as Social Phobia. Individuals with Social Anxiety Disorder often suffer from intense fear or shame regarding real or perceived judgments or evaluations from others and might avoid at all costs situations in which scrutiny is possible. The most extreme form of another’s judgment is, of course, rejection.

Social Anxiety Disorder can be treated in individual or group therapy. Using CBT and Jang’s experience, those with social anxiety disorder can tackle fears of unfamiliar individuals, judgments from others, and rejection-sensitivity through a series of exposure exercises. As with other exposures, these experiences become easier to manage over time and, therefore, anticipatory anxiety – and avoidance – can fade.

A while back, a meme was circulated encouraging those who struggle with depression, rather than taking medication, to just go for a run outside.

As a player in the fitness industry for over twenty years, and the author of a study on the mood-enhancing properties of exercise, I won’t disagree that physical activity can often improve how we feel. But it’s not going to help everyone, and an individual suffering from a severe depression might not be in a place to lace up her running shoes and hit the pavement. In cases of moderate to severe depression, treatment isn’t optional. This advice also overlooks those who struggle with eating disorders and/or compulsive exercise, who might have turned that prescription for a “run outside” into something problematic.

We see and hear a lot of these stock approaches to recovery. “Anxious? Try meditation – it worked for me!” “Have insomnia? Cut out [x] food.” And the old, “Why don’t you just eat?” to the individual suffering from an eating disorder. While the comments might be well-intended, they fail to capture the diversity and significance of mental health presentations. A brain (not to mention, a personality, life history, cultural experience, etc.) is a complicated thing, and when we try to compare one to the other, we lose a lot in the process. Suggesting that someone with panic attacks take a meditation class might be akin to asking him to write a book when he’s only capable of drafting an outline. Encouraging someone with an eating disorder to “just eat” without significant structure and supports in place is asking her to accomplish the unthinkable.

In many cases, therapy and/or medication is required in order to make progress from a mental condition. (Side note: Taking psychotropic medication is not unfeminist, as a psychiatrist in New York City suggested in a recent Facebook post.) All of the self-care and self-help exercises in the world are not enough to tame some of the symptoms we see in practice. So, if you know someone who’s struggling, my advice is to back off the advice. Listen and express compassion. Read up on evidenced-based treatment. Ask the individual if there’s anything she needs or wants from you. And then just be there, minus the platitudes and trendy treatments, the quick fixes and what-worked-for-me’s.

One of the most frightening things that many of my patients experience is a panic attack – or worse, a series of them.  According to the DSM-5 (American Psychiatric Association, 2013), a panic attack is:

“An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur. Note: The abrupt surge can occur from a calm state or an anxious state:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or going crazy
13. Fear of dying”

Many individuals who experience panic attacks present in hospital emergency rooms, afraid they’re having a heart attack. Others are convinced they’re losing control or going insane. In reality, panic attacks are uncomfortable physical and psychological experiences, but they aren’t dangerous, an important distinction to make.

One of the best things someone can do at the beginning of a panic attack is to try not to “panic about the panic.” It’s easier said than done, but this will only make things worse. A panic attack is the body signaling a false alarm. Responding to the alarm as if it’s real validates the symptom. Instead, labeling the symptoms as panic is a helpful first step, as is challenging some of the the catastrophic thoughts that arise (e.g., “I’m dying”). The more you are able to identify the symptoms as panic, accept them, and potentially distract, the sooner the panic attack will pass. Many become afraid that they’ll pass out/lose consciousness during a panic attack, but heightened physiological arousal is generally contraindicated with fainting.

Developing a sense of acceptance around panic – rather than fearing another attack – can go a long way toward recovery. Cognitive-behavioral therapy is an evidence-based approach used in the treatment of panic attacks. Patients might also find meditation, deep breathing, and regular exercise helpful. For some, medication is indicated, with the typical offerings being SSRIs (e.g., Zoloft, Lexapro), taken daily, or benzodiazepines (e.g., Xanax, Ativan), taken briefly or when having or anticipating symptoms. Some patients find that carrying around medication, without ever using it, can ward off panic attacks.

For help with panic attacks, or other symptoms of anxiety, please contact our team at Gatewell.

One of my favorite definitions of mental health is the ability to experience and express emotions in an effective way. It’s simple, but so on point.

Recently, I came across this blog post on how parents can help their children identify and express their emotions. I love how the author encourages naming – and honoring – of emotions from birth.

All too often, though, children are raised without this kind of emotional attunement, or as we call it, “mirroring,” by the adults in their lives. Kids are told not to cry, not to be scared, to get over it, and to be happy – even when they’re not. Parents might have the best intentions – most don’t want to see their children upset – but avoiding and discouraging emotions will invariably backfire.

It’s never too late, though, to build your own emotional vocabulary, to respond to your emotions compassionately, empathically, and with curiosity; and to practice acceptance of the waves of feelings that course through you each day. Can you acknowledge your feelings without negating them? Can you accept what you are feeling without trying to make it go away? Often, the more we accept our emotions – and then less we discount them or try to suppress them – the less power they have over us.

Why would you want to sit in a room with complete strangers learning about their struggles and being encouraged to reveal your own? It might be daunting to consider group therapy when even the notion of individual therapy might be overwhelming or when you think that being in group might not allow you sufficient time and space to process your concerns.

But what if you learned that group therapy is just as effective as individual therapy – for treating a wide range of symptoms  – and that group participation offers a unique therapeutic advantage? For instance, group therapy provides a venue where you can learn from your peers and receive their feedback and support. It’s one thing to discuss strategies with a therapist regarding how to target a specific difficulty and another to hear from someone who has successfully overcome this same difficulty. Being among peers might also provide an additional layer of support, as you recognize that you’re not the only one who struggles in certain ways. The universality of experience should not be underestimated. Moreover, as we bravely reveal ourselves in group, we directly challenge some of the vulnerabilities and shame that might be holding us back.

For those who are looking to improve how they communicate with and relate to others, group provides the perfect “laboratory” in which to try out new ways of interacting. Interested in becoming more assertive or setting firm boundaries with others? How about managing anger and conflict more effectively? Your individual therapist can address these issues with you as you bring content into your sessions, but it’s a whole other ballgame when your group therapist is able to witness how these dynamics unfold in real time. She can use information from group to help you establish more effective interpersonal patterns in “real life.”

Not sold yet? Group therapy offers a cost-effective alternative to individual therapy, and group treatment allows access to a larger population of individuals, who might not otherwise receive care.

Check out Dr. Rosenfeld’s interview on group therapy with ABC News:

Curious about group? Explore Gatewell’s groups and let us know if you think group participation might be beneficial for you.

While living in Los Angeles, I tried out my hand at improv at the famed Second City. Each Sunday afternoon, our Improv 1 class gathered to play games, act out skits, and laugh together. As I was taking the class, I remember thinking that much of what we were learning – and doing – was applicable to life.

1. Acceptance: One of the first improv lessons is a concept called “yes and.” If you’re in a supermarket skit with someone, and he blurts out, “Look, there’s a dinosaur,” instead of freezing or saying “Dinosaurs don’t go to supermarkets,” you have to play along. In practice, you acknowledge what he’s said (the “yes”) and then further along the concept (the “and”). So, in this case, you might say, “And he’s coming right at you!” Off the stage, yes-and’ing life can have dramatic implications for mental health. We know that refusing to accept our circumstances is the root of much distress, as we resist against the discrepancy between how things are and how we want them to be. Instead of bumping up against what comes our way, what if we accepted whatever it was (referred to in dialectical behavior therapy as “radical acceptance”) and then “and”-ed it? When faced with adversity, what if our primary response was acceptance (the yes) and what to do about it (the and)?

2. It takes a village: Something that gave me comfort whenever I acted in a skit, which wasn’t my favorite thing to do, was the improv guideline that the performers are all in it together. So, if I couldn’t think of the next thing to say, then the person acting with me was equally responsible for rescuing the scene. Wouldn’t it be nice if, when facing difficulties, we allowed ourselves to be vulnerable and reached out for help/support, instead of thinking that the responsibility was all ours? What if we all agreed to help each other during our most challenging scenes?

3. Find humor in your mistakes: Even when someone botched a scene, how the person handled the “error” could become fodder for perfect comedy. Writing the mistake into the script was often the funniest part. What if we wrote our errors into our life scripts? What if we made habit of laughing at our foibles instead of blaming and shaming ourselves?

4. Laughter is medicine: Not many things feel as good as uncontrollably laughing with other people. We underestimate the function that laughter – and fun – can serve in our lives. It wasn’t long before Sunday afternoons became a natural high for me. Life can be challenging at times, and unbridled laughter serves as a respite from the headaches of work, family, stress, loss, trauma. . . even headaches themselves.

If your interest is piqued, you might want to check out an improv class. If not, these lessons from the stage are easily yours to apply to daily life.