pi3: February 2020

Saturday 29 February 2020

17 Deceptive Excuses for Abusive Behavior

Having grown up in an abusive family and now in a relationship with an abusive wife, Bradon believed the excuses constantly dished out to him by his abusive mother and...

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Day #194: Know your spinal cord – The spinoreticular tract

We've arrived at day thirty-seven in the spinal cord series and we're still covering new ground. You can find all of our sweet spinal cord action in the neuroanatomy category, which at this point is pretty extensive for a high-level look. Yesterday we talked about the reticulospinal tracts so today we are talking about the sister tract, the spinoreticular tract. Are they related, or is it all just in the name?

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The Foods That Protect Against Anxiety (M)

Anxiety disorders are more common in women.

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Psychology Around the Net: February 29, 2020

In this week’s Psychology Around the Net, we discuss raising awareness for eating disorders, the benefits of intuitive eating, why therapists have so little training (if any) in helping suicidal patients, the plunging mental health of modern farmers, managing coronavirus anxiety, and more.

It’s National Eating Disorder Awareness Week and Health Experts Want to Raise Awareness: We are on the tail end of National Eating Disorders Awareness week (February 24th to March 1st), and clinicians are hoping the exposure increased awareness of these often debilitating illnesses. Eating disorders come in a variety of disguises, from anorexia to obesity to an over-fixation on healthy eating. All eating disorders, however, cause disturbance within a person’s eating pattern that affects their physical and mental health.

She Learned to Love Eating — And Herself — Despite a Lifetime of Fat Shaming: Around 30 million Americans struggle with an eating disorder and shame is a major part of their lives. “So many people with a higher weight are embarrassed to go out on the street and walk because stigma is really more toxic than the weight on them,” says registered dietitian Elyse Resch. This article discusses the concept of intuitive eating, where no food is off limits, and how it dramatically changed the life of Harriet, a woman with PCOS who has struggled with obesity since childhood.

We Tell Suicidal People to Go to Therapy. So Why Are Therapists Rarely Trained in Suicide?: Suicide is the nation’s 10th leading cause of death, yet training for mental health practitioners who treat suicidal patients — psychologists, social workers, marriage and family therapists, among others — is dangerously inadequate, says the author. This article thoroughly probes this topic and explores what can be done.

‘I’m Constantly Putting on a Brave Face’: Farmers Speak Out on Mental Health: A recent survey conducted by the Farm Safety Foundation in the U.K. found that 84% of farmers under age 40 believe mental health is the biggest hidden problem they face. This article details the many pressures farmers experience today, from loneliness to anti-meat movements to devastating floods.

How to Manage Your Anxiety About Coronavirus: Now that the CDC has told Americans to get ready for the coronavirus to disrupt our day-to-day lives, it’s easy to see why so many people are starting to feel a little panicky. In this article, several experts give their take on what we can do to ease our disease-related anxiety. “There’s no correlation between how worried you are and how at risk you are,” says Catherine Belling, an associate professor of medical education at Northwestern University’s Feinberg School of Medicine.

Isolated and Sequestered in Their Homes, Chinese Citizens Report Anxiety and Depression While on Lockdown Amid the Coronavirus Outbreak: Amid transportation bans, strict quarantine measures, and lockdowns, many Chinese citizens are facing a mental health crisis. Unfortunately, the culture’s ongoing stigma of mental illness prevents many sufferers from seeking help, and there are very few resources available for those who do. More than 300 24-hour mental health support hotlines have been launched since the outbreak. “They leave messages saying they’re exhausted, that they’re scared,” said a Seattle-based hotline volunteer.

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Friday 28 February 2020

5 Simple Ways to Find Peace After a Divorce

Do this for yourself.

Figuring out how to move on after divorce is really challenging because the end of your marriage itself is so traumatic.

Loneliness takes over and your life gets ripped apart all at once and again and again. You struggle to find happiness, a new equilibrium, and a new way of living — on your own.

Dealing with divorce is kind of like facing a huge, catastrophic earthquake followed by all these aftershocks of varying intensities (like a nasty text from your ex, selling your home, or paying child support instead of living with your children every day).

But, eventually, you’ll be able to complete your healing and move on from the end of your marriage. Post-divorce care is essential for you to have a happy life once more.

You might believe that your divorce recovery is subject to the whims of others like your ex, your attorney, the judge, or even your kids. And you’d be right, but only partially and only slightly.

The biggest determining factor in your healing after divorce is your peaceful core.

A peaceful core is that place you can go to on the inside where you feel calm and powerful. Nothing can shake you when you’re at this place of peace.

You can often discover new ideas to help you on your healing journey when you regularly spend time with your inner calm.

In his book, The Power of Positive Thinking, Norman Vincent Peale writes, “A peaceful mind generates power.”

And I completely agree with him.

It’s only when you remove yourself from the distractions of all the aftershocks of your divorce that you’ll find the powerful thoughts that will help you speed your healing after divorce.

Are you worried that you aren’t sure how to reach your peaceful core or if you even have one?

Here’s a great exercise I learned from John Addison of Success Magazine that will help you get in touch with your inner calm:

Close your eyes and picture a moment when you were at complete peace. It could be a time when you were 5 years old or just last week. The when doesn’t matter. What does matter is the experience and how vividly you can remember it.

Now, I’ll bet that if you really let yourself fully relive just that moment of complete peace you’ve got a smile on your face.

This place of pure contented peace is your peaceful core.

Since you now know what your peaceful core is, you can purposefully build it.

By doing so, you’ll find it to be the bedrock of strength you can call on to help you recover from your divorce and move on with your life no matter what challenges you face along the way.

You’re probably wondering how to build that inner bedrock of strength so you can live a happier life after divorce.

You do it by creating more experiences of complete peace and there are 5 ways to do it.

1. Regularly spend time enjoying a calming and rejuvenating hobby.

Some hobbies are stressful or frustrating.

If you have any stressful hobbies that you enjoy, it’s great to stretch yourself beyond your comfort zone — they lead to improved self-confidence when you become proficient at them.

But they’re different from the hobbies I’m talking about. These recreational activities are the ones you can lose yourself in and feel completely at peace doing.

Gardening, dancing, stamp collecting, and writing are examples of hobbies that I’ve heard some people say they can lose themselves in. (Dancing and gardening both work for me, personally.)

2. Enjoy Nature

Spending time outside listening to the birds singing, watching the clouds move leisurely across the sky, or feeling the grass beneath your feet are all ways to disconnect from the hectic pace of divorce and slow things down.

Nature has a way of healing bodies, minds, and souls that most of us don’t take advantage of often enough. Who knows, your next experience of calm could be waiting for you right now just outside your front door.

3. Meditate or Pray

These practices are all about creating peace and have been advocated as doing so for thousands of years. (There’s plenty of current research that supports this.)

If you need some suggestions for how to get started with meditation, you can check out YouTube or listen to this 2-minute guided meditation I’ve put together.

4. Listen to music.

Music can completely transport you. I listen to music to help me express emotions or just to relax. (I love to listen to Mozart when I want to happily relax.)

What music can you completely lose yourself in? Listen to more of it to build your peaceful core.

5. Develop an attitude conducive to peace.

This includes genuine happiness, gratitude, and perspective. It’s really hard to be peaceful if you’re consistently feeling attached or miserable.

However, if you can shift your perspectives to ones of happiness, gratitude and thoughtful responsiveness instead of reactivity you’ll discover that peace comes more naturally to you.

Yes, I know I might be starting a bit of a chicken-or-egg discussion here, but does it really matter? I don’t think so.

The goal is to increase your experiences of peace. So do what you can whenever you can to shift your attitude toward peace.

(Once I got past the chicken-or-egg nature of this suggestion, I was able to create a whole lot more calm in my life by shifting my attitude.)

Moving on after the divorce process can be a struggle. And just because you develop the skill of experiencing your peaceful core doesn’t mean that you’ll never lose touch with it again as you continue your healing after divorce.

What it does mean is that the inevitable aftershocks won’t throw your equilibrium off as a must. You’ll find it easier to deal with and move forward from whatever challenges you face.

And before you know it you’ll be living a new life as a confident, calm recently single person instead of a frazzled recently divorced one.

This guest article was originally published on YourTango.com: How to Move On After Divorce & the Most Important Quality You Need to Find Happiness

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Frequently Moving College Student Without Access to Therapy

I’m a college student with one more semester left until I graduate, and I’ve been struggling with some mental health issues. However, I’m moving every few months between home, school and internships, so I haven’t been in one place long enough to find a therapist. I mentioned my mental health concerns to a doctor at my school, and she encouraged me to make an appointment with a counselor at my school or my doctor at home, but then a month later I moved abroad for the semester.

I’m about to graduate, but it seems like I’ll still be moving every 6 months or so still between internships after I graduate, so I’m wondering what can I do in the meantime while I’m frequently moving? Are there any tips I can use going forward, and would it be worthwhile to try to find someone for only a couple months?

I’ve tried to follow advice like being active to help myself, but I can feel my mental health declining still, and I think it’s unrelated to moving because being in new places and meeting new people has seemed to help.

Even if you are only seeing a professional for a few months at a time, it’s better than not at all. In fact, sometimes people only need to see a therapist for a short time in order to feel better. How much treatment one needs depends upon many things, primarily the nature of the issue. It’s always better to have some help than to have none. Don’t suffer unnecessarily when help is available.

In addition, if you find someone you like but are planning to move soon, you may be able to continue that relationship long distance. This is something you should discuss with a new therapist upon your first meeting. You can say to them “I really want help but I might be moving soon. Are you open to conducting therapy sessions via teleconferencing or phone?” Teleconferencing can be done for via Skype or Zoom or related technologies. Some people even prefer therapy via those online technologies. That may or may not be an option for you.

Relatedly, if you know you’re going to be moving soon, consider online therapy. There are several companies that offer this type of service. You can explore these by doing a Google search and researching the best companies.

You might also try consulting your insurance company and asking them if they provide any online assistance or therapy via teleconferencing. In modern times, many insurance companies are exploring these options. Therapy via teleconferencing may not be right for everyone, but it can work for people who, like yourself, are moving a lot and who don’t have access to services in their communities. Many insurance companies reimburse for online therapy and are exploring these technologies and incorporating them into their plans. Try calling your insurance company and inquiring about online services. It could be an ideal solution for you.

Online therapy has many benefits, especially for people who travel frequently. It’s convenient and allows you to speak with a therapist from the privacy and comfort of your own home. The availability of the internet eliminates many barriers for people who may live in communities where there simply aren’t many or any therapists. Studies have also indicated that videoconferencing in place of face-to-face counseling can be as effective as in-person therapy.

Your insurance company may be able to refer you to a qualified online therapist. If you choose to explore the world of online therapy, outside of what your insurance company may offer, be certain to choose a therapist who is qualified, licensed and has experience. It’s important to choose an online therapy platform that has a good reputation.

Another consideration regarding digital therapy is the nature of the problem. Research indicates that certain telehealth modalities may not be ideal for individuals with serious mental health issues or for those experiencing severe suicidal ideation. You did not indicate in your letter the nature of the problems with which you are dealing so I cannot comment about whether telehealth would be good for you. Generally speaking, serious mental illnesses include those such as schizophrenia and bipolar disorder. Disorders that are considered less serious, and likely more amenable to digital therapy, are those such as anxiety and depression.

I hope that I have effectively answered your questions. If you have additional questions, please don’t hesitate to write again. Please take care.

Dr. Kristina Randle

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The What, Why, When and How of Detaching from Loved Ones

Codependents become overly attached — not because they love so much but because they need so much. Attachment is based upon need — need for someone to be a certain way so that you can feel okay. Although it’s painful to see a loved one being self-destructive, detachment allows us to enjoy our life despite another person’s problems and behavior. What gets in the way are codependent patterns of managing and controlling, reacting and worrying, and obsessing.

Attachment and caring are normal. It’s healthy to get attached to someone in our family or with whom we’re intimate, but codependent attachment cause us pain and problems in relationships. We can become over-involved. The antidote is to detach and let go.

What is detaching?

Detachment implies neutrality. Detaching is a way of separating the unhealthy emotional glue that keeps us fused in a codependent relationship.

What Detaching Isn’t

It doesn’t mean physical withdrawal. Nor is detaching emotional withdrawal, such as being aloof, disinterested, emotionally shut down, or ignoring someone.

Detaching doesn’t mean neglecting family responsibilities or leaving someone. Although physical space or separation may be useful as a means of setting boundaries and centering ourselves, this is not what detaching means. For example, some people decide to not have contact with someone, because the relationship is too painful.

Physical proximity is irrelevant. In fact, some divorced couples are more emotionally attached and reactive to one another than most married couples. Someone living far away can push our buttons in a phone call. We might dwell on the conversation for days — or we dwell on the fact that there wasn’t a phone call! Detaching is about refocusing and taking charge of ourselves.

Key Ingredients of Detaching

It involves letting go of our expectations and entanglements with other peoples’ problems and affairs. We stop reacting to things they say and do and obsessing and worrying about things. We take control of our feelings and thoughts, and mind our own business. It doesn’t take away our feelings and concern, but channels them in a healthy manner. In practice, it’s more compassionate and loving than codependent attachment.

Detaching involves four key concepts:

Having appropriate boundaries
Accepting reality
Being in the present, not the past or future
Taking responsibility for our feelings and needs

Detaching is letting go with love.

When first learning to detach, people often turn off their feelings or use walls of silence to refrain from codependent behavior, but with persistence, understanding, and compassion, they’re able to let go with love. Gradually, rather than be invested in changing or controlling others, we can be compassionate and encourage them. We have no need to argue or persuade others, but instead are curious of differing points of view. This shows respect and honors boundaries and separateness.

Rather than manipulate people to be like us, we risk being authentic. For example, we can say, “I feel sad when I see you depressed.” Instead of trying to change someone’s need for space or silence, we enjoy our time alone or with someone else. This may sound impossible, but the pay-off is rewarding.

Are You Over-Involved?

When we worry, it’s a sign that we’re attached to a certain outcome. When we’re frustrated with someone, it’s because we’re attached to them being different from who they are and accepting their flaws. When we’re giving unsolicited advice, we’re crossing a boundary and assuming a superior position. We all do this sometimes, but codependents do it excessively. Instead of two people with separate minds and independent feelings, the boundaries are blurred. Does this apply to you?

Do your moods and happiness depend on someone else?
Do you have strong emotional reactions to someone’s opinions, thoughts, feelings, and judgments?
Do you spend time worrying and thinking about someone else’s problems?
You analyze someone’s motives or feelings?
Do you think about what someone else is doing, not doing, thinking, or feeling?
Do you neglect your career, hobbies, activities, or friends due to a relationship?
Do you drop other activities if someone else won’t join you or disapproves?
Do you please someone because you’re afraid of rejection?
Do you become anxious doing things alone?

When we’re over-involved, we’re myopic. Others become extensions of us. We try to control their opinions, feelings, and actions to get what we need and feel okay. We try to manage them to avoid witnessing their suffering. We try to impress and please them. We try to persuade them to agree with us or do what we want. Then, we react with hurt or anger when they want won’t. If you relate, learn why detaching is helpful.

Benefits of Detaching

Letting go reaps us profound benefits, not only in the relationship, but in personal growth, inner peace, and all areas of our life.

We learn to love.
We gain peace, freedom, and power.
We gain time for ourselves.
We become more resilient to loss.
We learn independence and self-responsibility.
We encourage that in others.

We’re responsible for our thoughts, feelings, actions, and the consequences of those actions. Other people are responsible for theirs. Cheering someone up occasionally or giving him or her more attention is not codependent. A benefit of a good marriage is that spouses nurture one another when one is troubled, but it’s supportive, not codependent caretaking, and it’s reciprocal.

In contrast, when we consistently try to change others’ moods or solve their problems, we’re becoming their caretaker based upon the erroneous belief that we can control what’s causing their pain. We’re assuming responsibilities that are theirs, not ours. Sometimes codependent couples unconsciously agree that one spouse has the obligation to make the other happy. That is an impossible task and leads to mutual unhappiness, anger, and resentment. The cheerleader is always failing and frustrated, and the recipient feels shame and resentment. Whatever we try won’t be quite right or enough.

How to Detach?

Detaching starts with understanding, but it takes time for the heart to really accept that ultimately we’re powerless over others and that our efforts to change someone are unhelpful and possibly detrimental to us, the other person, and the relationship. Take these steps to practice detaching:

Ask yourself if you’re in reality or denial.
Examine whether your expectations of the other person reasonable.
Honestly examine your motivations. Are they self-serving?
Practice allowing and accepting reality in all aspects of your life.
Allow your feelings.
Practice meditation to be more attached and less reactive.
Practice compassion for the other person.
Be authentic. Make “I” statements about your genuine feelings rather than offer advice.
Practice the tools for detaching in the “14 Tips for Letting Go” on my website.
Attend Al-Anon or CoDA meetings.

If you answered “yes” to several of the above questions, consider learning more about detaching and get support. Detaching can be very difficult to do on your own.

©Darlene Lancer 2020

Adapted from Codependency for Dummies, 2nd Ed. (2015) by John Wiley & Sons

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Day #193: Know your spinal cord – The reticulospinal tracts

It's day thirty-six in our spinal cord series and I yesterday I lied, we're not done quite yet. First, as always we have a super helpful neuroanatomy category for anyone wanting to read the posts from this series. For the rest of us, today we're talking about the reticulospinal tracts, yes tracts with an s. There is a good reason for this, but you'll have to read on to see why.

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9 Ways to Improve Emotional Health

It doesn’t take much for Peter to have an emotional reaction. Most of the time, his family believed that he was overreacting. Commercials would make him cry, he would...

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A Fascinating Sign Of OCD (M)

The reason the world is more uncertain and surprising to people with OCD.

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The Uncommon Juice That Lowers Blood Pressure

Drinking this uncommon juice can lower blood pressure.

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How Voters Psych Themselves Out and Choose the Wrong Candidate

Democrats are psyching themselves out this election season, and psychological research dating back nearly 30 years helps to explain why. Right now, the behaviors and thought processes of Democrats are among the most salient examples of the particular psychological dynamics in question, but there are lots of instances in other important domains as well.

Erika Weisz, a Stanford Ph.D. and Harvard postdoc in psychology, explained what is happening in an article at Nautilus. She offered this example:

“Last summer, in a New York Times article about Warren, a voter stated, “I love her enthusiasm. She’s smart, she’s very smart. I think she would make an amazing president,” before adding, “I’m worried about whether she can win.” The voter’s sentiment is reflected in a 2019 poll in which 74 percent of Democrats said they would be comfortable with a female president, yet only 33 percent of them thought their neighbors felt the same way.”

If the person quoted by the Times voted on the basis of her own beliefs, she would vote for Warren. But she’s worried about whether other people will vote for her. Weisz believes that Warren’s political fate could “turn on voters who think she would make a great president choosing another candidate because they think that’s what their neighbors will do.”

Weisz used Elizabeth Warren as an example, but reasoning about other candidates, too, has devolved into the same dynamics. Above all, Democrats want to beat Trump. By a margin of more than 2-to-1, in the exit polls from the New Hampshire Democratic primary, and probably more generally, voters said they cared more about defeating Trump than about particular issues.

Rather than voting their own preferences, Democrats try to figure out who everyone else would vote for. They are trying to act like pundits. But just like the pundits, voters don’t know which candidates are most likely to have the broadest appeal. And sometimes their assumptions are just wrong.

Social scientists have their own jargon-laden name for what is going on — pluralistic ignorance. It could play an outsized role in determining the results of the 2020 Presidential election.

The pluralistic ignorance process goes like this: You feel a certain way. So do most other people. But you don’t realize other people feel the same way you do. You think it’s just the opposite. You behave based on your false beliefs about other people, rather than behaving in a way that is true to yourself.

It’s “pluralistic” because you are holding onto two sets of beliefs at once — your true beliefs and what you think other people believe. It is “ignorance,” because you are wrong about other people’s beliefs.

It is also a shared ignorance. You think your favorite candidate can’t get elected because you assume most people would not vote for that candidate. Lots of other people are doing the exact same thing – they have the same favorite candidate that you do, but they also assume that other people won’t vote for the candidate. That candidate can end up dropping out of the race or getting defeated, not because people didn’t believe in that candidate, but because of the pluralistic ignorance of thinking their own belief in the candidate was not shared, when it was. Too many people end up voting based on their mistaken beliefs about other people’s preferences, rather than their own preferences, which really are popular.

The psychological dynamics of pluralistic ignorance have also been demonstrated in research on friendships between black and white college students, Weisz noted. Nicole Shelton and Jennifer Richeson asked students about their preferences for having more contact with students from a different race. They also asked how much contact they thought the other students wanted to have with them. Both the black and the white students wanted to have more contact with each other, but both groups mistakenly believed that the other group did not want as much contact with them. That’s the typical pluralistic ignorance pattern of findings.

It mattered. Other studies by the same authors showed that the students who were especially likely to demonstrate that pattern of thinking were less likely to have contact with people of different races.

In workplaces, similar psychological dynamics have been documented for the matter of paternal leave. Men who are interested in taking new parent leave assume that other men feel more negatively than they do about the practice. In fact, they were overestimating the judgmental attitudes of other men. But their wrong assumptions mattered, and they were less likely to take the leave they wanted to take.

The psychology of pluralistic ignorance has been demonstrated in other domains as well, including drinking, willingness to report sexual harassment, and efforts to address climate change. With regard to drinking, Debra Prentice and Christine Schroeder found that educating students about pluralistic ignorance motivated them to make better choices about alcohol.

No one has yet tested whether it would work to enlighten voters about pluralistic ignorance. If it did work, then more citizens would vote for the person they really do want to be President, and not the person they think other people would want.

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Fear of Embarrassment Is Ruining My Relationship

From a teen in Scotland: I find it very hard to function socially (jobs and relationships) because I get anxious that I’ll do something embarrassing to the point I’ll never stop thinking about it and sometimes it makes me physically sick. I can’t communicate with my boyfriend and our relationship is practically non existent because neither of us are good at socialising. I can’t stop myself from eating my feelings all the time yet I’m underweight (I do not make myself sick) and I’m not sure where to go in life since I’m so young i want to live like a teenager but I can’t get past this.

I’m concerned that you are over-eating yet underweight. It’s just possible that at least some of your anxiety is due to an underlying medical problem. For that reason, I urge you to see your medical doctor for a complete exam — just to make sure.

If you are medically fine, then please do see a counselor. The embarrassment you are reporting may be a symptom of social anxiety. People with social anxiety fear the judgment of others so much that they have difficulty in environments (school, job, social situations, even shopping) where they have to interact with others. Many people with this disorder only feel safe when they are accompanied with someone they trust.

The good news is that social anxiety is treatable. There is no reason to live like this. The usual recommended treatment is a combination of an anti-anxiety medication and talk therapy. The medication can take the anxiety down a bit. It should not be a substitute for talk therapy. You need to learn ways to manage anxiety and to cope with social situations instead of avoiding them. No medicine will teach you that.

And this is important: Very few people know where they want to go in life when they are 17. That part is normal. The next few years should be about exploring your interests and passions. Dealing with your anxiety now will free you to do that exploration.

I wish you well.
Dr. Marie

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Optimism and longevity.

I want to point to recent articles relevant to an issue most of us mull about: "Is my glass half empty or half full?" Jane Brody describes a number of studies linking greater optimism to a lower risk of developing cardiovascular disease and other chronic ailments and to fostering “exceptional" longevity, defined as living to 85 and beyond. And Susan Shain does a self-help piece, citing numerous studies on how to be more optimistic. Finally, Parker-Pope, in the NYTimes Well section summarizes her recipe:

Spend time with optimistic people. Optimism, like pessimism, can be infectious.

Reframe negative situations. When something bad happens, ask yourself if there is a potential upside. A setback at work can be an opportunity to rethink your goals. By mindfully looking for a positive, we retrain our brains, and optimism will come more naturally.

Minimize your exposure to negative news. Don’t bury your head in the sand, but when bad news hits, educate yourself and then turn it off. We don’t need to expose ourselves to a 24-7 bad news cycle just because it’s there.

Start a gratitude practice. Try writing a nightly journal documenting three good things from your day. Or start meals with a family conversation about how you dealt with a daily challenge.

Try meditation. A daily meditation practice is a great way to ease your mind and shift yourself into more positive thoughts.

Adopt a mantra. When times get tough, fall back on a mantra that can put you in the right frame of mind. “I’ve got this!” or “Accept what you can’t change” can help you get through tough times.

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The Impact of the Media on Perceptions of Psychiatric Medications

Research studies and clinical experience certainly influence prescribing practices. However, in recent years the media has had a profound effect on public opinion and ultimately on clinical practice. In the...

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Thursday 27 February 2020

How to Make Healthy Lifestyle Changes That Last

Most people are aware that making healthy lifestyle changes would be good for their long term well-being, yet doing so can feel daunting for many. According to an article in US News and World Report, about 80% of people will fail at their New Year’s Resolutions, and many by the middle of February.

If you are feeling stuck trying to make changes, don’t dismay! First, know that you are in good company and it can take lots of stops and starts, steps back as well as steps forward, to make wished for changes. Second, consider the following steps below to shift how you might be approaching change and notice if this makes a difference.

Here are a few suggestions:

1. Psychologist Dr. Robert Brooks, writing on the topic of lifestyle medicine, emphasizes the importance of setting very realistic, specific, small, concrete, and measurable short-term and long-term goals. For example, he shares an example of a person who might first commit to walking a half mile a number of times a week and gradually increase this over the course of the next month or two, so that they work in increments toward their ultimate goal of walking three miles, five days a week. Identifying realistic, measurable, short and long term goals can make it more likely that people will follow through.

From my clinical and personal experience, I have experienced that the less people leave things to chance, the more likely they are to succeed. If you are going to walk a half mile tomorrow, choose what time of day you are going, put it on your calendar, set a reminder, and have your walking clothes picked out and laid out beside your bed the night before.

If you are going to increase your intake of vegetables at lunch, go grocery shopping on the weekend, plan out your lunches for the week, and pack your lunch the night before. Have already cut up veggies and healthy dip in the fridge to snack on for when you are hungry, rather than trusting that you’ll take the time to do this when a hunger urge sets in. In other words, be proactive and intentional.

2. Once people have specific goals in mind (see above) Dr. Brooks highlights the importance of coming up with a plan to handle inevitable setbacks. He suggests reflecting on potential obstacles from the very beginning and building in a way to handle negative mindsets and self-defeating thoughts and behaviors before they even occur. One benefit of doing this, Dr. Brooks suggests, is that it can lead to implementing proactive behaviors (for example, committing to exercise with a friend if you know you might give in to “not feeling like it” otherwise).

But another benefit of planning for setbacks, Dr. Brooks describes, is being able to rehearse responses to negative mind-sets by asking yourself what you might be likely to tell yourself if you encounter an obstacle, how would this affect your subsequent behavior, and how might you change the message you say to yourself to have a more positive outcome?

In my clinical experience, having a plan to handle setbacks is one of the most important factors in making lasting changes. I have observed that most people start off with good intentions but get derailed once they have a setback, and it can become hard to pick back up and move forward. Having a script for how you will handle this (write it down in advance!) can be essential for moving forward.

For example: When I have a day where I don’t follow through with my goals, I’m going to remind myself of the positive steps that I’ve already taken and that it is normal and human to slip backwards. In fact, I will remind myself that doing so is a natural consequence of growth, and forward and backward steps are part of the same path. I will also call my friend who always offers me an encouraging voice, and I will commit to doing one small positive thing for myself today.

3. Judson Brewer’s research on how mindfulness helps to break unhelpful habit loops offers powerful insight into changing behaviors. Having studied such addictive behaviors as smoking and overeating, he found that when people become very curious about their behaviors and what they get from their actions, observing their experience with a willingness to turn toward it and notice body sensations moment to moment, they naturally discover information that guides them toward making healthier and ultimately more rewarding choices.

For example, the smoker who truly pays attention to the experience of smoking may discover that smoking tastes disgusting, and thus become disenchanted with it. The person driven by food cravings might discover that such cravings are made up of body sensations that come and go and are in any given moment, actually manageable.

When we learn to pay attention to our unhealthy behaviors with mindful awareness, we step out of automatic pilot and give our brains accurate and up to date information about what is and is not actually rewarding, and this can help to break old habit loops.

4. Be wary of the diet you feed yourself (and I’m not talking about a diet of food). I’m talking about paying attention to your diet of thoughts. While I touched upon this in point #2, it bears further attention. It is common for people to be quite hard on themselves and harshly criticize themselves when they fall short of their goals (e.g., what’s wrong with me, I’m so stupid, I can’t do anything right). In fact, many people believe that self-criticism may be necessary to motivate and push themselves toward their goals. In fact, the opposite is true. As health psychologist Kelly McGonigal writes in her book The Willpower Instinct, self-criticism is associated with lower motivation, less self-control, and a sense of feeling stuck and being inhibited from taking positive actions.

So what is the antidote Feed ourselves a healthier diet of thoughts, especially ones that are self-compassionate. Self-compassion may feel foreign to many people, but it is the voice of care, kindness, understanding and encouragement that you would offer to a good friend — but instead offered to yourself. It might sound something like this: I can see I’ve fallen back into some old patterns today and I’m feeling disappointed. That happens to all of us sometimes. But I’ve had plenty of days where I’ve made healthful choices. I already know how to do this — I’ve just got to stick with it and be willing to work through setbacks along the way. At least I know I’m human.

5. Move towards your goals from a place of “already full” rather than from not good enough, less than, striving or stress. Take some time to appreciate what you are already doing to take care of yourself. Write down and reflect on things you have achieved in your life that you feel proud of, or things you did that took courage. Note what inner strengths you drew on to help you get there (which may be able to help you with future changes). Also reflect on things you appreciate about yourself and your life, and things you are grateful for. It is OK to work to improve things in your life, but if you come from a place of already enough you will be able to move toward your goals with greater ease.

6. If you are having difficulty making healthy lifestyle changes, don’t abandon hope. Instead, seek social support and connection! In fact, besides the encouragement and sense of shared common humanity one can get from others, there is another surprising benefit. In a meta-analysis study from 2010 researchers found that having social support and social connections was a major protective factor against dying, boosting survival rates by 50%. According to this study, the benefits of having healthy social relationships was as good as giving up 15 cigarettes a day and had a more important impact on physical health than exercising or avoiding obesity. Doing what you can to cultivate social connections may enable you to enjoy not only greater emotional but also physical benefits from these connections.

While changing behaviors is difficult for most of us, sometimes shifting how we are approaching our goals can help to make them more attainable. When we face obstacles along the path toward our goals, consider seeing them not as setbacks but as opportunities to build resilience along the way.

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Lawfulness of Behavior (FK-01): Simplify Family Life by Believing that Behavior is Lawful

A lot of people can relate to the idea of wanting life to be simpler and more easily manageable. This is especially true for parents. When life gets overwhelming or...

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Day #192: Know your spinal cord – The Tectospinal tract

Welcome to day thirty-five in the know your spinal cord series! For the new people, we have a whole neuroanatomy category dedicated to these posts! For everyone else (or those of you just interested in today's topic, this is going to be on another smaller tract of the spinal cord we haven't covered yet. Today we are talking about the tectospinal tract, not to be confused with the spinotectal tract, so let's get started.

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My Fiancé, Who Might Be Bipolar, Broke Up with Me

Last sunday my fiance broke up with me suddenly, i’m desperate, i’m heartbroken, his family and me think he might be bipolar type 1, he even thought so himself weeks ago, but he just broke up with me, during what i think it could be a manic episode. He swears he is in love with this girl he obsessed over during a previous manic episode with psychotic features, i can see that he’s being manic right now, i want to know if he is coming back to me, to us, we went thru a lot during our long distance relationship, we were about to get our visa to get married, i’m heartbroken and i love him, and i wanna be with him regardless. Is he coming back? How can i approach him? Why this happened? HELP!

If one person in the relationship is unstable, it can cause many problems. It seems that your fiancé is unstable. He may be mentally ill and experiencing a significant psychotic episode. If so, he needs help. It may not be the best time to pursue marriage.

Imagine, for a moment, that the two of you were married and this episode occurred. What would you do? If he acts like this before marriage, expect that it may happen again after getting married. People don’t change simply because they’re married.

You’re also assuming that he may be behaving erratically because of a mental illness. It may be the case but without a professional evaluation, you don’t know that with certainty. You need to know what’s wrong and have a plan for correcting it before you pursue marriage.

You also mentioned that the two of you have been dating long distance. Perhaps you didn’t know him as well as you thought you had. Again, you need to have stability and full knowledge about what you’re getting into when contemplating marriage. Being married means that you are legally bound to another person. It’s important to have a deep understanding about who you are marrying and what they are truly like.

I would recommend thoroughly assessing the nature of this relationship and his problems. Should you marry, his problems become your problems. Is that something you’re ready for? You might gather information by asking his family about his history, behavior, potential psychological problems, and so forth. Gather as much information as you can and use it to determine if he is the right life partner for you.

The fact that he left you for another woman is also something to consider as a possible red flag. He is “obsessed” with another woman. Who is this individual? Why is he interacting with her? To be obsessed is to have an intense interest in something beyond the norm. It would suggest potentially a mental illness or some other problem.

Obviously, you love your fiancé and want to be with him but you need to be certain that this is the best relationship for you. Sometimes, people ignore obvious red flags in relationships for a multitude of reasons. It may be that they don’t want to be alone or are desperate to be loved or many other reasons. Choose a marriage partner wisely. It would be ill-advised to marry someone who has untreated mental health problems and who has left you for another woman with whom he has become obsessed. These are red flags that indicate a potential problem in the relationship, including a potential break with reality, both of which are serious and need addressed.

Perhaps, after receiving treatment, he will be more stable and ready for marriage. Until then, it may be best for you to keep your distance and gather more information about your potential marriage partner so that you can make the best decision about how to move forward. Use this time apart to seriously contemplate if this is the right relationship for you.

Good luck with your efforts. Please take care.

Dr. Kristina Randle

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2 Trainable Traits That Support Good Mental Health (M)

Both traits can be increased with practice.

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Weight Loss: Avoid This Type Of Food If You Gain Weight Easily

The type of food that interacts with genes causing an increase in body weight.

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Podcast: Postpartum Psychosis Warning Signs

Having a baby is a wonderfully happy time, right? For many women, it certainly is, but estimates show that 1 in 5 women who give birth will suffer from some type of perinatal mental illness, such as depression, anxiety, OCD or psychosis. Chances are, this includes someone you know. In today’s podcast, Dr. Katayune Kaeni, a psychologist who specializes in perinatal mental health and a sufferer herself, discusses these often confusing and debilitating disorders, particularly postpartum psychosis, a more rare and severe form of perinatal mental illness.

Who is at risk? What does perinatal psychosis look like? And what is the treatment? Join us as we discuss an often misunderstood disorder.

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Guest information for ‘Dr. Kat- Postpartum Psychosis’ Podcast Episode

Katayune Kaeni, Psy.D., PMH-C, is a psychologist in private practice specializing in perinatal mental health. She was drawn to this specialty after going through Postpartum Depression, Postpartum Anxiety and Postpartum OCD with her first child.

Dr. Kat is involved with Postpartum Support International as a subject matter expert for PSI’s certification exam development, helped develop advanced training curriculum for PSI and is a board member and Chair of Education, Training and Certification. She also works with her local community to provide training and education about perinatal mental health.

Dr. Kat is the creator and host of Mom & Mind Podcast, which focuses on perinatal mental health and wellness. Through interviews with experts and people sharing personal stories of healing, the podcast raises the volume on issues to give information, reduce stigma and support families in the transition to parenthood.

About The Psych Central Podcast Host

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 the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Dr. Kat- Postpartum Psychosis’ Episode

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

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome, everyone, to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Dr. Katayune Kaeni. She is the host of the Mom & Mind podcast, which focuses on perinatal mental health and wellness. Dr. Kat, welcome to the show.

Katayune Kaeni, Psy.D.: Thank you so much for having me. Glad to be here.

Gabe Howard: Well, I’m always excited to have a fellow podcaster because you know what we go through.

Katayune Kaeni, Psy.D.: Yeah, right. Yeah. It’s a thing.

Gabe Howard: It really, really is. Now, today, we’re going to discuss postpartum psychosis. And you were drawn to this specialty after you yourself went through postpartum depression, postpartum anxiety and postpartum OCD after the birth of your first child.

Katayune Kaeni, Psy.D.: Correct. Yes. There’s a lot of things that can happen in the postpartum period. I’m here to talk about one of the more severe conditions.

Gabe Howard: In the interest of full disclosure, I’m a 43 year old male. I’ve never been pregnant and I do not have children. I’m really, really entry level when it comes to understanding what postpartum anything is. So thank you so much for helping to educate people like myself. It really is an important topic.

Katayune Kaeni, Psy.D.: Yeah, it’s absolutely important and a lot of people have that same feeling. I don’t know anything about it. It seems like this weird thing that happens to other people. And chances are, you know, somebody who has suffered through some form of perinatal mental health condition, even if they don’t talk about it, which is very common, a lot of people don’t talk about it because there is so much shame around kind of not feeling well or not feeling yourself even during pregnancy or postpartum. There’s all these ideas out there that it’s this wonderful magical time and hopefully it is. But for a lot of people, it isn’t.

Gabe Howard: That’s one of the things that came up while I was trying to do research for the show so that I could talk somewhat authoritatively on this subject. I was shocked at how many times I Googled postpartum psychosis or postpartum anything, and the articles that came up were, Am I a bad mother? Am I a bad parent? Am I harming my child?

Katayune Kaeni, Psy.D.: Right, yeah.

Gabe Howard: That really kind of spoke to me like in a visceral way, this idea that you also have the illness and there’s all this stigma and shame surrounding it. Is that what you found working as a therapist?

Katayune Kaeni, Psy.D.: Oh, absolutely. I hear those comments all of the time. I feel like a bad mom. I’m not good enough for my child. Feeling the shame and the blame and confusion around why do I even feel bad? We are just not educated on what can happen. I think it’s a great disservice to everybody who goes through any kind of perinatal mental health condition because they’re mostly blindsided by it. Right? You’re like here I’m supposed to be having the best time of my life. This is like what my body is supposed to do, quote unquote. And here I am feeling like a failure.

Gabe Howard: And just to be clear, none of this is true. You are an excellent parent. This is just sort of the illness and society’s misunderstanding of the illness taking hold in an unexpected way.

Katayune Kaeni, Psy.D.: Oh, for sure. This is a very treatable and very temporary condition. If you get the right help and if you get it as soon as you know, even if you’re getting it a little bit later down the road, you still can feel better. And there’s not a huge impact throughout the life course of you or your child. However, again, in the more severe cases that are not treated, there are some long term effects. And I know that might sound really scary to people. So I want to dispel the myth that if you have a condition, you’re going to be like messing up your kid in some way. Like I said, this is very treatable. And also, when it’s very, very severe, there can be really life-threatening consequences.

Gabe Howard: So let’s talk about postpartum psychosis. What is the definition of postpartum psychosis?

Katayune Kaeni, Psy.D.: Typically, a postpartum psychosis is very rare. One to two out of every one thousand deliveries, and it is not postpartum depression or postpartum anxiety. The onset of these symptoms are usually in the first two weeks, but certainly can show up a little bit later. There’s a really rapid onset meaning symptoms start quickly and it is characterized by the mind is kind of going off on its own, in part because of hormonal changes, in part because of your own mental health history and in part because of sleep deprivation. So people who are experiencing postpartum psychosis are having rapid mood swings. They are potentially having delusions or strange beliefs about themselves or their child or people around them. They may be having hallucinations. Feeling very, very irritated. The difficulty to sleep or inability to sleep. Sometimes paranoia and what’s really hard about postpartum psychosis is that the symptoms wax and wane, meaning they come and go. So sometimes people can sort of be and feel like themselves and appear to be like their normal selves. And then sometimes people around them might observe that they don’t look like themselves or sound like themselves. So it can come and go for quite a few people. And then for some people, the symptoms, once the onset is there, just continue. So I know all that probably sounds pretty scary and serious and it actually is pretty scary and serious. Like I said before, it’s very rare. And people who have a history of a bipolar disorder are at a high risk, or if there’s bipolar disorder in the family, they’re at higher risk. Oftentimes psychosis in the postpartum is an undiagnosed bipolar disorder.

Gabe Howard: So let’s talk about that for a moment. I myself live with bipolar disorder. And I understand psychosis from a lived experience perspective because I have experienced psychosis. Is it the same? Is postpartum psychosis, and for lack of a better phrase, “Gabe Howard” psychosis, is this a similar thing or is it completely different?

Katayune Kaeni, Psy.D.: There’s certainly some similarities in terms of symptoms of psychosis are the same. But what’s very different here is that there is a new baby involved. And sometimes the delusions or hallucinations are in relation to this new child. This new very vulnerable child. And also the perinatal person is also very vulnerable. They’ve just given birth. They’ve had massive changes in hormones, both during pregnancy, at delivery and then in the postpartum there are really, really rapid kind of swings in the hormones during that time. And the sleep deprivation is, you know, when it’s sort of like just you quote unquote, you have capacity to possibly sleep. In these cases, there’s a baby involved. And babies cry and they wake people up. And that’s what they do and that’s what they’re supposed to do. But for somebody who needs sleep and isn’t getting it and can’t get it, it adds a whole other layer of complexity into into the life and into the symptoms, because you’re in relation to a baby while having psychosis for some time. That means that there’s like a hyper vigilance around the baby. Like it’s really hard to not be around them or to let anyone else support them. Or sometimes it’s like a kind of a total disregard. Like people in some psychoses, they will kind of forget that the baby is there. So it brings a whole other level of danger and complexity also. Then there’s this additional layer that people around them are thinking, oh, well, she’s had baby. She’s not quite herself or giving some other explanation for odd behaviors, the strange behaviors. And it kind of puts people in a more of a dangerous situation because symptoms are explained away because they’re not understood and it’s not expected that these kind of symptoms will show up.

Gabe Howard: I’m kind of assuming that the way that postpartum psychosis is played out in the media as well as how motherhood is played out in the media, those two things combined. Because like you said, we want to defend new parents. We don’t just want

Katayune Kaeni, Psy.D.: Right.

Gabe Howard: To throw every new mom under the bus and say, oh, well, you have a serious mental illness. That’s the problem. But of course, this can be dangerous because it lacks care. I suppose my specific question is, how is postpartum psychosis played out in popular culture?

Katayune Kaeni, Psy.D.: It’s actually in very dangerous ways. So in ways that further stigmatize the perinatal period. So mostly what we’re seeing in the media, what you see on the news, is that postpartum psychosis that has led to infanticide and this is a really, really hard topic for people to hear about. And also, this is a very real possibility with postpartum psychosis. Out of that 1 to 2 percent of people who have postpartum psychosis, 4 to 5 percent of those mothers will kill their children. They kill their baby. It’s really, really a hard reality to hear. And what I want people to know is that when this happens, women are not in their right mind at all. They are not themselves. They do not know what they’re doing. They are often being told by their delusions to do something. Sometimes there are delusions that the baby is possessed. So they can’t be here. Although this might not make any sense, but most of the time it’s really out of love. A lot of love, like the world is too harsh for this child. So they have to go. And this is a very severe departure from reality. The moms who are in this situation do not know what they have done. If they come out of it and get the medication that they need, they can’t even fathom what has happened. People think and say, oh, what a horrible person. I can’t believe she has done this. I would never do this to my child. And the thing is, is that if she were in her right mind, she wouldn’t either. So what we’re seeing in the media is usually the moms who have done something like this and who are being handcuffed or going on trial. So this most severe, this is the most severe consequence of perinatal mental health condition. Postpartum psychosis and infanticide is how postpartum psychosis is viewed. Most people with postpartum psychosis are experiencing hallucinations or delusions or some kind of waxing and waning symptoms that does not reach that level. Typically, they may need hospitalization and medication, but it’s not always that people go on to hurt their children in this way.

Gabe Howard: It’s very interesting what you said there, because, of course, when something as terrifying and scary as infanticide happens, we say, oh, I would never do that as a mom. I can’t believe that a mom would do that. I mean, we have a lot of like really fear-based reactions.

Katayune Kaeni, Psy.D.: Yeah.

Gabe Howard: Because it’s terrifying. But then when we hear about somebody getting help for mental illness after the birth of a baby or not being excited about the birth of a baby, which is very common, we also say that exact same thing. Well, I would never do that as a mom or, oh, my whole

Katayune Kaeni, Psy.D.: Mm-hmm.

Gabe Howard: Family was excited or I just can’t imagine not loving. It’s the same reaction and it stops people from getting help.

Katayune Kaeni, Psy.D.: Oh, totally. It absolutely does. Yeah. This is the stigma. And when you are feeling as bad as you might be feeling in the postpartum period, even if it’s not psychosis, you’re dealing with depression or anxiety or OCD or PTSD or even a bipolar disorder in postpartum. You being the one who’s not well, also have to sort of fight against people around you who don’t want to think that you’re not well to advocate for yourself to get help. And sometimes it’s with the medical providers, too, who unfortunately in their training don’t get a lot of education on this. So getting to the point where as a person who is suffering to also be in charge of finding the help that you need when you don’t know what’s going on is an incredible hill to climb. I see it all the time. I see it all the time. People who come in not wanting to say out loud how badly they feel. And they finally get to help. And then they get to learn about how common this is and how preventable or treatable. And all of that. There is an amazing amount of strength in people who are dealing with a mental health complication while pregnant or having a newborn. It is phenomenal.

Gabe Howard: We’ll be right back after these messages from our sponsors.

Sponsor Message: Hey folks, Gabe here. I host another podcast for Psych Central. It’s called Not Crazy. He hosts Not Crazy with me, Jackie Zimmerman, and it is all about navigating our lives with mental illness and mental health concerns. Listen now at Psych Central.com/NotCrazy or on your favorite podcast player.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing postpartum psychosis with Dr. Kat, the host of the Mom & Mind podcast. To switch gears a little bit, we know that you’re an accomplished therapist and you understand this, of course, from the medical side and helping people. But this is also something that you went through personally.

Katayune Kaeni, Psy.D.: Oh, yeah.

Gabe Howard: I imagine that these myths and misconceptions from both society and whatever lived in your brain made the treatment and the acceptance of it very, very difficult.

Katayune Kaeni, Psy.D.: Oh, my gosh. It really did. So I was already a psychologist. I had a full time job. You know, I was helping other people and I got pregnant. Pregnancy was fine. Birth was fine. But very quickly, like day one, after my daughter was born, anxiety was there. I was so hyper vigilant. Not your normal checking on the baby. Like I could not not watch her because I was so afraid she was going to die. And she was fine. Physically, she was fine. Looking back on it now. That was the first sign. I want to say, before I go into the rest of this, is that I was a therapist and I didn’t know what was going on. It took me a full year to figure it out. And I myself have a history of depression. But it felt different in part because of those myths that you mentioned. It was crying all the time. I felt really alone. I felt like I didn’t know what I was doing. Everything that I was doing was wrong. I started having intrusive thoughts that something bad is going to happen. And I had them all the time. But because I had this idea of motherhood, or maybe like an incorrect idea of motherhood, I thought to myself, well, I guess this is what it’s like. I guess this is normal. I guess this is what I’m supposed to be experiencing.

Katayune Kaeni, Psy.D.: And it didn’t fully register to me until later that it was depression and anxiety and then OCD. And it went on for a year, a good year. I felt horrible the whole time until I figured out what was happening. I had read about one of my symptoms in a book and immediately had immediate relief like, oh my God. It’s not just me. And then I started researching a little bit more and realized there’s this whole world of mental health conditions that I had never learned about in grad school. I never learned about in any of my training anywhere. Maybe there was like a one page in one book that described it, but really no actual education on it. So I didn’t even know that postpartum anxiety was a thing. Certainly not postpartum OCD. I had heard about postpartum depression, but I thought, oh, no, no, no, no, not me. I’m a therapist. I’ve gone to therapy. I’ve done a lot of work on this stuff. So that’s not what this is. And looking back on it now, I can see how and when I started and all the factors that contributed. But at the time, when you’re in it, it just feels horrible and it just feels like it’s only you. And it’s incredibly embarrassing and filled with shame.

Gabe Howard: When did you finally realize something was wrong and what steps did you take to get help?

Katayune Kaeni, Psy.D.: Yeah, it was about around my daughter’s first birthday. It was almost like after I made it to that year, something just cracked in me and I knew something was wrong for sure. So, again, I was a therapist. I was working in a major medical system and we give out the PHQ-9, a ten item questionnaire, which is a mental health depression screening. And I said, OK, I’m going to take this and I’m going to be honest so that I can see objectively really how bad off I am. Mind you, I had taken this PHQ-9 several times in just regular doctor’s visits and in my postpartum visits. And I lied. I lied on those. I did not want to be as bad off as I was because I was like, I know what this is asking. I know. Like, nobody else needs to know about how I feel. So anyhow, that day where I just sat down and had an honest conversation with myself and that was the turning point. Again, it was around a year. So I went back to my therapist and I talked with her about what I thought was going on. And unfortunately, she didn’t have training in this. So she disagreed with me that I was having postpartum depression. So I started doing my own reading and really learning as much as I could. And then that helped a lot. I wish I would have known at the time to seek out a specialist who could know what I was talking about. But yeah, I went to therapy. I did a couple of other things, like I went to get my thyroid checked out and I started a bunch of supportive types of things to help me get back. So I took that kind of a route. I had taken antidepressants in the past, but again, I didn’t really know enough about antidepressants during this period of time to feel okay about it. But knowing what I know now, I know that they’re largely safe. So I did go to therapy. I did reading and I sought out whatever kind of supportive things I could.

Gabe Howard: And you’ve described it as very scary, and as you pointed out, you’re a mental health professional.

Katayune Kaeni, Psy.D.: Mm-hmm.

Gabe Howard: If a mental health professional is scared to seek mental health treatment after the birth of her child, what are the odds for the rest of us? Which brings me to my next question. What are the odds for the rest of us? And that’s kind of an all encompassing question. How many people have postpartum psychosis that never get help? And I guess it naturally goes away or of course, something bad happens. Once you get help, what percentage of people get better? I know it’s kind of a big question, but what’s the prevalence rate of postpartum psychosis?

Katayune Kaeni, Psy.D.: Prevalence for postpartum psychosis specifically is 1 to 2 percent, which is very low.

Gabe Howard: Very rare.

Katayune Kaeni, Psy.D.: Yeah. Very rare, but for postpartum depression and anxiety, it’s in around 20 percent, a huge number. So one in five people will deal with a perinatal mental health condition. So I’m talking about like the umbrella of things that can happen. 20 percent is a lot. And when you put that out into like the population of the United States, we’re getting into the hundreds of thousands of people every year who are dealing with this. So it is super treatable. And there are a lot of people who now are specializing in this area, perinatal mental health. So when people get help, symptoms resolve relatively quickly. All of these conditions are treatable. So if we can get somebody who is at risk for postpartum psychosis into the right psychiatrist and the right therapist or the right support team, then the symptoms can resolve relatively quickly. But the longer it goes on, the harder it is to heal and recover. So the sooner that we can get people in and seen, the sooner it will resolve and people go on to be fine. Absolutely fine. And also people who come in for therapy, sometimes there are some underlying things that have contributed to the anxiety or the depression or the OCD. And if people are getting the right kind of help, I really hear sometimes that they’re better off than they were before because they’ve caught something and gotten help for something that was actually had been bothering them for years. Let’s say anxiety for instance, a lot of people just live with anxiety and don’t specifically know that they have it. But if there’s a peak in symptoms during this period of time and it’s finally bringing them in for help, then we’re able to help them not only in the postpartum period, but also just help them with life skills that can benefit them for years.

Gabe Howard: It sounds to me like while postpartum psychosis is scary, it is treatable and it’s most treatable if you get help immediately. And one of the reasons that people aren’t seeking help immediately is because of a lot of, you know, myths and shame that isn’t really relevant to the disease that you have, the illness that you have, the disorder that you have. And then we’d be in a much better position if people got it checked out before it became, you know, bigger and bigger and bigger or before the worst case scenario happened.

Katayune Kaeni, Psy.D.: Absolutely. The sooner you get in, the better. And I’m also a really big fan of prevention. So if you are planning on getting pregnant or get pregnant and you know that your family has a history of any mental health conditions, I would say just find somebody who specializes in perinatal mental health. Go talk to them about your concerns and develop a plan. I think really when we can get ahead of it, it’s even better. So there are things that we know how to do, like protect sleep and negotiate that within the family to help with the baby and have meals brought in. There are so many things that we can do to help prevent this. And also sometimes it’s not completely preventable, but we can help reduce the intensity by quite a bit if we’re ahead of it. So although I know people kind of don’t want to think or believe that these kinds of things could happen and therefore sometimes don’t get preventative care, I would highly recommend to do that because it will make your experience so much better.

Gabe Howard: Dr. Kat, thank you so much for being here. I can’t thank you enough. And I hope that everybody checks out your Mom & Mind Podcast. Do you have a Web site where people can find you easily?

Katayune Kaeni, Psy.D.: Yes, www.momandmind.com.

Gabe Howard: Again, Dr. Kat, thank you so much for being here. Do you have any last words for our listeners?

Katayune Kaeni, Psy.D.: Thank you for having me. I would just like to say to anyone who’s listening, who is concerned about these symptoms, you are definitely not alone. There is help. And with the right help, you will be well.

Gabe Howard: Thank you so much. And remember, everybody, wherever you downloaded this podcast, I just need you to do a couple of things. Give as many stars as you feel comfortable giving. Hopefully it’s all of them. But no matter what, use your words. Tell people what you like or tell people what you don’t like. You can always e-mail show@PsychCentral.com and let me know what kind of shows you would like to hear. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. And we’ll see everybody next week.

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Why Does my Sister Keep Fighting with Me?

From a teen in the U.S.: So freshman year of highschool, I developed really bad aniexty maybe depression I’m not sure but anyway, I was so sensitive and cried over everything like one time my brother looked cute and I cried because I thought of myself as a mean person and if anyone said anything mean ab me i cried. Always told myself I would get through it and stay strong because I have so much to live for.

I now am happy and that experience made me so grateful for everything around me. I live my life now and think about everything I say and do. That being said my sister always fights with me and will rip me apart. She will call me a wh*re and a b*tch for no reason and she says I have a God complex because she thinks im being crazy because i try to hold it in. I hold it in because i like to set an example and not curse in front of my younger siblings and i do even when im mad. but its like stop means keep going and she will record me yelling at her once she knows she got to me.

she is so manipulitive and i just want her to stop but all she says is “i dont care, i dont care” i care too much to say that especially since i always feel guilty about bad things i do and honesty is the best policy w me but she goes out of her way to make me mad but then when i flip out I look insane.

I just want her and I to be happy and she doesn’t care when my mother takes her computer away. My mom said we are going to therapy but i doubt that will happen due to her views on therapy. She thinks its nonsense. My sister has always been picked on by my older siblings so i protect her and yet when im the nicest and closest to her she picks on me. I just want to know whats happening with her. I can only take so much and we share a room and go to the same highschool. shes a freshman and recently lost her best friend so i support her but this started before she lost her friend. Maybe she feels alone? I know i make mistakes but she straight up doesn’t care HELP

I am very glad you wrote. You are correct that this isn’t normal sibling rivalry. Without talking to your sister, I don’t know what is going on for her but I have a couple of ideas for you to think about:

You said that your sister has been picked on by your older siblings. It may be that she doesn’t trust you even though you are nice to her. She may think it’s only a matter of time before you pick on her too. She can’t stand the anxiety of waiting for you to bully her too. She therefore provokes you until you confirm her worst fears that you are no different from the others.

It may also be that she has no idea how to be in a friendly relationship with a sibling. She provokes you because to her fighting is “normal.” Fighting does keep people connected with each other, even though it is an unhappy connection.

You are right that she doesn’t really need a fight. She needs help. But until she gets some help, the person who can change things, at least a little, is you.

You can’t change how your sister treats you. But you can do better at declining the invitations to fight. Remember: When you flip out, you are inadvertently showing her that her manipulations work. Instead of fighting, find a few phrases to use to respond like “I’m sorry you feel that way” or “I love you too much to fight” and then quietly and calmly LEAVE the situation. You can go to another room. If she follows you, go for a walk. You can go to the library or a friend’s house. The exception to this is if she ever escalates to physically hurting you. Then do involve a parent immediately. Even then, keep as calm as you can. Stress your concerns about her, not your anger. Do tell her how much it means to you to have a sister to talk to whenever she is behaving decently.

Yes, this will be hard. Yes, it isn’t fair that you should have to put up with your sister’s abuse. Things aren’t always fair in families. I hope you can look at this as an exercise in teaching yourself how to stay centered in spite of what others say.

I hope your parents will reconsider their attitude toward therapy. You are 18. You can do the groundwork by looking for a therapist who specializes in family work. School guidance counselors often know where teens can get free or low cost therapy. Once you identify a therapist, you can give that information to your parents and see whether there is insurance to cover it.

If no one else in the family will go to therapy, please consider going yourself. You deserve to have the ongoing advice and support of a therapist.

I wish you well.

Dr. Marie

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