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Panic Attack Coping Statements

panic attack

Panic Attacks Defined

You’re on a plane. . . or in your car. . . or in a restaurant. . . or seated in class or at work . . when all of a sudden it happens – a panic attack.

The DSM-5 defines a panic attack as an experience characterized by four or more of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of unreality (derealization) or being detached from oneself (depersonalization)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations (paresthesias)
  • Chills or hot flushes

The experience of fewer than four of these symptoms may be described as a limited-symptom panic attack, or more colloquially, an anxiety attack.

For those who have suffered panic attacks, these can be some of the most frightening experiences there are, especially when you don’t know what they are. Learning how to cope with them is key – and can reduce their intensity and duration. While the following coping statements don’t serve as a substitute for professional treatment, they can help you begin to weather these attacks.  Some might also be helpful when experiencing difficult emotions or urges to engage in self-destructive behaviors.

Panic Attack Coping Statements

  1. My body is issuing a false alarm. In a few minutes, the alarm should stop.
  2. I am not in physical danger.
  3. These symptoms are uncomfortable/unpleasant, but my health is not at risk.
  4. This is my brain misreading and misfiring. I am actually okay.
  5. My body knows how to breathe on its own.
  6. If I can accept these feelings and breathe through them, they’ll likely go away sooner.
  7. I have survived similar experiences before.
  8. Symptoms of panic do not mean I’m “going crazy” and are not indicative or predictive of other mental illnesses.
  9. Panic attacks are fairly common and short-lived experiences.
  10. I can do this.

Have you used any of these coping statements yourself? Which of these (or others) can you imagine working for you?

Gatewell has a team of therapists specializing in anxiety disorders and can help you implement these coping statements and offer other strategies toward addressing symptoms of panic and anxiety.

How Psychology’s Focus on Obesity Does More Harm Than Good

obesity

Psychology, taking its tune from medicine, has honed in on obesity as a problem its providers need to fix.  Medicine views obesity/overweight as a disease; psychology has co-opted the disease model and posits weight as a behavior demanding therapeutic intervention. But these approaches are flawed, and psychology’s focus on weight-loss interventions is unethical, violating the basic ethical principle of Nonmaleficence (do no harm).

Weight, like height, is a individual variant largely influenced by genetics.  We believe that weight is significantly more manipulable than height, but research suggests otherwise. The body has powerful hormonal and metabolic mechanisms in place designed to maintain its natural weight. When healthcare providers recommend weight loss in order to improve health, they’re dangerously missing the mark and possibly promoting a disordered relationship with food and the body. Instead of getting stuck on obesity, providers are better served focusing on indices of health, such as blood pressure and cholesterol levels, and on predictors of health, such as stress, access to healthcare, mental health concerns, etc., all of which can be improved without losing a pound.

Here’s why we’ve gone wrong:

  1. Most diet/weight-loss efforts fail, with individuals gaining back the weight (and then some).
  2. Since diets are largely ineffective, many will go on and off them, with corresponding ups and downs in weight, a process known as yo-yo dieting or weight cycling. Weight cycling is associated with more negative health outcomes than remaining at a higher, stable weight.
  3. Those who are encouraged to restrict their diet often develop disordered eating habits, with a portion developing full-blown eating disorders. Some might develop Anorexia Nervosa, while dietary restriction might lead others to struggle with compensatory overeating, perhaps developing into full-blown Bulimia Nervosa or Binge Eating Disorder.
  4. Weight-loss recommendations are rich in weight stigma and often lead individuals to feel bad about their bodies and themselves, which can paradoxically lead to emotional overeating and/or to negative health outcomes.
  5. Punitive, compensatory, or un-enjoyable exercise has the potential to negatively influence health via over-training injuries and cortisol spikes. At the very least, exercise adherence will likely be lower if the activity is too challenging and lacks reward.

Here’s what we can do instead:

  1. If providers really want to focus on health, focus on health! What recommendations do you make to those with thinner frames? Those same recommendations can be made to those who live in larger bodies.
  2. Help patients develop a healthy relationship with food by encouraging a balance diet that includes nutrient-dense and fun foods. Labeling certain foods as “bad” or off-limits is likely to backfire.
  3. Help patients find physical activities that they enjoy and can see participating in for the long-haul. This will increase exercise adherence and promote a healthy relationship with movement.
  4. Research and be mindful about the many ways that societal and clinical weight stigma can impact patients’ health.
  5. Get schooled in the Health at Every Size (HAES) approach.

*More extensive info on this topic (along with a host of references) is available in Does Every Woman Have an Eating Disorder?

12-Step Approaches: Pros and Cons for Alcohol and Substance Use Disorders

12-Step

Success of 12-Step Approaches

Most people are familiar with AA (Alcoholics Anonymous), NA (Narcotics Anonymous), and other 12-Step (self-help) groups. In fact, many treatment providers, when learning of a client’s alcohol or substance misuse, will immediately suggest that the client begin attending 12-step meetings. But do these meetings work?

AA, the largest and most well-known 12-step group, seems to have a varying success rates,  depending on who you ask. In 2014, AA reported the following about its membership:

  • Sober 20+ years: 22%
  • Sober 10-20 years: 14%
  • Sober 5-10 years: 13%
  • Sober 1-5 years: 24%
  • Sober less than a year: 27%

These statistics are misleading, though, as they do not capture those who have tried AA and dropped out. Were the numbers to include this subset of individuals, the success rates would likely be significantly lower. Peer-reviewed studies typically indicate that AA has a 5-10% success rate. In 2006, the Cochrane Collaboration, conducted a large meta-analysis examining the efficacy of AA and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF* approaches for reducing alcohol dependence or problems.”

As success rates might be equivocal, we can also take a look at some of the pros/cons of attending self-help meetings. Members might still benefit from attending, even if they cannot demonstrate long-term abstinence.

Pros of 12-Step Meetings

  1. Community: This might be one of the biggest benefit to participating in 12-step meetings. The fellowship is a remarkable source of community and support. Members can rely on each other when struggling, when approaching difficult situations, and when celebrating their victories.
  2. Modeling: It helps to know that others have struggled in similar ways and overcome similar challenges. Moreover, for some folks who have difficulty imagining what a sober life would look like, being with others in the rooms helps them understand that sober life is possible – and can even be fun.
  3. Helping others: Many members of self-help groups report that their sobriety is reinforced when they reach out to struggling newcomers or take on a sponsee. Helping others strengthens their sobriety muscles.

Cons of 12-Step Meetings

  1. Higher Power: Some people might have trouble with the “Higher Power” concept, no matter how creatively they are encouraged to define this for themselves. For these individuals, the concept of a Higher Power becomes a sticking point that clouds further engagement.
  2. Groupthink: Some people object to the rituals and messaging in AA. While some find them helpful, others complain that the sayings, the teachings from the Big Book, etc. are difficult to stomach.
  3. The shame of a slip: For those who slip or experience a lapse or full-blown relapse, picking up another white chip can be a shameful experience and might even discourage honesty or continued meeting attendance. Some do not like the concept of “starting all over” after a relapse, which seemingly negates the work they’ve already put in.
  4. Meetings are not therapy: Self-help meetings are community run without professional oversight. Members might choose to work the steps with a sponsor, but moving through the steps is not a substitute for therapy.

Summary

Some individuals who struggle with alcohol or substance problems might benefit from attending 12-step meetings, especially as an adjunct to individual therapy. In cases where treatment is not an option, participation in meetings can offer an alternative, rich in community and support. Still, it is important to keep in mind that self-help meetings do not constitute treatment and that groups are not equipped to address co-occurring mental health concerns.

*TSF = 12-Step Facilitation Therapy

Celebrating National Taco Day at Gatewell

taco

At Gatewell, we’re strong proponents of the intuitive eating and “all foods fit” philosophies. That’s why we were thrilled when our in-house registered dietitian, Christine Tellez, shared this easy recipe. Christine’s Taco Meat recipe kicks off a series of easy recipes featuring Latin-American cuisine, in honor of Hispanic Heritage month. So many ingredients associated with Latin-American cooking have gotten a bad rap recently in our current carb-fearing climate. We’re here to take back the beans, the corn, the rice, the tortillas, and to help you develop a healthy, pleasurable, and sustainable relationship with food.

Easy Taco Meat Filling (serves 4-6)

This easy recipe is perfect for a quick weeknight dinner.  By adding beans and mushrooms to the mix, we increase the fiber and add in some extra flavor as well. This makes a good amount of leftovers and can be added as a quesadilla filling, served over rice, greens, and even sweet potatoes. Add your favorite toppings to make it a delicious, balanced meal.

Ingredients:

Taco Seasoning Packet or Your Own taco seasoning
¾ c water
1 lb. ground beef, turkey, or even soy crumbles
1 8 oz. carton of portabello or white mushrooms
½-1 can black or red beans
½ an onion (optional)

Directions:

  1. Dice your ½ onion and mushroom and set aside.
  2. Heat pan on medium and add canola oil and diced onions once oil is hot. (Skip this step if you are not using onion.)
  3. Add in ground meat of choice and cook for a few minutes. Then add in mushrooms.  Cook until meat is browned.
  4. Add in taco seasoning mix, water, and beans.
  5. Turn down heat and simmer until water is soaked up.
  6. Serve in a tortilla, over rice, add to a quesadilla, on greens, or over a sweet potato.  Top with sour cream, avocado, guacamole, salsa, tomatoes, and other toppings that you love.

Happy National Taco Day – enjoy!

Mental Heath Insurance – To Claim or Not to Claim?

Mental Health Insurance

Mental Health Insurance:

Before the millennium, many Americans lacked mental health insurance. The Affordable Care Act (aka, Obamacare) expanded on the Mental Health Parity Act to require most insurance plans to cover therapy and treatment for psychiatric disorders. With it, millions of American had new access to behavioral health coverage, insurance that would pay (at least partially) for mental health services.

With increased coverage comes more frequent discussions about what using this coverage entails. What does it mean to have a diagnosis on record? Can your employer (assuming you have health insurance through your employer) access your insurance claims? What are the pros/cons to submitting claims for mental health services?

Pros to Using Health Insurance:

The benefits to using your health insurance for mental health services are largely financial. You pay for your insurance, and with this, comes the coverage it provides. If you see an in-network provider, you might be required to pay just a copay (following meeting your deductible, if applicable). Copays (or coinsurance, as some plans use) have a large range (I’ve seen $0-$65) and seem to be trending up over time. If you see an out-of-network provider, you would likely get reimbursed a portion of the out-of-pocket fee you pay up front (again, following meeting the deductible). The reimbursement is usually a percentage of the visit, but note that insurance companies will reimburse what they think the visit should cost (i.e., “usual and customary”), not what your provider charged and what you paid, so the percentage reimbursed might be lower than anticipated.

Again, the main argument for using your health insurance to pay for therapy, intensive treatment, etc. is to save you money. You’ve paid your premiums, and you’re entitled to the benefits that come with your policy. For most Americans, ongoing therapy is a major expense made possible only by the use of behavioral health coverage.

Cons to Using Health Insurance:

The most significant con, in my opinion, to using mental health insurance is that once a diagnosis is on file with an insurance company, this information is no longer private/confidential between therapist and client; it becomes “out there,” on record. Can your employer access and review your health insurance claims? No, not according to HIPAA. But, once information leaves a therapist’s office, the therapist can no longer guarantee its security. We guard information according to HIPAA and only release records with permission and/or a court order, but we can’t protect the information once it’s out of our hands.

Additionally, once a diagnosis is recorded with an insurance company, that diagnosis is officially “on file.” What this might mean for securing healthcare coverage in the future remains to be seen. Having a diagnosis, and particularly certain diagnoses, might make it more challenging to acquire health insurance, life insurance, and other future policies. Parents might be particularly concerned about a entering a diagnosis on record for their children.

Finally, if insurance companies are paying for treatment, they might want to limit coverage and payment. They might want to dictate the duration of treatment or how frequently therapy occurs. To do this, they might request detailed records (beyond just the diagnosis required for reimbursement), and the therapist and client would have to decide together if submitting more personally detailed information would be more helpful or harmful.

The Bottom Line:

As evidenced above, it can be difficult to decide whether or not to submit mental health claims to insurance for coverage/reimbursement. Some clients might choose to pay out-of-pocket (seeking out sliding scale providers in many cases); others might choose to use employer-based HSA or FSA plans, which require documentation of a doctor’s visit but don’t require a diagnosis on file. These plans won’t cover the mental health visits, but they will allow you to pay for the services pre-tax. Whether or not you choose to use your insurance benefits is an individual decision that requires carefully weighing the pros and cons.

To learn more about the pros/cons of using your mental health insurance, contact us at Gatewell.

The Good Enough Mom

The Good Enough Mom
The Perfect Mom

Are you a Pinterest-worthy mother? Do you create edible dioramas, crafted only out of bamboo shavings, low-glycemic fruit, and unconditional love? Have you found the perfect tipping point in meditating alongside little one, balancing modeling a spiritual practice and self-control, while attending to the ever-flowing needs of baby? Do you playfully conjugate verbs in your child’s third language to and from school, unless you’ve established a more teachable political, philosophical, or entrepreneurial point for that day? If not, you’re probably comparing yourself to a number of unrealistic standards that exist around motherhood today.  We internalize these expectations from social media, mom blogs and mom groups, and exposure to a culture that demands full-time, expert performance from mothers and women in general.

Here are just some of the expectations that modern mothers face:

  • You choose between working mother and stay-at-home-mom, and whichever your choice, you have some regrets and a number of people who judge you for it.
  • Of course you breastfeed, and you do so for at least a year, ideally two.
  • You baby-wear, based on your personal attachment to attachment parenting.
  • You never let your baby cry, especially before sleep. Instead, sleep onset is a deliberate, hours-long operation of rocking, singing, and chanting, culminating in an expert transfer of the sleeping infant, a precise maneuver, the likes of which are witnessed only on neurosurgical operating tables.
  • You prepare nutritious, organic, whole food for your children. You practice baby-led weaning, which you researched long before your child was born.
  • You don’t use screens as “babysitters” and avoid any screen time until your children are at least two, ideally older.
  • You parent peacefully, focusing on natural consequences. Discipline is unnecessary if you’re doing this correctly.
  • You are never “that mother” with “that kid” at Target.
  • You purchase only products and toys that enrich your child’s emotional, intellectual, and physical well-being. Better yet, you provide all that enrichment yourself.
  • You potty train your children not a day before they’re ready but of course before it’s required for school.
  • You are “room mom” in your child’s class and effortlessly coordinate teacher gifts, holiday parties, fundraisers, and the like.
  • You provide your children access to a variety of stimulating and skill-building activities. You encourage, but never force, participation in classes for which you’ve signed up, despite any anxiety about the scheduling and financial commitments you’ve made.
  • You invest in your child’s emotional development and well-being and listen patiently and understandingly when your child screams, “I’m mad at you!” each time you gently suggest a shower. You reply that you understand how your recommendation would trigger this emotion and quickly default to your philosophy of bodily autonomy.
  • You understand that you are there to guide, not control, your children, even if that means a 30-minute socks-and-shoes motivational inquiry when you’re already late for school, work, and life.
  • You consistently put your children’s needs above your own.
  • What energy you have left, you invest in your partner, if you have one, because it’s even more important to nourish that relationship when parenting. Date nights, visiting the in-laws, etc. are priorities, even if you’re tired and desperate for some time to yourself. If you’re flying solo, this time is better spent doing anything above even better.
The Good Enough Mom

Long before Pinterest was worthy, British pediatrician/psychoanalyst Donald Winnicott coined the term the “Good Enough Mother.” Winnicott’s theory suggests that mothers can fail their children at times, not meeting each and all of their needs, and that, essentially, that’s okay. In fact, Winnicott contends that as babies grow, their development is enhanced by some delays in mothers meeting their needs (maternal “failures”). Infants begin to understand that they are not the center of the universe and develop more realistic expectations of others and the world around them. According to Winnicott, a mother does not have to be perfect, just “good enough.”

So, what does a “good enough mom” look like in real life? She need not adhere to all of the above standards in order to mother a healthy, resilient child. In fact, the good enough mom might:

  • Make a practice of attending to her own self-care.
  • Get as much help and support as she can.
  • Remember that she is a multi-dimensional being, not just a mom, and invest in growing herself in different arenas.
  • Forsake comparisons with other mothers.
  • Make mistakes and then amends, focusing on repair, not perfection.
  • Evoke that old, airplane-oxygen-mask analogy (i.e., adults’ masks go on first).
  • Consider that each stage of childhood requires a new maternal role with an evolving set of demands and responsibilities and is patient with herself as she learns the ropes.
  • Do the best she can.
  • Remind herself that she is doing the best she can.

For help with navigating maternal expectations and demands, along with the distress this can elicit, and with practicing becoming a good enough mom, please contact us at Gatewell.

Fighting Insomnia with Reverse Psychology

Insomnia

Do you have trouble falling asleep? Does bedtime create significant stress for you? You might be struggling with insomnia.

According to the American Sleep Association, 10 million adults experience chronic insomnia, while 30 million adults have periodic bouts of difficulty falling asleep. Insomnia can have various causes and may be related to other mental health conditions, such as anxiety or depression. Other culprits are medications, substance use (including alcohol, nicotine, and caffeine), poor sleep habits, and stress.

A common treatment for insomnia involves improving “sleep hygiene,” a variety of behaviors designed to ensure a good night’s sleep. A sleep hygiene protocol might involve reduced daytime napping, avoidance of stimulants, such as coffee, close to bedtime, and reduced exposure to stimulating content prior to sleep (e.g., conversations, television shows, etc.). Patients with insomnia are generally instructed to avoid any screen time close to bedtime, as the blue light that cellphones and other devices emit interferes with melatonin production. Melatonin is a hormone produced in our brains that regulates our sleep-wake cycles and signals us it’s time to go to sleep.

While it is often helpful to develop a solid sleep hygiene routine, sometimes that isn’t enough. Patients with insomnia often complain of anticipatory anxiety leading up to bedtime, anxiety that interferes with them relaxing and falling asleep. They worry that it will take hours for slumber to set in, or as they lie in bed awake, they think ahead to how tired they’ll be the next morning with only four or five hours’ sleep. They watch the clock with worry and dread as the minutes tick away. They try so hard to fall asleep that they can’t.

Enter paradoxical intention, or in lay terms, purposely engaging in a feared behavior. In this case, the feared behavior is not being able to fall asleep. So, the paradoxical intention is to try to stay awake. Paradoxically, if someone changes the goal from desperately trying to fall asleep to trying to stay awake, the anxiety around falling sleep decreases, allowing it actually to happen. Most people who struggle with insomnia aren’t too keen on the idea of trying to stay awake longer than necessary, but they can usually understand the rationale and often report that when they shift the goal, anticipatory anxiety diminishes, and sleep occurs more readily.

If you are interested in working with a therapist on insomnia or related concerns, please contact us to schedule a consultation.

The Link Between Exercise and Eating What You Want (Hint: It’s Not What You Think)

exercise

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 and/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 you 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 your body, if done intuitively and non-punitively can serve a similar function. Physical activity is innately rewarding, unless you 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.

Rejection Therapy and Social Anxiety Disorder

social anxiety

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.

Why It’s Important to Work with a Specialist

Specialist

Let’s talk about the importance of choosing a specialist when deciding on a mental heath provider.

Recently, in an online professional group, a group therapist shared that leading groups is not that much different than conducting individual therapy. Not true! There’s so much more that goes into working with groups – into studying and working with group dynamics- that I was surprised to hear a professional make this statement. When I think about everything that was involved in earning my Certified Group Psychotherapist credential – the hundreds of hours of experience, supervision, and education required in order to earn this title – I wonder how individual therapists can so comfortably make the transition to group therapist without similar training.

The same goes for working with particular disorders and specialty areas. In my work, I have acquired specific specialties in working with eating disorders and substance use disorders. This goes beyond the generalist training that most therapists receive and that equips us to work with more commonly presenting conditions such as anxiety and depression. For me, the ability to work competently with eating disorders and with alcohol and substance use disorders involved years of supervised experience using evidence-based approaches. Not every therapist knows how to work with these disorders, and even the most well-intentioned therapist can do a lot of damage trying. In the same way, I would never try to work with conditions with which I have no (or minimal) experience treating. If someone comes my way who struggles with a developmental disorder, psychosis, or certain personality disorders (among other conditions), I readily refer out to specialists in these areas.

So if you’re seeking help for an eating disorder or an alcohol or drug problem – or for that matter, any specific concern, ask your potential provider:

  1. How long have you been working with this disorder?
  2. Did you receive supervised experience in working with this disorder? How/where were you trained?
  3. What type of approaches do you use to work with this disorder? Are they evidence-based?
  4. Do you collaborate with other professionals on your cases?

Please Contact Us at Gatewell to learn more about choosing a specialist that’s right for you.