pi3: 2019

Tuesday, 31 December 2019

Highlights from 2019: Reflections on Applied Behavior Analysis Blog

This post will be a collection of articles published in the blog: Reflections on Applied Behavior Analysis, specifically articles that were featured throughout 2019. ABA Concepts and Application Offering Choices:...

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What is Applied Behavior Analysis: Definition and Scientific Principles of ABA

What is Applied Behavior Analysis (ABA)? Let’s review a basic explanation of what applied behavior analysis means. One of the most popular and most widely accepted definitions of applied behavior...

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New Year, New You?

As the New Year approaches, it gives many pause for reflection over the last year’s events or in this case, the last decade. This practice can be quite valuable and an excellent opportunity to evaluate goals you want to set for yourself or to give yourself a clean slate and permission to start fresh.

But there is some amount of danger in this way of thinking, too. In some cases, there exists an implication that whatever you are doing now is not enough or that drastic change is the only way to experience the type of fulfillment you are really seeking for your life.

It is true that sometimes, radical change is needed to make the impact we desire. But more often, our goals do not have to be that extreme in order to be implemented and if we ignore this fact, we set ourselves up for disappointment.

When we create New Year Resolutions for ourselves, sometimes we create an unseen pressure to become something we are not or in a timeframe that is not realistic. Sometimes, the key to generating greater fulfillment and achieving what we want to accomplish begins instead with an acceptance and appreciation for what we are already doing really well. In fact, if we are constantly trying to think of ways to improve ourselves, it can make it really easy to lose sight of what is actually working for us.

Another pitfall of this way of thinking is the implication that seizing our personal growth has only limited windows of opportunity, as if it were structured like open enrollment for health care. The reality is, it is within your power to make different choices for yourself at any time. You do not have to wait until the calendar rolls over or the clock strikes midnight. In fact, if you do wait on some arbitrary marker, you risk stunting the natural momentum that can be gained from ideas that occur spontaneously.

Growth is organic, not formulaic. It often happens in unintentional moments while we are busy working away at something we love. Think about a time in your life when you learned an important lesson that helped you grow. Was it a result of a carefully laid plan? Or was it related to variables outside of your control? It is true that setting goals for yourself and being intentional about the direction of your life is important, but the key to growing within those expectations is to remain open and authentically in touch with where you really are and what opportunities you may not have even thought of yet that lie ahead.

This is not to suggest that we do not deliberately challenge ourselves, quite the opposite. The difference is in giving space and appreciation for what we have done well and then building naturally upon that. Instead of rigid declarations, for instance, approach your new goals like riding a wave or allow them to unfold like a blooming flower. It is true there are times when your goal planning calls for specific, definitively outlined goals, but there are also many times when you know you need to change the direction of your life, but you may not know what the end goal will look like exactly. You do not have to have it all mapped out and risk assessed or all the answers before you begin to move things forward in the direction you want to go. Just take one, small step, then go from there.

Likewise, missteps on the road to goal making are not failures. If you start a diet plan but can’t resist one piece of grandmother’s pie at a family gathering, you do not have to throw the whole plan out the window. If you would like to be the type of person that exercises at 5:00am before work everyday but you miss a day here and there, try adjusting your expectation to making it happen three out of five days a week and increase from there. When you surround your goals with expectations of incremental progress, moving steadily in a direction you want to go, and accepting and appreciating where you really are, you liberate yourself to make that move more fluidly and maybe, overall, with greater success and happiness.

Instead of New Year’s resolutions, this year I propose we consider New Year’s Integrations. Keep all the wonderful things about yourself that make you YOU, while folding in some new and exciting opportunities to challenge yourself to grow and change. Integrate these bit by bit and before you know it, you will be counting down the ball drop for 2021, having realized your 2020 goals and planning for even more new ideas for growth.

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During Some Nights an Extreme Paranoia and Fear of Being Killed Strikes Me and I’d Like to Do Something About It

I am a little bit on the paranoid side even during the day. However, on some nights an extreme case of paranoia hits me and keeps me awake for hours, sometimes even for the whole night. I am convinced that someone is in my room and is going to severly injure me or even kill me. Sometimes it even becomes a specific non-existing person whom I’ve nicknamed Joe. He lives in the closet and as soon as I’ll shut my eyes he’s going to strangle me with a belt.

That feeling usually comes if I stay up a bit later than normally, but it also occurs completely randomly. The scariest part of it is that I think I can hear the breathing of that person, though I’m quite sure it isn’t an actual auditory hallucination, rather my mind playing tricks on me. I’ve tried to make it go away with logical thinking, but I always get something else to be deathly worried about. (For example, I also suffer from sleep paralysis every other night, but I rarely hallucinate much during those and am somewhat in control. I get terribly afraid about the possibility of me having a very bad one and getting mentally scarred and then I’ll be afraid of falling asleep for that night)

There aren’t any life changes or other things that would make it reasonable to feel a fear like this, it’s also been around as long as I can remember, but it keeps getting stronger as time goes by. I’d really appreciate some tips on how I’d be able to get rid of this, since I haven’t really found anything remotely similar from the rest of the internet.

This seems like a complicated matter. You mentioned that you have sleep paralysis and on occasion experience hallucinations. It’s possible that your sleep paralysis indicates a potential sleep disorder. It’s not uncommon for people with narcolepsy to have dreamlike hallucinations much like what you have described. The hallucinations typically occur just as one is falling asleep or waking up. Hallucinations that occur while falling asleep are known as hypnagogic. The hallucinations that occur while awakening are called hypnopompic.

One key aspect of these dreamlike hallucinations associated with narcolepsy is the sense of a threatening stranger, a dangerous animal or moving objects in the room. These images and experiences can be quite realistic, frightening and confusing. Often, these hallucinations are rapid eye movement (REM) dreams that are occurring when you’re only half awake. The same is true with sleep paralysis. It tends to occur during REM sleep.

You mentioned hearing the breathing of a person in your room. It’s so real that you have become convinced that there is someone actually in the room. That type of hallucination would be consistent with the possibility of a sleep disorder.

Other symptoms of narcolepsy include excessive sleepiness and a sudden loss of muscle control. Individuals with narcolepsy often feel very tired during the day and may find themselves falling asleep without warning. It is estimated that one in every 2,000 or 3,000 individuals has narcolepsy. It can go undiagnosed for many years.

To be clear, I am not diagnosing you with narcolepsy or any other sleep disorder. That cannot be done over the internet. I’m simply explaining that you may have some of the symptoms consistent with the disorder. The only way to know with certainty if you have narcolepsy or any disorder would be to consult a sleep specialist. Given that you are struggling with issues related to sleep and having these frightening experiences, it would be wise to consult a professional. They can conduct a sleep study and determine if anything is wrong.

If you were to undergo a sleep study, you will likely have to stay overnight in a sleep lab. The test they give is called a polysomnogram typically followed by the Multiple Sleep Latency Test. The polysomnogram records brain waves, eye movements, and so forth, as you sleep. The Multiple Sleep Latency Test is important for diagnosing narcolepsy. It involves a series of five scheduled naps across the day. Typically, this test monitored by a doctor.

I can’t offer any suggestions for how you can “get rid of this” on your own. This seems like something that requires examination and testing. You should consult your PCP and ask for a referral to a sleep specialist. They would be in the best position to help you. It’s important that you do this sooner rather than later because this problem is affecting your sleep. Sleep deprivation is associated with a number of medical conditions. You need sleep to function on a day-to-day basis. Without proper sleep, you may experience mood instability and the ability to think clearly and rationally. Sleep is vital for your health and well-being. Good luck with your efforts. Please take care.

Dr. Kristina Randle

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Day #134: New Year’s Eve!!

Well it's new year's eve so I'm taking the day off. What? No, no party or anything, I'll probably be asleep when the new year hits. It's just a good excuse not to have to blog today and get some house work done instead. Maybe I'm old or maybe I'm just boring, but it beats trying to be social.

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Depression: How To Avoid Self-Medicating With Alcohol (M)

Does drinking cause depression or depression cause drinking?

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The Reason Poor Sleep Makes Weight Loss Difficult

After a bad night sleep, don't follow you nose.

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A Beautiful Way to Cultivate Gratitude—Even When You’re Super Busy

We’re all busy. Jam-packed schedules. Demanding jobs. Early mornings. Late nights. And we’re all tired, too, right?

So, when you think about adding another thing to your to-do list, you likely blurt out, “no thanks.”

But cultivating a gratitude practice is worth it—no matter how busy you are.

One powerful strategy?

Writing heartfelt thank-you letters.

In January 2016 Nancy Davis Kho sent her father a thank-you note, which he framed and kept in his office. That summer Kho sat in the same room at her father’s desk composing his eulogy.

She was grateful that her father knew exactly how much his love, support, presence, and wisdom meant to her.

“That letter created a moment of peace for me at a time when I badly needed it,” writes Kho in her beautiful, encouraging book The Thank-You Project: Cultivating Happiness One Letter of Gratitude at a Time.

A vast collection of research substantiates the power of gratitude. For example, Kho cites research published in 2015 in Frontiers in Psychology that “found that an ongoing practice of gratitude basically rewires our brains to reward us for the positive perceptions we have of the people around us.”

Sociologist Christine Carter, Ph.D, told Kho that positive emotions “reset the nervous system.” Gratitude, Carter notes, helps us to relax, feel safe, and feel connected to others.

Kho cites emerging research that suggests gratitude is effective at overriding negative thoughts. Studies also show that practicing gratitude can improve sleep, boost energy and self-esteem, reduce aches and pains, and bolster resilience.

According to Carter, “if you could sell gratitude as a pill, you’d be very wealthy.”

Still, gratitude, like other repeatedly recommended practices (think meditation), tends to get dismissed. We read about it so much that it becomes background noise during our already hectic days.

The year that Kho penned her letter to her father and composed his eulogy, she embarked on a project that would change her life and become her book: writing 50 thank-you letters to the people, places, and pastimes that shaped and inspired her.

If you’d like to start your own letter-writing practice, below are some helpful tips from The Thank-You Project:

Identify the people you’ll write letters to. Kho suggested exploring these questions: Who has helped, shaped, or inspired you? This could be anyone: your parents, great aunt, or childhood friends; your teachers or your child’s teachers; nurses and doctors; your boss or employees; your AA sponsor; a priest or rabbi; a meditation teacher; a postal carrier; your favorite musicians, artists, and authors (living or not). For example, Kho penned a letter to her high school AP English teacher, who she credits with making her a writer. She wrote a thank-you letter to her obstetrician who safely delivered her daughters. She also wrote letters to Jane Austen, the late humor columnist Erma Bombeck, and music writer and memoirist Rob Sheffield. You can even write letters to places and pastimes. Kho wrote a letter to Oakland and one letter to all the bands she’s ever loved.
Use a simple structure for each letter. Kho’s letters included: a short introductory paragraph; how she met the person; why she appreciates them; and a conclusion about spending time together or activities she’d like to do together.
Answer these questions in your letter: How has this person helped you? How have they shaped or inspired you? What are the most memorable experiences you’ve shared? Have there been any lasting impacts on your life? “If you had a problem and were given one Phone-a-Friend Opportunity, for what kind of question, encouragement, or dilemma would you call this person?”
Set a schedule. Kho penned one letter per week on late Friday afternoons. She’d also reflect on each week’s letter during her walks. She writes, “I sifted through memories, let my mind wander, and generally tried to think deeply, with that week’s letter recipient at the center of my thoughts. In some ways, the time I spent noodling over the person became its own prayer of thanksgiving, a meditation of gratitude.” What pace and time feels feasible for you?
Make a copy of each letter so you can savor it. If you’re typing your letters, you can simply print them out and bind them. If you’re handwriting your letters, you can scan or photocopy each one. According to Kho, “I keep my Thank-You Letter book on the bottom shelf of my nightstand, and I pull it out to flip through at random times—in the middle of getting dressed, before going to bed, when I’m procrastinating instead of folding laundry.” Looking over your letters is a reminder of how many individuals have supported you in all sorts of vital ways.

Ultimately, do whatever works best for you. Do whatever feels easiest and most exciting. This might mean writing one letter each month. It might mean writing letters in your notebook, which you never send. (Research shows that the benefit is in writing your letters, not in sending them.) It might mean writing shorter notes. It might mean creating a ritual around your letter writing: Every morning, you listen to a guided meditation, set a timer for 20 minutes, and compose your note.

We all lead full, bustling lives. And, understandably, it’s stressful to add another task to your list. And yet writing gratitude letters can have profound physical and emotional benefits. It reminds us of the incredible blessings—big or small—that we have in our lives. And, if you do mail your letters, you pay your blessings forward.

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Can a Person with a Mental Health Diagnosis Be a Psychologist?

From a teen in the U.S.: I just wanted to know if it is possible for someone who has a history of depression and or mental illness to get a masters or doctorate in psychology?

I’m not aware of limitations based on a history of mental illness for entry into graduate school. I would only caution you to do your own therapy before thinking about grad school. Getting an advanced degree is stressful, regardless of the field. Getting a degree in psychology can be particularly challenging since the content of some of the courses can feel very “close to home”.

Whether or not it is required, healing yourself is important if you are going to work as a healer. It’s important to be reasonably certain that client issues won’t trigger you and that your own issues don’t intrude in some way in your professional relationship with future clients. It never hurts to increase personal awareness and to develop more coping skills.

I do suggest you learn as much as possible about the field. There are many career opportunities. If direct work with clients isn’t appealing but you are curious about what makes people think and feel and behave as they do, consider doing research. Researchers advance what we know about psychology and find new ways to better understand and help people. There are also jobs for psychologists in schools, in sports programs, even in engineering and business. Look into the scope of opportunities before you apply. Each grad program tends to prepare people for specific career tracks.

I wish you well.
Dr. Marie

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Can a Person with a Mental Health Diagnosis Be a Psychologist?

From a teen in the U.S.: I just wanted to know if it is possible for someone who has a history of depression and or mental illness to get a masters or doctorate in psychology?

I wish you well.
Dr. Marie

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Feeling Scared That You Will Always Feel Depressed and Anxious

If you have struggled with anxiety or depression, you may have experienced the fear and wondering if things will ever get better. Some people feel distressed that they will be cemented forever in the pain and cyclone of the mental storm that doesn’t want to seem to end. For someone like myself who has had anxiety all of my life, I know that it can come in varying degrees where it sometimes interferes with my life, and other times it is so minimal that I am thriving despite anxiety.

What I can say as a person who has experienced anxiety and depression is that living in the fear of being stuck has never helped me. Steps that I have taken to keep moving forward have sometimes been as simple as changing perspective, and as difficult as digging deep in therapy, and everything in between. In action, there are glimmers of optimism, motivation, and change and that has been the way that I navigate through the mental health relapses.

It can be hard to see the light at the end of the tunnel when days turn into weeks and weeks turn into months of trying to find your way through anxiety or depression. It can feel exhausting and like a never-ending battle. There is no doubt that this mental exhaustion can elicit feelings of hopelessness, despair and even suicide. This place of feeling stuck is terrifying, and from the countless times in my past that I have sat on my bathroom floor sobbing alone and wondering how I am going to make it another day, I understand what it means to feel broken inside.

When I am in the midst of an anxiety or depression cycle that seems endless, I try to move through what I’m feeling. This could mean I’m meditating more, practicing better self-care, talking to my therapist, exercising, writing or engaging in other passions I enjoy. Motivation can be hard when you are feeling so low, and the thought of doing anything can seem like a daunting task. I know that when the pain of staying the same becomes greater than the pain of change, I need to try my best to muster up enough willingness to do at least one thing that will help. Sometimes that one thing can mean getting honest and asking for support. Asking for help can be hard, especially if you are the one everyone turns to for support and guidance.

The thought of anxiety and depression not going away can be unbearable. Trying to predict what tomorrow will bring, or how you will feel does not help either. There have been many times that I have anticipated feeling anxious about a situation the next day, only to have the day arrive and feel fine. I also know that the idea of just thinking positive is not one of those things that is going to miraculously make someone feel better. Let’s be realistic about that. If positive thinking was a cure-all for mental illness, we would not have the epidemic that we do. Not all depression and anxiety are rooted in negative thinking. Let me repeat that: not all depression and anxiety are rooted in negative thinking.

So, how do you deal with the lingering fear that you will always have anxiety and depression, when you are in the midst of a difficult and unwavering, painful place? The truth is, you don’t know how long you will feel this way. There is no textbook answer to someone’s mental health crisis. There is no prescription of taking antibiotics for five to seven days and your symptoms will be gone. Sometimes medications for anxiety and depression will alleviate and change a person’s life for the better and sometimes it doesn’t. Medication has never been an answer for me, and I have had to find other coping strategies that work in my life.

The answer is not always easy to find. Sometimes when people are doing everything they can to try and help their situation, things don’t change either, and that’s the confusing reality of living with a mental illness. Everyone is worthy of having a life that brings them joy and peace. It doesn’t come easy for some people, and I get that. I never want to dismiss and devalue the pain and suffering of someone who struggles every day.

Learning new coping skills, how to manage thoughts, behaviors, and emotions are good starting points for managing anxiety and depression. We live in a time where resources are easily accessible for finding tips and tools. Mood and anxiety apps are available to track and teach you strategies. Information is power, and being proactive with your mental health can help you develop the skills that you need to combat the thoughts and fears that accompany anxiety and depression. If you can find a way to try and transition the thoughts of what if I always feel this way, to what if I won’t always feel this way, it can give you the hope you need to keep searching for what might help you long-term.

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Loving Someone With a Mental Illness

What is mental illness? Mental illnesses are conditions that affect mood behavior and thinking. It’s challenging to live with a mental illness, and that’s why it’s crucial to have a support system. That way, you feel connected to others and loved. People with mental illness are just like everybody else. Whether it’s anxiety, depression, or bipolar disorder, mental illness is real. They live with mental health conditions that affect them, but they deserve love. Here are some ways that you can love somebody who has a mental illness.

Empathy

Everybody wants to be understood. Human beings need to feel loved. Part of showing somebody that you care about them is being empathetic. You may not know what they’re going through, but you can still care. People with mental illness experience different challenges such as mood shifts, erratic behavior, and trouble with thinking clearly as a part of their conditions. Depending on your mental illness, it can be extremely challenging to function. That’s why having a support system that is empathetic towards you is essential. If you are living with a mental illness your experiences are valid and you have the right to express yourself to those you love. Knowing that your loved ones care about what you’re going through is comforting.

Listening

It is vital to listen to your loved one who has a mental illness. People with mental health conditions need a sounding board to express their feelings. You don’t have to fix their problems. They are in charge of their life and they need to figure out what coping skills to use to feel better. But you can listen when they express their struggles. It could be tempting to try to fix what they’re going through, but you don’t have to take that burden on. Listen to them and let them know that it’s going to be okay, and you’re there to support them.

Learning

When it comes to mental illness, there are so many things to learn. You may not understand what your loved one is experiencing, but that doesn’t mean that you can’t educate yourself. Let’s say that your partner lives with borderline personality disorder. Now is the chance to ask questions about what they are experiencing and try to understand. You can also buy books on the condition and read up on it. Part of learning about mental illness is reading and educating yourself. Another aspect is lived experience. You can talk to the person who has the condition and hear what they have to say. You can gain a better understanding of what it’s like to live with a mental illness by listening to your loved one’s experience and asking any questions that you might not know the answers to so you can be supportive.

Ask questions

One way to learn about mental illness is to ask your loved one questions. You don’t know all the answers, and to be supportive, you need to have a clear understanding of what their condition entails. Ask them questions in a nonjudgmental way. Ask them how you can be supportive and what works for them. You can also communicate that you’re willing to learn, and that is crucial to the relationship. Your loved one will appreciate your willingness to understand their condition, and they will be grateful for the support.

Communication is key

It’s essential to communicate your feelings when you have a relationship with somebody who has a mental illness. It’s not just about their experiences, it’s about how you feel as well. A friendship or relationship is a two-way street, and if something is hurting your feelings, it’s important to let that person know. They have a right to their feelings and you have a right to yours. It’s essential to express yourself and tell them what you need in the relationship just as they’re telling you what they need. Another place that you can talk about what it’s like to love somebody with mental illness is therapy. Whether you work with an online therapist or someone in your local area, it’s crucial to express yourself and get the support that you need. Online counseling is an excellent place to express your feelings to a licensed mental health professional. Don’t hesitate to reach out for support if you’re having trouble in your life and need to speak to somebody. Loving somebody with mental illness is not easy, but everybody deserves care no matter what their life circumstances are.

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Monday, 30 December 2019

Day #133: The truth of VA healthcare

I'm a disabled Marine veteran. From a TBI to my mental health, I've got some serious issues. Furthermore, with the rate of suicide among veterans ever increasing it may be odd to an outsider why this is happening. After all, the government provides us with free healthcare, why are so many of us dying, why are so many of us killing ourselves? The answer is sadly straightforward, although grim, so let's talk healthcare as a veterans.

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The Most Common Cause Of Brain Fog (M)

People often report experiencing a mental sluggishness or 'brain fog'.

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Weight Loss: Research Reveals An Easy Way To Shed Pounds

Surprisingly, weight loss was achieved without making other changes to diet or lifestyle.

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The Integration of Biological and Psychological Perspectives

During the 1980s, a shift began in which increasing numbers of mental health practitioners and researchers widened their previously narrow views on etiology and treatment of mental illness. Increasingly, it...

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I Wonder if My Wife Has a Personality Disorder and if It Has Contributed to Infidelity

My wife and I have been together since high school. I love her. We have created so many special memories. We now have two sons. However, in many ways being with her has taken a toll me. I am aware of new information and behaviors that have me worried.

Throughout our relationship, she has always been too flirty with other guys. She has also always been a people pleaser and attention seeker. For the first several years in our relationship, and right after we got married, I would have to point things out to her to keep her in check. Still, I did not imagine she would fully cross the line and have an actual affair.

Several years ago I got skeptical. I didn’t have real proof of anything, besides her being overly protective of her phone and spending way too much time reading really graphic erotic romance novels. I also noticed Facebook messages left up on the computer. They were with other men and heavily flirtatious. I questioned her if she was having an affair. She was upset but swore that she was not and never would. She was embarrassed when I asked about the novels and the Facebook flirting, but said I was over exaggerating.

Well, recently she decided to tell me she kissed a coworker shortly before our wedding. I wanted an explanation. She said they were just friends and it was an accidental quick kiss. However, she has continued to tell me other versions.

Most recently she said that the kiss was much more sensual in nature and that after he quit working with her they texted back and forth for months. I am hurt by the betrayal, but also creeped out because things seemed so perfect when that was supposedly going on. There were no red flags. Plus, she cannot even explain why she did what she did.

I am now worried that she was, in fact, having an affair during the time when things did seem off. She swears up and down she was not. My gut tells me that something is not right. I want to live in the present and enjoy life, but wondering what she did makes me worry about the future. She seems to align with the criteria for histrionic personality disorder and borderline personality disorder. I know she was sexually abused growing up. What should I do?

Labeling her behavior, if she is histrionic or borderline, doesn’t change the reality of her lying and disrespect of your feelings. Whatever you want to call it, whether it is a full-blown personality disorder or elements of one, the pain and sense of betrayal is the same.

Trust yourself. If you feel something is off, trust that feeling more than what your wife is telling you. It sounds like she doesn’t know herself very well as she denies the impact her behavior has on you and your family. She might not be the best source to confirm your suspicions. Looking for a diagnosis to explain her behavior is very understandable, but it doesn’t necessarily do much more than giving a name for what is happening, even if it is accurate.

There are several things I would recommend. First and foremost take ownership of what you are feeling. You have a profound sense that something isn’t right — and it isn’t. Realize that your discomfort and concern is enough to declare the marriage is in trouble. You do not need your wife’s confirmation. Her behavior is unacceptable because it makes you feel uncomfortable. s confirmation. You are uncomfortable because her behavior has become unacceptable. This is yours alone to validate. Don’t look for her to give you permission to be upset.

Secondly, seek personal therapy for yourself for this realization and these feelings. When this type of thing happens the spouse that has to declare the marriage unsuitable needs support from an outside source. Do not burden extended family members with your concerns as this will tint their perception of your wife and if the marriage gets back on even footing any you and she have recovered — the family may not be as ready. Share your concerns with a therapist that can help you sort through your feelings and thoughts.

When you are ready to confront your wife decide if it is something you want help with through a marriage and family counselor, or if you will need to do this on your own. If your wife is unwilling to go with you to a couples counselor then this confrontation may have to be one-on-one. I recommend if it is with a counselor that you ask your wife to come with you because you think the two of you need the help of a professional. If she is unwilling have your conversation in a public place without the children present. This is not a conversation to take on in the privacy of your home with the children’s home. Using public space as a type of container for a difficult conversation is one way to help keep the discussion civil. At home, the familiar space may create a too comfortable environment for excessive feelings.

Be clear about what isn’t okay without it being an attack. This isn’t a character assassination. It is time for you to discuss your disappointment, pain, confusion, and discomfort. This is more about you than it is about her. During these times the key is to use “I” statements rather than “you” statements. “I’m uncomfortable with the way I feel;” I don’t feel good about our marriage;” “I’ve lost my ability to trust.” Are ways to keep the issue on your side of the fence. Blaming your wife isn’t the goal — helping her understand that you are taking action in dealing with your feelings is.

Next, this isn’t something that you try to fix for her. This is hers to deal with — or not. Explain what you are willing and not willing to do. As an example, you might say you are willing to go to couple’s therapy, but you are no longer willing to ignore your feelings about this issue. Do not set ultimatums at this point. Statements like: “If you don’t go to therapy I’m going to divorce you,” doesn’t help very much. “I love you and I want to figure this out, but I can’t take care of my feelings and yours.” Give a more balanced sense of the truth — without saying if this — then that.

Finally, keep in mind that whatever is going on for your wife is — at the very least — on a different timeline than yours. You have been dealing with your disappointment, anguish, and uncertainty for a long while before this comes to the surface. For your wife, she has been living in a different awareness. She may be in denial, she may be suffering from a personality disorder, she may be doing things deceitfully, but whatever her state of mind is she is not on the same timeline as you are with being confronted with this issue. Give her time to adjust and be clear about what is true for you and what isn’t. Saying things like:” I don’t know what it means for our marriage, but I do know that something has to change for me.” Is a truth that lets your wife know this is serious and you are taking a stand for yourself. What happens next largely will depend on her ability to hear you.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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How a Yogic Lifestyle Can Enhance Your Mood and Reduce Anxiety

More than 16 million cases of depression occur each year in the United States. Depression is scientifically linked to having lowered levels of serotonin, one of the primary chemicals produced in the brain that affects our happiness. A regular yoga practice is known to increase serotonin. Imagine that? One in six Americans take some form of medication to help reduce depression or anxiety, myself included. Yet something as holistic as yoga can raise serotonin similarly to how antidepressants can. I’m pro-medication in every respect, but it isn’t a cure-all. A multitude of other methods are often recommended to combine with medication to dispel those feelings of gloom and distress that mental illness can elicit.

I am a 29-year-old female who suffers from Generalized Anxiety Disorder, ADHD and Major Depressive Disorder. I also struggle with agoraphobic tendencies, resulting in a fierce panic when I leave the confines of my home. I took my first yoga class eight months ago. I’ve since attended 4 to 7 times weekly, as consistency is key. The studio is conveniently located one mile from my home, which comforted my apprehension. Midway through my first class, I felt at ease. My anxiety drifted away like a paper airplane in the wind. My first month of yoga practice was the beginning of my spiritual epiphany.

That mindfulness I experienced on my mat would stay with me for the remainder of the day. My perspective on life became more optimistic, my mood was uplifted with decreased daily anxiety, and I was actually leaving my house more frequently without the usual hesitation and panic attacks. As a woman who formally found it problematic to exit my front door, I am now a yogi leading a life that is filled with gratitude, peace and acceptance. These feelings of positivity aid me in facing my agoraphobia and fighting my depressive propensities. I find it is easier to accomplish tasks when I’m in a healthy mindset. I genuinely believe yoga is therapeutic based on my personal experience.

To help me clarify just how beneficial yoga is, I’ve conducted an an interview with Kanjana Hartshorne, Licensed Clinical Social Worker, C-IAYT Yoga Therapist and Reiki Master. In her work with clients Kanjana offers an evidence-based blend of traditional Western psychotherapy and neuroscience, as well as ancient Eastern comprehensive yoga therapy. Kanjana happily agreed to partake in this article to inform readers that yoga can be a powerful treatment option for many mental illnesses.

Q. Do you believe yoga can help balance the state of a person’s mental status?

A. Yes, I strongly believe that yoga and meditation can help to balance a person’s mental state. For me, the most powerful aspects of applying yoga for mental health (and how yoga helps us live) are:

Increased awareness about our bodies, minds, and selves. Because if we aren’t aware of where we begin, how are we supposed to make a shift?
Adding yoga skills to our toolkits for both emotional regulation (our ability to manage and respond to an emotional experience) AND down- or up-regulation of the nervous system (our ability to move from fight/flight to rest/digest or vice versa, as needed.)
Increase our ability to tolerate stress in all facets of life. Every time you practice tolerating discomfort on the mat or meditation pillow, whether it’s in a pose, being silent, or witnessing uncomfortable thoughts, you are practicing distress tolerance! The more you practice, the easier it gets. Just like riding a bike. And, eventually, you can ride that bike or tolerate lower levels of stress without much effort at all. Of course riding up a mountain or tolerating a higher level of stress will be more challenging and require more effort. But if you’ve been training for a while, you’ll have the confidence that you can use the skills you’ve built to get up that mountain.

Q. Have you had any past or present patients that practice yoga? If so, can you describe to me how they’ve relayed their experience?

A. I’d say the majority of my clients practice yoga or meditation. This is mostly because I’ve found it to be so impactful that I’ve built my career around it. My niche is yoga therapy as a modality for trauma and anxiety. I’m currently researching its impact as an add-on to traditional talk therapy. So this means I mostly work with people interested in bringing yoga into session. And it doesn’t hurt that I get to wear yoga pants to work everyday!

There are a wide range of experiences, but a few themes tend to come up again and again. People share how they now have the tools they need to manage their stress or anxiety on their own. They now have a better understanding of who they are and what they value and can use their values to live their best life. They are able to better tolerate uncomfortable emotions like anxiety, fear, sadness, and loneliness. When they practice yoga, whether that’s in little one minute practices throughout the day or an extended home/class practice, they notice an impact on their ability to tolerate stress and regulate mood. When doing deeper, long-term work with clients I hear things like, “I finally can be on my back without flashbacks to my assault”, “I feel safe enough to now bring up my trauma in therapy and start to process it”, “I am kinder to myself and my body both in my thoughts and actions.”

I feel so lucky that I am able to use yoga as a modality for mental and emotional wellness. It’s been years, but I still hear feedback that blows my mind and reminds me of the power of a somatic (body-based) approach to mental heath.

Q. In what ways do you believe living a yogic lifestyle can help uplift a person’s mood and reduce anxiety? Are there any other benefits you can think of that we haven’t touched on?

A. I believe a yogic lifestyle can help people to balance their mood. That could look different person to person, day to day, or even moment to moment. From helping to bring a little more energy and inner strength to a tough day to decreasing a racing heart and racing thoughts. Practices from yoga can help people with a variety of mental and emotional concerns. The wonderful thing about yoga is that it’s so holistic. It addresses the body, mind, emotions, intuition, and spirit, whatever that is for each individual. How can yoga cover all that? Those new to yoga may think it’s all about the poses. And while that’s a part of it, there’s so much more. There’s meditation, philosophy, nutrition, and unity — with self, body, beliefs, and community.

Q. Depression is known to also produce physical symptoms such as stomach discomfort, stress headaches, fatigue and digestive problems. Can you name a few poses that you would you suggest to someone suffering from these matters as a result of depression?

A. I always recommend ruling out a medical cause first. So hit the doctor’s office to make sure nothing else is going on. If the symptoms are then attributed to anxiety or depression, there are several practices from yoga that can be helpful. I have to be honest and say that I feel this is very individualized, and if someone has a history of trauma, often poses that are helpful to others can be triggering for them. Having said that, many people find the following yoga poses helpful. For sluggish digestion, many find wind-relieving pose and gentle spinal twists to help get things moving. For stomach pain, “legs up the wall” with a meditation for pain relief can be extremely powerful. For fatigue, gentle heart-openers such as reclined bound angle can be helpful. And for tension headaches, many find opening up the back, neck, and upper-chest area to be helpful. Some poses for this include cat/cow, thread the needle, eagle arms, cow-face pose. And I know we are talking strictly asana (yoga poses), but there are a LOT of other practices from yoga that can also be helpful for these concerns. If you feel lost or have a history of trauma or a health condition, I’d recommend working with a yoga therapist to figure out a practice personalized to your needs.

Lastly, I want to add that an ongoing study in the Netherlands has proven that yoga and meditation are linked to having a smaller right amygdala volume. The right amygdala is the part of our brain that sends out negative emotions within us, such as fear-inducing stimuli. The researchers conducted multiple MRI brain scans of 3,000+ participants over time. These scans are resulting in solid proof that the right hemisphere of our brain can actually shrink in size with something as natural as regular yoga and meditation practice. With that being said, I urge anyone who has been contemplating taking a yoga class to give it a try. The internet also offers wonderful tutorials for those on a low-income budget. I truly believe anyone who is skeptic will be highly impressed with just how glorious a yogic lifestyle can be, if they step out of their comfort zone and test the waters.

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Podcast: Do Suicide Questionnaires Save Lives?

Should we be talking so plainly about suicidal ideation? What are the benefits of assessing our thought patterns over a period of time? Join us as we discuss the Columbia-Suicide Severity Scale screening tool. We tackle this sensitive topic after Jackie was surprised by a suicide assessment at a physician’s office. Rare trigger warning this week for a tough subject, as we explore talking openly about suicidal ideation.

(Transcript Available Below)

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About The Not Crazy Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Jackie Zimmerman has been in the patient advocacy game for over a decade and has established herself as an authority on chronic illness, patient-centric healthcare, and patient community building. She lives with multiple sclerosis, ulcerative colitis, and depression.

You can find her online at JackieZimmerman.co, Twitter, Facebook, and LinkedIn.

Computer Generated Transcript for “Suicide Questionnaires” Episode

Editor’s Note: Please be mindful that this transcript has been computer-generated and therefore may contain inaccuracies and grammar errors. Thank you.

Jackie: This episode discusses the Columbia-Suicide Severity Rating Scale. Listener discretion is advised.

Announcer: You’re listening to Not Crazy, a Psych Central podcast. And here are your hosts, Jackie Zimmerman and Gabe Howard.

Gabe: Pay attention Not Crazy fans, right now Not Crazy listeners get 25% off a Calm premium subscription at Calm.com/NotCrazy. That’s C A L M dot com slash Not Crazy. Forty million people have downloaded Calm. Find out why at Calm.com/NotCrazy.

Gabe: Welcome to the Not Crazy podcast. I would like to introduce my co-host, Jackie, who still has not seen the new Star Wars, just unacceptable. This is why you live with depression. You realize this, right?

Jackie: Wow. That snarky A-hole is my co-host, Gabe Howard, whose absolute lifetime favorite Star Wars character. Jar Jar Binks.

Gabe: Oh, that that is not true. That is a lie.

Jackie: Maybe that’s why you experience being bipolar. Because you can’t handle the guilt you feel about you having your favorite.

Gabe: I this is gonna be the last episode of Not Crazy because that’s so mean, you just can’t tell people.

Jackie: The truth?

Gabe: No. My favorite Star Wars character is probably like a toss up depending on my mood between Princess Leia, because a beautiful bad ass, and Darth Vader because, you know, I’m adopted. So he could be my real dad.

Jackie: I still maintain that before we started recording, everybody, he told me it was Jar Jar Binks and now he’s lying for the masses. Speaking of the masses, I was recently given my very first suicide severity rating test, and that was a bit of a doozy that I did not see coming. We don’t normally do this, but I feel like this episode might be a massive trigger. So here’s your trigger warning about suicide and suicidality. We are going to be talking about it in depth because of the in-depth questions on the screener.

Gabe: To put a little context here, a suicide severity rating scale test and one of the most popular ones is the Columbia-Suicide Severity Rating Scale. It’s essentially a questionnaire that medical personnel ask people to determine if you are suicidal, passively suicidal, actively suicidal.

Jackie: This screener was specifically was developed by Columbia University, the University of Pennsylvania, and the University of Pittsburgh in 2007.. But since then, in 2011, the CDC took it on using the protocols, definitions for suicidal behavior. And then in 2012, the FDA declared this protocol to be the standard for measuring suicidal ideation. So this is something that’s out there. And I guess I’m still surprised I didn’t know about it or didn’t see it coming.

Gabe: Is this literally the first time you’ve ever been given one?

Jackie: Literally the first time and a little bit of background, so I recently started a clinical trial for a multiple sclerosis drug. So on my first appointment they gave me this screening and I was assuming it was gonna be your average sort of like, have you ever been suicidal in the last two weeks? And you’re like, yes or no? And then you move on. End of quiz. But it wasn’t, and it was oof . Some of the questions I just did not see those coming. It was very I mean, it does its job. It’s supposed to find out on the scale how severe you are in terms of being suicidal and or how much you’ve planned around suicide. So I immediately sent Gabe a text and was like, do you know about this? Have you ever had it? We need to talk about it on the podcast.

Gabe: You were like, hey, they want to talk about suicide and the questions, I didn’t expect them. And the first question is, do you wish to be dead? And I don’t mean to make light of suicide. I’m sincerely not trying to do that. But one of the things that is fascinating about what you just said is you didn’t expect the suicide screener to ask if you wanted to die. And this is sort of where we are as a country. We always talk about suicide in like, hey, how you feelin? And the person’s like, pretty good. Excellent. They’re not suicidal. We’ve done the screener. And when the questions are really direct, they feel like like they feel heavy on your chest, like, oh, why are you asking me direct questions about life and death? I don’t like this. And I understand that, they’re heavy.

Jackie: Well, on my own behalf. They did not tell me actually the name of this scale. They were like, we’re gonna do a C-SSRS test. And like, I don’t know what the fuck that means, but hit me with the test, right. And then she did. And the first question, as you said, is do you wish to be dead? That is also not phrasing you generally get from medical professionals. And I think that is really the root of what kind of threw me on this one is the verbiage throughout the screener almost feels conversational. It doesn’t feel medical, which is, again, I think the point. This sort of conversational colloquial test is the standard now.

Gabe: As somebody who’s been in the mental health advocacy game for almost a decade now, it is interesting to see how it’s changed. People like me have been banging the drum that we need to talk about suicide, using real words directly. We can’t change speech patterns. We can’t come up with, you know, the words that make people feel comfortable, right. Because nobody feels comfortable if they’re dead. This screener does do a really good job. So full disclosure, we found the screener. This is the nice thing about having an extraordinarily popular podcast. People tend to give you shit when you ask for it. So we contacted a psychiatrist. We got all of their opinions on the subject. We got opinions of some of their colleagues, both good and bad. But the first topic is wish to be dead. But they actually have the specific question. And one of the suggested ways to ask the question, I really love it. It says. Have you ever wished you could go to sleep and never wake up?

Jackie: That’s what I’m saying, the verbiage here. Again, if you’re not expecting it also, I just want to like sidebar for one second. First of all, this protocol is meant to be given by trained professionals, which we are not. We are not giving each other the screener. We are merely discussing the questions on it.

Gabe: And just to be very, very, very, very, very clear, do not e-mail us and ask us for the screener so you can give it to your friends. It doesn’t work that way. If you feel that you have a friend that this needs to be given to, please go to an emergency room, call 9-1-1, make an appointment with their general practitioner. If you suspect they might need this screener, please act. Just don’t act by emailing a podcast, act by getting them medical attention.

Jackie: So the way that this protocol works is it asks you yes or no questions. And it talks about in your lifetime and then also within the past month. So, for instance, on the first one, it would say, have you wished you were dead in your lifetime? And I said uncomfortably, Yes. And then it said, have you wished you were dead in the last month? And I said, no. And that’s the thing, too, is they repeat the question completely for lifetime and last month. So it’s not like, OK. But in the last month, it’s they repeat it word for word. So you hear these questions at least twice during the screening.

Gabe: Jackie, while you were sitting there because you’re there for a physical health issue. So you weren’t planning on dealing with your mental health at all because again, for reasons that we can never explain. Most people separate physical and mental health out entirely. So I kind of want to give like a round of applause to this clinical trial and this medical staff that they understand that your mental health and your physical health go hand in hand. You kind of bought into this idea. You were there for physical health. Right. So the minute mental health questions came up, it was like an extra whump because it was unexpected.

Jackie: It was a whump, indeed, Gabe. I felt shame. I felt so much shame to have to say, yeah, I wanted to kill myself. And later on, this is how I plan to do it. I did not expect to feel that. But then as I realized the questions were going to be quite detailed, I almost had like an internal pep talk where I was like, nope, own this. Don’t be ashamed of this. It’s not who you are right now and you can’t learn from it, they can’t learn from it, if you’re not honest. So I had to like pep talk myself to get through some of these because the shame storm was brewing, but it didn’t need to.

Gabe: Let’s talk about the shame storm for a moment. Jackie’s shame storm, because you have been suicidal in the past. So the lifetime question you answered, yes. But in the last month you answered all no’s you have not been suicidal in the last month. You have not been suicidal in years.

Jackie: Correct.

Gabe: And yet the shame storms still came a comin’, even though you were essentially answering, for lack of a better word, correctly. Are you suicidal today? No. Do you want to go to sleep and never wake up today? No. In the last month, have you wanted to kill yourself? No. Like these are the right again making air quotes. These are the right answers. And yet you still reflected back to all those years ago when you answered yes and felt shame. Didn’t you feel any pride at how far you’ve come?

Jackie: No. And I think part of that is because of the nature of the questions. And don’t get me wrong, I think that this protocol is smart. It is the only one that really measures the severity of your suicidal ideations. However, for me personally, being in a good spot. Going back and reliving it in detail was kind of shameful because dying by suicide is shameful. Just ask anybody. Right. I don’t agree with that statement, but I think that’s the go to an end. The person giving me the screener, I was like, she doesn’t know me. She’s going to judge me. Just all these like negative self-talk moments came up and I just really wasn’t expecting it.

Gabe: I don’t think that anybody ever expects to talk about suicidality. It’s not a subject that most of us gravitate toward. Right. You know, we started this podcast out by teasing each other about Star Wars. That’s the kind of stuff that people want to talk about, pop culture. Small talk is designed around the weather and the local sports team. This is a weighty subject. But as we’ve learned, not talking about these weighty subjects is one of the things that’s given these weighty subjects space to really do a lot of damage. People who are feeling suicidal, they don’t have the words, they don’t have the words to walk up to somebody and say, hey, I want to kill myself. I want to go to sleep and never wake up. I have a plan. They don’t understand any of this terminology. And perhaps even more dangerous, even if somebody in that position does have the words, most people don’t understand how to respond to it. We tend to make jokes. I want to go to sleep and never wake up. Oh, don’t we all. Wake me up when September ends. Ha ha ha. Well, everybody feels this way in the winter. The winter blues. We just dismiss that person entirely. This obviously cuts through that.

Jackie: We’ll be right back after these words from our sponsors.

Announcer: Interested in learning about psychology and mental health from experts in the field? Give a listen to the Psych Central Podcast, hosted by Gabe Howard. Visit PsychCentral.com/Show or subscribe to The Psych Central Podcast on your favorite podcast player.

Gabe: Hey Not Crazy fans, this is one of your hosts, Gabe Howard. Are you struggling to sleep these days? Did you know that a good night’s sleep is like a magic remedy for the brain and body? When we sleep well, we are more focused and relaxed, and best of all, sleep makes us happier. And that’s why we are partnering with Calm, the number one ap for sleep. If you want to seize the day and sleep the night, you can with the help of Calm. Right now Not Crazy listeners get 25% off a Calm premium subscription at Calm.com/NotCrazy. That’s C-A-L-M dot com slash Not Crazy. Forty million people have downloaded Calm. Find out why at Calm.com/NotCrazy.

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Jackie: And we’re back talking about the Columbia-Suicide Severity Rating Scale, which freaked me right the f out when I received it at the doctor.

Gabe: Did you feel supported in this process? Because you’ve described feeling shame. You’ve described being caught off guard. You’ve described being scared. And then you described wanting to do a podcast on it. But never anywhere have you described feeling supported.

Jackie: The person giving me the screener, honestly, it’s not her job to be supportive or to be comforting during this process. I mean, she indicated even a little discomfort with the questions. At some point, because I guarantee you most people she’s asked this to said no to everything. She was just like, boom, boom, boom, this is super easy. And then she got to me and it was not easy. Because the first question said, have you ever wish you were dead or wished you could go to sleep and not wake up? So, yeah, right. I’ve wished I was dead. But the next question says, have you actually had thoughts of killing yourself? Which I thought was fascinating because you would think it would be. Well, yes, duh right. But it’s not right. They’re not the same question. They’re different. And the nuances of the question, I think, is what makes this interesting, also triggering, terrifying all of the like negative feelings that can come out of it or hopefully if you’re not me and you’re just sort of like owning your past and your story, just willing to say, yes, this is what happened.

Gabe: I want to give a little push back on something that you said, you said that it wasn’t the person’s job to make you feel comfortable, it was the person’s job just to ask the questions and fill out the charting. The pushback that I want to give is this is kind of untrue, right? It is the medical person’s job to make the patient feel comfortable. And I think this is one of the things that gives suicide space to hide. Right. So the person giving the test is uncomfortable. The person answering it is uncomfortable. So it sort of feels like that rhythm of, hey, how are you today? I’m fine. I’m fine, too. In the meantime, both of the people saying that are actually in extreme distress, but they both assume that the other person is fine. This shows you that we’re not doing a good job of training our medical personnel, especially since I would almost guarantee that that person probably thinks that mental health isn’t the primary part of their job because you were there for a physical issue. And again, I know I sound like a broken record, but this is why we have to stop treating them separately. The psychiatrists that I talked to that administer this test, they’re a lot more comfortable and they’ve talked about practicing poker faces and they talked about the advantage of silence where they would say, have you actually had thoughts of killing yourself? And then they would just sit and the person would mumble and make a joke.

Gabe: And just on and on and on. And they would just sit politely with that poker face and look at them and wait for that person. That’s like an excellent training point, right. Because when you’re uncomfortable and when people are making jokes, your knee jerk reaction is to like joke back. But then that diminishes the question. Obviously, I want to educate all the patients because I don’t think we have a lot of doctors listening to the show. Take this seriously. It’s a great way to gauge whether or not you’re doing better. The majority of us are in long term mental health care. We’re seeing therapists and doctors talking to our general practitioners. We’ve been dealing with mental illness and mental health issues for a long, long time. So having this in our charts and being able to look back five years from now and be like, oh, my God, I’m doing so much better. Like, that’s awesome. Right. But it’s also an early warning system.

Jackie: I actually totally agree because every time I go back now, they ask me the same questions and I’m in a good spot, right? So I say no to everything. But I wish that I had this when I was actually severely suicidal because it would have been nice to see where I was. And maybe then I could have said, like, look how far I’ve come. Right. So, question 5 Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan? And that’s where I was like, oh shit. I’ve never really told anybody my plan to kill myself. Right? It’s one thing to say I’ve had suicidal thoughts. I really thought about it. But it’s another thing to say this is exactly the plan that I had and I told her and that felt wildly uncomfortable. She gave me a look of like, oh, wow, this is intense, right? Like when people give you a suicide screener, say, hey, how you feelin? And you’re like, I’m cool. All right. How’s your blood pressure? It doesn’t get into tell me how you planned to kill yourself. That feels like a therapy question.

Gabe: I believe that 100 percent of conversations about mental illness, mental health, our emotions, our feelings, have value 100 percent. And people say things like, well, even the asshole trolls on the Internet? Yes, it has value. It shows you what not to do. It shows you how not to behave. It shows you how not to be supportive. There is something to glean from every interaction. And we, Jackie, hate it when people tell you the right way to talk about mental health. We hate it when people tell us the right way to discuss mental illness, emotions, mental health crisis, grief, anxiety, because not everybody has the same words as Gabe Howard and Jackie Zimmerman. And we don’t have the same words as everybody else. When I was a kid, I described anxiety as a tummy ache, and I was shocked to learn years later that a research study confirmed that kids who have chronic stomach aches more often than not are having issues with anxiety. But my family did the same thing that other families did. Oh, it’s just butterflies. Oh, you’re just nervous. Oh, don’t be a baby. And of course, it was the 80s, so I got don’t act like a girl. Don’t be a sissy. And none of this addressed the anxiety that I was having and my family, they go all the way back to all of this. And like, man, imagine if we would have gotten Gabe help for his anxiety when he was twelve instead of 25. Like what horrors could he have avoided? It’s all water under the bridge now. But, I’ve always said that I want the next Gabe to have better resources and openly discussing these things is going to get you better resources. I don’t know that this was available back in 2003 when I was in the hospital.

Jackie: It wasn’t. It came out in 2007.

Gabe: Yeah. So Gabe in 2003 was kind of asked some basic and some blunt questions. Now, ultimately, it did get me admitted to the psychiatric hospital. But I read over this thing and I read the history of this thing and it’s an excellent step. And I talked to the psychiatrists, and even some of the psychiatrist that were like, you know, it needs work, they still see it as a vast improvement

Jackie: Hmm.

Gabe: Over doing nothing. They still see it as a vast improvement over the well, every psychiatrist just kind of figures out how they ask and uses their gut. This has a scoring method. This has a list of questions that you really don’t skip over. Right. You ask them all. You score it. It doesn’t rely as much on an individual’s provider’s gut instinct. And I think that’s incredible.

Jackie: Yes, there is no subjectiveness it’s still is on the patient to give honest answers, but at no point in here does the facilitator of the protocol give an opportunity to say, oh, I think they’re actually feeling this way. I don’t know if maybe some of the other screeners do that, but this feels like actual data that they are collecting. It’s not subjective and it’s measurable based on the scoring over time as well, like you said, which makes it a great tool, right? It is a great tool. It’s just when you’re not expecting it. It is a slap to the face where you’re like, oh, we’re talking about this now. We are like really talking about this now.

Gabe: I understand it’s scary. I understand it’s a slap to the face, but there’s lots of things in our life. That’s a slap to the face. There just are. Having somebody that you respect and somebody that you trust to tell you that your favorite Star Wars character is Jar Jar Binks is a slap to the face. But then it gave me the opportunity to explain to everybody that Jackie is an idiot and that Jar Jar Binks is awful and that allows us to work it out and move forward. The bottom line is, if we’re not discussing Jar Jar Binks, Jar Jar Binks would have had a much larger role in episodes 2 and 3. But by openly discussing how much we hated that character, he was diminished. And that’s what we want for suicide. We want suicide to be diminished and impact less people.

Jackie: It’s not funny, I’m laughing, but it’s not funny. It’s kind of funny. But yes, I agree. I think that the better tools we have, the more we make this something that people can talk about now. You know, it’s not supposed to be hidden. And I think that there’s a lot of motion among advocates and among patients worldwide to make this something that we talk about now, only because it helps with prevention, but also because it gives us something to learn from. And this protocol is a great way to do it from a medical provider standpoint. I just think that you should give your patients a little bit of warning what they’re getting. But if you are that patient, use it as a learning tool, like Gabe said earlier. It is a great tool. It’ll be kept in your file. You’ll be able to refer to it later. If you get this protocol don’t want the shame storm build like it did for me. Look at it as a learning experience and be proud that you’re still here to be answering these questions, even if they’re difficult.

Gabe: And Jackie, don’t be so hard on yourself. Yeah. It’s a big topic. You had a shame storm. You owned it. You admitted it. And you called a buddy.

Jackie: I agree there is no easy way to talk about how you planned to kill yourself. There just isn’t. But you can own those experiences by talking about them and by reaching out to people like Gabe said.

Gabe: I like it. Now, I want to be very, very, very clear, if you are worried about yourself, tell somebody call 9-1-1, go to an emergency room, and tell your general practitioner. Tell a trusted friend or family member. If you are worried about a friend or family member, encourage them to seek help. We don’t want to sit at home and doctor each other. That’s not how any of this works. So please, please, we’re really serious about that. Jackie is in roller derby and she will check your ass.

Jackie: [laughter]

Gabe: All right, everybody here is what we need you to do: where ever you downloaded this podcast, leave us as many stars, bullets, hearts or whatever they’re using this week as possible. But use your words. Tell people why you love this podcast. We would take it as a personal favor if you share us on social media. Want to hear something on the show? Email show@PsychCentral.com and tell us what you want to hear, know about, what you like, what you dislike, and whether or not Jackie should die her hair blue again. Gabe has personally missed it. Remember after the credits there are always outtakes because it turns out that Jackie and I screw up a lot. We will see everybody next week.

Jackie: Have a great week.

Announcer: You’ve been listening to Not Crazy from Psych Central. For free mental health resources and online support groups, visit PsychCentral.com. Not Crazy’s official website is PsychCentral.com/NotCrazy. To work with Gabe, go to gabehoward.com. To work with Jackie, go to JackieZimmerman.co. Not Crazy travels well. Have Gabe and Jackie record an episode live at your next event. E-mail show@psychcentral.com for details.

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The Rude Awakening of Realizing You’ve Been Duped by a Covert Narcissist

They will break you and they will walk away. Richard Grannon A narcissist or other psychopath will see the parts of you that have not been healed and will exploit...

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What’s My Diagnosis?

From a young man in the U.S.: Sometimes when I walk in this world, I feel defective and like an inconvenience to other people and when I get in a conflict or a disagreement with another person I feel even more humiliated and inadequate. I tend to try to protect myself by getting defensive and angry. I experience an empty void in my chest and panicky feeling when I receive negative feedback.

I look outside to other people for self esteem and self definition because I’m very self conscious and insecure. I sometimes experience fatigue and blushing as a result of reacting to everything in my environment. When someone says critical words or looks at me funny, I go into an emotional tailspin. Also when texting, I turn off my phone if my friends don’t respond quickly because I’m afraid that they are mad at me or they no longer like me. I am terrified of getting rejected by another person as well. If I have a crush on someone, I will deny it to avoid putting myself on the line.

I have had issues with insomnia, emotional eating, reactive aggressive behavior like yelling at and/or hitting if someone else makes fun of me, running away, self -harm- had 2 infections from self inflicted cuts before I reached for help, talked about suicide and had suicidal thoughts in the past . Also I hold grudges and resentments towards people who are not nice to me back after engaging in people pleasing and validation seeking and I have issues with trust and forgiveness.

I try to make people happy at the expense of myself so they don’t get angry at me or disapprove of me. I have also attempted to break my own things in anger and that only helped in the moment, but not long term. A year ago I attempted to O.D on prescribed medications right after I got yelled at by someone. I also have issues regulating my stress and anxiety levels in interpersonal situations and I can experience reactive mood swings, emptiness and depression in response to those situations.

I had a history of getting bullied all of my childhood and adolescence and have once gotten an in school from school and spent over a year in emotional support for taking it in my own hands.

What diagnoses would my descriptions describe the symptoms of, even though I know this is for getting diagnosed.

Thank you for writing. You’re correct. This site is not intended to be a substitute for an assessment by a licensed clinician. I can’t make a diagnosis. I can tell you what you already know: This is a very hard way to live. There is probably a mental health issue, possibly grounded in a history of being bullied. You deserve to heal. There is no reason to continue to be under this kind of stress.

I think you made an important first step in writing to us here at PsychCentral. Now do yourself the great service of following through. Make an appointment with a licensed professional to get an assessment and an individual plan for the help you need to get on with life with more self-confidence and less stress.

I know it can be hard to share painful stories and the many challenges you mentioned in your letter. For that reason, I encourage you to bring your letter with you to your first appointment as a way to introduce yourself to the therapist and to jump-start the session.

I wish you well.
Dr. Marie

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We’ve just had the best decade (and year) in human history. Seriously

To provide a faintly upbeat end of the year post, I want to point to a Matt Ridley piece in The Spectator that provides a bit of a tonic for our times, by pointing out facts that haven't made the news, because good news is no news. Bad things capture our attention while the world overall is still getting better. In the same vein, Nicholas Kristof does a NYTimes piece titled "This Has Been the Best Year Ever" which has some nice graphics describing amazing declines in poverty and infant deaths, and gains in literacy. Some clips from the Ridley piece:

Extreme poverty has fallen below 10 per cent of the world’s population for the first time...Global inequality has been plunging as Africa and Asia experience faster economic growth than Europe and North America; child mortality has fallen to record low levels; famine virtually went extinct; malaria, polio and heart disease are all in decline.

...we are getting more sustainable, not less, in the way we use the planet...some nations are beginning to use less stuff: less metal, less water, less land. Not just in proportion to productivity: less stuff overall...what if economic growth means using less stuff, not more?’ For example, a normal drink can today contains 13 grams of aluminium, much of it recycled. In 1959, it contained 85 grams. Substituting the former for the latter is a contribution to economic growth, but it reduces the resources consumed per drink...The quantity of all resources consumed per person in Britain (domestic extraction of biomass, metals, minerals and fossil fuels, plus imports minus exports) fell by a third between 2000 and 2017, from 12.5 tonnes to 8.5 tonnes. That’s a faster decline than the increase in the number of people, so it means fewer resources consumed overall.

Mobile phones have the computing power of room-sized computers of the 1970s. I use mine instead of a camera, radio, torch, compass, map, calendar, watch, CD player, newspaper and pack of cards. LED light bulbs consume about a quarter as much electricity as incandescent bulbs for the same light...Even in cases when the use of stuff is not falling, it is rising more slowly than expected. For instance, experts in the 1970s forecast how much water the world would consume in the year 2000. In fact, the total usage that year was half as much as predicted. Not because there were fewer humans, but because human inventiveness allowed more efficient irrigation for agriculture, the biggest user of water.

...despite the growing number of people and their demand for more and better food, the productivity of agriculture is rising so fast that human needs can be supplied by a shrinking amount of land...we use 65 per cent less land to produce a given quantity of food compared with 50 years ago. By 2050, it’s estimated that an area the size of India will have been released from the plough and the cow.

Since its inception, the environmental movement has been obsessed by finite resources. The two books that kicked off the green industry in the early 1970s, The Limits to Growth in America and Blueprint for Survival in Britain, both lamented the imminent exhaustion of metals, minerals and fuels. The Limits to Growth predicted that if growth continued, the world would run out of gold, mercury, silver, tin, zinc, copper and lead well before 2000...To this day none of those metals has significantly risen in price or fallen in volume of reserves, let alone run out.

A modern irony is that many green policies advocated now would actually reverse the trend towards using less stuff. A wind farm requires far more concrete and steel than an equivalent system based on gas. Environmental opposition to nuclear power has hindered the generating system that needs the least land, least fuel and least steel or concrete per megawatt.

As we enter the third decade of this century, I’ll make a prediction: by the end of it, we will see less poverty, less child mortality, less land devoted to agriculture in the world. There will be more tigers, whales, forests and nature reserves. Britons will be richer, and each of us will use fewer resources. The global political future may be uncertain, but the environmental and technological trends are pretty clear — and pointing in the right direction.

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