As a psychotherapist, I can’t count how many times I have seen individuals and couples struggle with building healthy connections in their relationships.

The most common complaint has been that they feel unfulfilled, devalued or unappreciated in relationships with others. It is my professional experience that when we get caught up in what others can do to make us feel good about ourselves, we are likely to become angry and resentful.

So how do you avoid the resentment trap in your relationship?

Four Tips to Avoid the Resentment Trap

1. Ask yourself: Am I being realistic with my expectations?

Perhaps due to unmet needs, you project your disappointments onto people who are incapable of meeting your standards. No one person can meet all of your needs. If this describes you in relationships, you will ultimately set yourself up for feeling unfulfilled and empty. Friendships, work relationships, family and partners all participate in your life in meaningful ways. But in the end, it is up to you to love yourself the way you deserve to be loved.

One common theme of having unrealistic expectations is getting caught up in the fantasy of what a relationship is supposed to look like — for example, having expectations that your “Prince Charming” will sweep you off your feet and all of your troubles will slip magically away. Now if this isn’t a resentment waiting to happen, I’m not sure what is!

How many women have dreamed of having their lives turn out like the fairy tale endings of Cinderella and Sleeping Beauty? Realistically, how many women have had those fantasies fulfilled to their expectations?

2. Remind yourself: I am a valuable, lovable human being.

No one person can make you feel good all of the time. You can feel loved in another’s presence, but if you choose one person to define how you feel in a relationship, you will be setting yourself up for deep disappointment. If you don’t feel good about yourself, begin by acting as if you do by creating a loving mantra and reciting it each morning in front of the mirror before the day begins. Examples may include “I deserve love,” “I am lovable,” and “I am perfect just the way I am.” Recite a mantra often enough and you will begin to believe it!

3. Surround yourself with healthy people.

By healthy people, I mean people who accept you unconditionally. I am talking about people who don’t shame you or try to prevent you from making your own decisions. These are individuals who will support you with your day-to-day challenges, accept you for your “human-ness” and are okay with you making mistakes. Write a list of people you know who have these qualities and keep in contact with at least one of them on a daily basis. These are also individuals who you can give you a healthy reality check. If you struggle with an issue that keeps you feeling stuck, ask for their perspective.

4. Focus on self-care.

If you deplete yourself to the point of exhaustion, it is far more likely that you will be vulnerable to wanting your needs met by others. You may possibly go to a child-like place and demand that you get your needs met immediately. I see this sort of thing in my work with clients who are struggling in love-addicted or codependent relationships.

So what is the best remedy for healing the vulnerable child within? Replace your expectations with gentle guidance and nurture yourself through a walk, deep breathing, a yoga class, journaling or meditation. Get to know yourself better.

One exercise I recommend is making an inventory of your strengths and weaknesses. Think deeply about your interests and passions. How can you begin focusing more on the things that bring you joy? You deserve loving care — and who better than yourself to give it to you?

Maybe they’re being secretive and have even stolen money from your wallet. Maybe their physical appearance has changed with rapid weight loss or red eyes. Maybe you’ve noticed a change in their sleep habits, energy level and mood. Maybe you’ve actually found marijuana or other drugs in their room.

Naturally, the thought and possible confirmation of your child using drugs trigger a rush and range of emotions: anger, frustration, disappointment, sadness, fear.

If you think your child is using drugs, how do you approach them? Where do you start?

Two parenting experts shared their insight below.

1. Be direct and calm.

“This issue is too serious for subtlety,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. He suggested readers approach their kids “directly and immediately.”

Avoid letting your anger and frustration spill over into the conversation. According to Lisa Kaplin, Psy.D, a psychologist and life coach who teaches parenting classes, “The best way to approach your child is with delicacy, not drama. If you approach them with panic, anger, aggression or accusations, you can be sure your child will tell you absolutely nothing.”

Yelling, threatening and lecturing your child typically leads them to withdraw, sneak around and lie, she said.

Duffy also suggested approaching your child “from an emotional space of genuine concern for well-being.” He understands that being calm and centered is a lot to ask of parents. “But it is, without a doubt, the approach that works best in my experience.”

It’s common for kids to deny their drug use, or to respond casually (e.g.,” It’s just pot, and I don’t smoke it that often, anyway”). If this happens, “give a brief response in which you tell them that you do not want them to use drugs of any kind,” Kaplin said. Reiterate your house rules about drugs and alcohol use and “the consequences that come with that behavior.”

2. Talk when your child is lucid.

Don’t try to have a serious conversation when your child is drunk or high, Duffy said. “This might seem like common sense, but I have worked with many parents who have attempted to lecture an inebriated teenager.”

3. Ask open-ended questions.

It’s more likely that your child will be honest, and talk about their drug use if you ask open-ended questions. According to Kaplin, these are several examples: “Can you tell me more about that?  How did you feel in that situation? What will you do if that happens again? How can I help you with this?”

If your child admits to using drugs, again, “ask them with open-ended, non-judgmental questions about what drugs they have used, how often, and if they plan on using again.” You also can ask “for their input on how to proceed.”

4. Don’t punish your child.

Avoid punishing your kids, Duffy said. It rarely works. For instance, “Taking a cell phone away will never keep a drug user away from using.”

5. Show your support.

If your child reveals their drug use, “Thank [them] for being honest with you,” Kaplin said. Let them know that you’re “here to help them. Tell them you love them.”

6. Get your child treatment.

It’s key to take your child to see a qualified therapist who specializes in working with teens and young adults. When talking about professional help, don’t negotiate with your child, or take “no” for an answer, Duffy said.

Instead be brief, firm and clear, he said. Duffy gave the following example of what you might say to your child: “It is clear to us that you have been using something, and we are really concerned for your safety. As your safety is our domain as Mom and Dad, we are going to pull rank here and schedule an appointment for someone for you, and all of us, to talk to about this issue.”

Depending on the situation, you can “give [your child] options regarding therapists or treatment centers,” Kaplin said.

Even if your child is over 18 years old, Duffy suggested having a similar conversation. While you can’t force your older child to attend therapy, you can leverage other things, such as your financial position, he said.

It’s also important to get clear on your limits, communicate them to your adult child and follow through, Kaplin said. For instance, “can your child still live with you if they’re using drugs? If not, when must they leave and will you help them with treatment or other living arrangements?”

Knowing your child is possibly using drugs is stressful, scary and painful. And it can be incredibly hard to have a calm conversation. If you feel yourself losing control, take a break, and return when you’ve cooled off. Whether your child admits to using drugs or not, having them see a qualified therapist is critical.

Further Reading

Here’s more on symptoms of teen substance abuse, what parents can do, and reasons your child might use drugs and how to help them.

How then later did I come to embrace cognitive behavioral and related therapies that spell out that we are, essentially, just a mess of behaviors (good and bad)?

If you dig into your family dynamic, and maybe establishing relationships with others from equally dysfunctional backgrounds, you are bound to have a change of heart about old Skinner. Maybe there is something to behaviorism after all, and it can jibe with the deeper therapies that ask you to reflect on early places of pain and identity-molding.

Dialectical Behavior Therapy (DBT) is particularly of interest not just to me, but folks trying to come to grasp with certain subsets of mental illness — borderline personality disorder, bipolar and other depressive disorders. But its principles can be significantly farther-reaching than mental illness circles alone.

There are 4 critical components to the DBT methodology. The categorical names alone should conjure hope for those suffering from mental illness symptoms and individuals afflicted with interpersonal issues at home and in workplace: mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation.

Any reader of Daniel Goleman’s Emotional Intelligence, with an introduction by the Dalai Lama, knows that mindfulness is at the core of human attempts to find balance and centeredness in our own body, as well as connection to others. Nothing is more key for individuals with beginner-level trust in family or therapists or slowly-developing insight into dysfunctional ways of relating to colleagues.

Interpersonal effectiveness involves “strategies” — practical, effective means of dealing with thought, mood and behavioral maladjustments. Yes, actual skills are taught, driven by goals for different situations. (Sound like business counsel?) This is invaluable to those with borderline personality disorder, who “possess good interpersonal skills in a general sense” but are unable to have self-insight to get past “problematic situations” when stress hits.

Now, what better need do we have as humans than to develop distress tolerance? It can help us in our workplace, for ill loved ones, and for ourselves when debilitated by depression, addictive thoughts, or the surfacing of manic traits. This is integral to DBT’s beauty. As in Alcoholics Anonymous, where people are encouraged to discern between what can be changed and what can not, distress tolerance skills involve “the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation.”

The heart of helping ill individuals and ourselves lies, I believe, in letting this mindset seep in, allowing for gentle, passive strength. (Not to mention that this simple maxim is a behavioral powerhouse when artfully practiced and applied, and can profoundly affect our professional, family and social life.) “Self-soothing” and “pros and cons” work are two tactics in the distress tolerance strategy, one whose benefits to mentally ill family systems can certainly be equally applied to the needy masses of a larger society.

The last outlined DBT component is emotion regulation, so critical to disorders such as bipolar, where emotional intensity and stress make for frequent anxiety. But we all have encountered situations with bosses and friends that contain these elements. How do we identify obstacles and triggers, and then work on changing emotional patterns? And can we increase positive emotional experiences? Like the mouse after his cheese, is it not possible to stack the deck a certain way in families, in the workplace and within the mental health system so that the satisfaction of getting a little more of that nibble — stability, harmony, collaboration — can happen more effectively and more often?

Want to learn more about dialectical behavior therapy?
Follow our blog, Dialectical Behavior Therapy Understood or read the article, An Overview of Dialectical Behavior Therapy.

The focus for most treatment professionals is on a patient’s symptoms and the alleviation of symptoms. Few professionals delve into how a disorder — like bipolar disorder or clinical depression — changes our identity. Everything we know about ourselves.

Everything we thought we knew about ourselves.

That’s why this recent piece in the NYT Magazine by Linda Logan exploring this issue is so interesting and timely.

Our identities as unique individuals with well-worn and familiar roles in life — mother, confidante, partner, employee — are quickly stripped away when a new label takes over: patient. Inpatient. Psychiatric inpatient. In all of society, there is almost no worse label that could be applied.

The illness then takes precedent. Everything about you fades away. It’s all about treating the symptoms, bringing them “under control” — usually through a combination of medication and structured activities in an inpatient setting. It’s an unsettling and uniquely dehumanizing experience. In our society, I suspect only prisoners experience worse.

Linda tells the long and sad story of her grappling with her disorder — bipolar disorder — while a mother to three children and struggling to complete her doctoral studies in geography:

The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.

Linda writes, “I would try to talk to my doctors about my vanishing self, but they didn’t have much to say on the subject.”

While some medications affected my mood, others — especially mood stabilizers — turned my formerly agile mind into mush, leaving me so stupefied that if my brain could have drooled, it would have. Word retrieval was difficult and slow. It was as if the door to whatever part of the brain that housed creativity had locked. Clarity of thought, memory and concentration had all left me. I was slowly fading away.

Going back again and trying to regain your identity as a unique person with a number of roles in life can be just as hard.

Philip Yanos, an associate professor of psychology at John Jay College of Criminal Justice, in New York, studies the ways that a sense of self is affected by mental illness. [...] Yanos told me that reshaping your identity from “patient” to “person” takes time. For me, going from patient to person wasn’t so arduous. Once I understood I was not vermicelli, part of my personhood was restored. But reconstructing my self took longer.

Mental health professionals across all professions — psychiatry, psychology, social work, etc. — should be more aware that this loss of self identity is a very real component of some people’s mental illness and subsequent treatment. It should be addressed as a regular component of mental health treatment, especially when the loss is acutely felt.

Because across all of healthcare, we are quick to dehumanize patients and focus only on the treatment of symptoms. Maybe it’s a way some professionals seek to keep their patients at arm’s length — not to become too emotionally connected to them. But in doing so, it also sends a (perhaps unintentional) message to the patient — you are only a constellation of symptoms to me. That’s all we’ll focus on, that’s all we’ll treat.

As professionals and clinicians, we can do better. We should do better to not turn someone in emotional pain into a simple diagnosis or label. If we think of Linda as simply “Oh, the bipolar woman in room 213,” we’ve lost our humanity and our focus.

Linda is now 60, and has lived a life full of color and heartbreak. Her story is worth checking out below.

Read the full article: The Problem With How We Treat Bipolar Disorder

There’s something strangely comforting in looking at these lists and hoping that our life problems can be boiled down into five simple steps. I read them hoping for the answers, because I too want the secret to life, the universe, and everything.

However, I think the reality is this: As much as some lists offer interesting ideas, the majority mislead people about change. They offer false hope instead of facts. They generally encourage people to think their lives can be simpler if only they do those five secret things that may have worked for another person.

Come on, really? Life is so complex and the reasons why we feel and do what we do also are complex.

Take depression, for example. The reality is nobody really knows why people feel depressed; and nobody really knows what will cure each individual’s depression. When talking about cause and effect, there are so many factors to take into account: cognitive, environmental, social, biological.

What we do have is good empirical evidence that some therapies can help some people overcome depression. But that doesn’t mean everyone will overcome it through therapy. I’ve worked with many people and, for whatever reason, they remain depressed and sometimes become even more depressed. When that happens, the focus of therapy changes to learning to live with being depressed. No list is going to change that.

We know that medication can help. But it doesn’t help everyone. More often than not, medication is guesswork — an art more than a science. What works for one person can make another person sick. I’ve seen some people recover in a matter of weeks, and others poisoned to the point of hospitalization. Where’s the five-point list on that one?

Advances in neuroscience are helping us understand the brain and how it works. Yet, even super-intelligent scientists with the most sophisticated technology don’t fully understand what is causing depression. So, can a five-point list really tell us how to overcome it?

It’s clearly frustrating not knowing the secret to being well. As a therapist and coach, it’s my job to help somebody get well, so it’s easy to hope a list will provide me with the secrets that’ll help me and the person I’m working with.

But many lists just don’t cut it. I was reading a list on procrastination the other week and the first thing on the list was something like ‘just do it.’ I can imagine all the people who procrastinate reading that and thinking, “Wow, that’s amazing. Why didn’t I think of that?”

OK, I’m knocking these lists, so I must know all the answers, right? Nope. I wish I did but unfortunately I don’t (please don’t tell my wife I said that). With that being said, I will now counter everything I’ve just written and offer you my own secret five-point list to life, the universe and everything.

1. You are personally responsible for all that you think, do, and (mostly) feel.
2. Accept reality: Life doesn’t owe you a thing.
3. You are you. Nobody can ever know what it means to be you, so be kind to yourself and others.
4. Life is meaningless, except for the meaning that you give it — so use that power wisely.
5. Nobody has all the answers. We’re all just making stuff up as we go along, hoping for the best.

Mindfulness meditation is currently all the rage, and it works. But I am wary of its proponents who claim it can treat (or even cure) mental illness by itself.

Meditation is a powerful tool when used to decrease stress and increase well-being. But if we are to maintain that mental illnesses are biochemical malfunctions of the brain and nervous system, then we must allow room in treatment for medicine. Therapy also has a long history of positive impact on the lives of those challenged by psychiatric disease. Meditation, when added to more traditional and well-tested methods of treatment, can help a patient successfully manage a challenging life. I, and so many others like me, am proof of that.

I am sure that there are people who face serious mental illness well using only meditation. Dan Siegel writes of one teenager who manages bipolar disorder with meditation alone in his excellent book Mindsight.

But the popularization of such case studies may lead people to stop taking medication and pick up meditation in a hope to finally be done with meds. Anyone who hopes for this and changes his own medication regimen without proper medical oversight is asking for relapse and worse.

Another book on the benefits of meditation, Transcendence, by Norman E. Rosenthal, clearly states that meditation for mental illnesses such as bipolar disorder and schizophrenia should only be administered in conjunction with medication and therapy and should be monitored by a physician. I believe this more balanced view will help more people manage the symptoms of mental illness successfully.

Since I have become a disciplined meditator I have had little difficulty with my bipolar disorder. It is only natural to wonder if I could manage as well if I continued to meditate and came off the drugs. In fact, it is very tempting.

But my doctor advises me not to and, after much reflection and concern for my family, I agree. Just as I couldn’t manage this well without the meditation, much research evidence supports the idea that I couldn’t manage without the medication either. I’m not willing to take the chance.

Every person with mental illness to whom I have taught meditation has asked me if I think serious mental illness can be cured. At this point, with what science has discovered, I don’t. But it can be managed, and managed well, if meditation is added to the medical model of drugs and therapy.

Just as the person with diabetes will take insulin indefinitely, I must continue to take my medicine. And just as one with diabetes must adopt a healthy lifestyle to best complement her medication, the person with mental illness must as well. What I am sure of is that meditation is one of the best complements available.

The mental health charity Mind UK recently highlighted their concern that there is a serious need for a range of therapies to be made available to depression sufferers.

According to the best psychological working practices, medication is now considered to be only one option for effectively treating the illness.

Talk therapies — otherwise known as psychotherapy — such as cognitive behavioral therapy (CBT) have proven effective at alleviating melancholic symptoms in hundreds of research studies conducted around the world. In Australia, the Australian Psychological Society has identified a serious need for psychotherapeutic interventions in the lives of people with depression.

Cognitive behavioral therapy (CBT) is a form of psychotherapy. Participants work with a specially trained psychologist to make positive steps in changing their thoughts and feelings. Committing to CBT means accepting that your actions affect your emotions and reasoning. Therapists help you to learn skills and strategies for changing negative thinking. This helps many people to learn to cope with depressive illness.

A recent study in the UK, carried out over a period of 12 months, looked at the benefits of CBT for managing depression. Participants were allocated a one-hour CBT session each week for the period of the trial.

After six months, 46 percent of the group who had been previously resistant to medication reported a reduction in depressive symptoms. The study concluded that CBT can improve quality of life by reducing depression’s severity.

A 2012 study published in the Australian and New Zealand Journal of Psychiatry involved a review of Australian National Health data. Researchers became interested in the period between 2001 and 2006, when better access to psychological treatment was made available in Australia.

The study showed from 2001 to 2008, following health care reform, there was a drop in the use of antidepressant and anti-anxiety medications. CBT is currently recognized in Australia as being a viable and effective way of treating mental illnesses like depression.

It is important to note that CBT is not intended to be a substitute for medication. In many cases it will serve to complement any medicine from the family doctor or psychiatrist. However, in those for whom medication has failed, CBT offers an alternative while new medicines are being developed. Of course, not everything — whether medication or talk therapy — will work for everyone.

In Australia, there is still a shortage of psychiatrists. The right of psychologists to prescribe medication is now a subject for debate. If this becomes reality, the therapist will then be able to evaluate each patient’s needs, and only prescribe drugs when necessary.

In the meantime, although it may not be the best option, family physicians are able to prescribe psychiatric medications if they believe it warranted.

The theory behind this treatment is that free-association increases awareness of what is in the unconscious mind. Once you make the unconscious conscious, patients should, theoretically, become less neurotic.

That type of treatment seemed to work well for the idle rich in the late 19th and early 20th centuries.

But does it work well in the digital era?

No way. We want our problems solved quickly. We want solutions to be provided speedily. We savor the power of parsimony. The fewer the words, the more we value them. Short, sweet and to the point is preferable.

Is it possible to take the wisdom of Freud and apply it to the Twitter generation? I’m going to give it a shot. Here goes:

1. Quit comparing yourself to the best. You don’t have to be the best to make a valuable, worthwhile contribution to the world.
2. Don’t belittle yourself. Quit calling yourself derogatory names. Laugh good-naturedly at your mistakes, but don’t denigrate who you are and what you’re about.
3. Avoid sitting on the sidelines, bemoaning your circumstances without taking any action to improve your lot in life.
4. Even the best ideas are worthless unless you use your energy to execute them.
5. When you’re overstressed and overworked, take a break. Rest. Relax. Enjoy. Be with optimistic people. Then, get back to work.
6. Tolerate disappointment. There are days in which nothing works out well. This is a “bad day.” Don’t make it into a life position.
7. Allow your interests to emerge in their own way. Don’t attempt to make them fit into the box you (or others) think they should fit into.
8. Because a decision didn’t work out as expected doesn’t necessarily make it a bad decision. Reflect on what went wrong, however, before you move on to your next decision.
9. Acknowledge what you experienced in your early years. But put your energy toward living in the present where making good decisions can truly enhance your life.
10. Keep doing what you enjoy doing even if there’s no immediate reward to it.
11. When you believe in yourself, it’s amazing what you can accomplish.
12. Success is not an overnight happening. It’s the result of a consistent, driving energy that keeps you engaged, focused and moving forward.

Well, there it is. A dozen pieces of advice — short and succinct. Freud would appreciate, maybe even envy them.

Will just reading this advice allow you to make dramatic changes in your life? I doubt it. Freud was right. It takes time to change ingrained ideas and tenacious habits. But does it take as much time as Freud believed? Absolutely not!

Our sense of time is dramatically different than it was for people who lived 100 years ago. A few months of therapy once a week or even bi-monthly can help people truly change the direction of their lives by clarifying their thoughts, modifying their emotions and expanding their options.

And long-term therapy (still only once a week) is an amazing experience that can transform a life — from one that’s plagued with stress, tension and negativity to one that’s enriched, energized and full of enthusiasm.

First, don’t be scared. Although making the decision to enter therapy can be difficult, there is nothing to be afraid of. You’re in the hands of a professional who’s done this many times before, who will do their best to put you at ease. A good therapist will also take some time to orient you to therapy, and what exactly to expect in therapy with them.

Ask the Therapists Marie Hartwell-Walker, Ed.D. and Daniel J. Tomasulo, Ph.D., TEP, MFA talk a few minutes about what to expect in your first session of psychotherapy (or counseling, or talk therapy).

Need a little more? Check out this article I wrote a few years ago, Your First Psychotherapy Session.

For instance, psychotherapy can help you better understand how ADHD affects your life. And it can help you develop the necessary skills for managing symptoms, being successful and having healthy relationships.

But in order for therapy to be most effective, you’ll have to work at it.

In his excellent and comprehensive book More Attention, Less Deficit: Success Strategies for Adults with ADHD, clinical psychologist Ari Tuckman, Psy.D, features valuable tips for getting the most out of therapy. Here are five tips from his book.

1. Be an active participant.  

Don’t expect your therapist to do the work for you. Therapy is a collaboration. As Tuckman writes, “The harder you work at it, the more you will get from it. It’s won’t always be easy, but it will be good for you.”

2. Remember that change takes time.

“It’s easy to get excited about something new (This therapy stuff is awesome!) and just as easy to grow bored with it later (We just talk about the same stuff),” Tuckman writes. Remind yourself that change takes time and patience, he writes. But doesn’t anything worthwhile?

3 Be honest and direct with your therapist.

Don’t assume your therapist knows what you’re thinking, feeling or what you need.  Always speak up.

For instance, if you think your therapist is criticizing or nagging you, “… Ask about it, because that perception can really undermine your relationship,” Tuckman writes. It could be that you’re, understandably, extra sensitive after years of criticism. Either way, exploring your feelings is critical in therapy, he notes.

Also, be honest about the therapy itself. “Tell him when you feel that you’re not focusing on the areas that you want to focus on or if it’s not as helpful as you want.”

4. Take notes.

People with ADHD can ramble, which can eat away at their therapy appointment. Tuckman suggests bringing in some notes to your session of the main points you’d like to discuss. You can share your notes with your therapist in the beginning of every session, and they can redirect you when you go off topic.

It’s also helpful to write notes after situations between sessions. That’s because, according to Tuckman, “Good therapy tends to rely on details — what happened, how you felt, what you did next.” So if you have a hard time remembering these points, take notes after something happens, as well.

5. Work between sessions.

Often therapists will assign “homework” for you to do between sessions to help you practice and cement the skills you’re learning in therapy. If you forget to do your assignments, create reminders. For instance, write it down in your planner, and set several alarms on your cell phone and computer. Sometimes, it isn’t that you forgot to do your homework; it’s that you didn’t understand it in the first place. Be sure to raise any questions you might have, so you’re clear on your assignments.

There are many things you can do to ensure you benefit greatly from therapy. Tuckman also stresses the importance of being yourself. He writes, “The goal is for the therapist to really get to know you. Not just the polite you that knows all the social rules, but also the private you that you try to not show too often.”

Now imagine that out of nowhere, a repulsive creature has stepped into your path. He’s got a grotesque body, horns on his head and a menacing smile. You freeze in terror as this hideous face stares into yours!

Though you desperately wish to flee, you find yourself helplessly frozen. Your heart is racing. Your chest is pounding. You can’t catch your breath. You feel lightheaded. You feel faint. You think you might die right there on the spot.

Now imagine feeling this very same terror when there’s no creature in your path. What would your experience be? Would you feel mystified? Bewildered? Embarrassed? Wonder if you’re going crazy?

This is the experience of those who endure panic attacks. Many keep their experiences secret, for they are embarrassed and at a loss for words to describe what happens to them. Nobody else has ever had such a reaction, or so they believe. Panic attacks, however, are more common than you may think.

The word “panic” emanates from the ancient Greeks, who were said to experience overwhelming terror when they encountered Pan, their god of nature. Half man, half beast, Pan had a scream so intense that terrified travelers who happened upon him in the forest died from fear.

In our modern world, we don’t believe in Pan. But we do have plenty of fears that paralyze us. Those who have had panic attacks are fearful of having another one. So they avoid being in places or situations in which they feel vulnerable or where there’s no quick and easy escape. For some, this means they can’t be alone. For others, it means they can’t be with new people or in crowds of people. In their attempt to create a safe life, they inadvertently create a small life.

Some panic attacks are not so omnipresent, occurring only when zero hour draws near. Students panic before an exam. Hosts panic before their guests arrive. Actors panic before the curtain rises. Working folks panic before their annual evaluations. Patients panic before their medical test.

When family and friends witness the panic, they typically offer well-meaning advice. “Just relax.” “Chill out.” “Take it easy.” “Roll with the punches.” Easy to say. Hard to do.

If the panic doesn’t subside, many people confide in their physicians. They are then prescribed anti-anxiety medication. At first, these meds may take the edge off. Over time, however, nothing changes. So, the medication is increased or another drug, usually an anti-depressant, is added to the mix. Fogginess, sleepiness and lethargy now become additional issues that the panicky person needs to deal with.

There’s a better way to treat panic attacks. It involves a combination of:

• Cognitive therapy (changing your thought patterns and internal dialogue)
• Behavioral therapy (gradually exposing yourself to scarier situations)
• Body therapy (controlling your breathing and muscle relaxation)
• Adjunct medication, if needed, to calm your body down.

If you or a loved one are sweating bullets over an upcoming event, feeling frenzied about the future, restricting your life to cope with your fears or shuddering at the thought of another panic attack, don’t shrug your shoulders and assume that nothing can be done. Actively seek appropriate treatment that can help you master your fears and get on with your life.

For more information about strategies and skills that can help you move forward, read my book, “Master Your Fears: How to Triumph over Your Worries and Get on with Your Life,” available at Amazon or at www.PsychWisdom.com

Panicked woman photo available from Shutterstock

That’s why I’m pleased to introduce Lessons from the Couch with Karisse Callender, MS. Ms. Callender is a relatively new therapist who would like to share her experiences as she conducts therapy with her clients.

“I enjoy the process of seeing things unfold with clients who have mental health and addiction concerns and consider them to be “Lessons From The Couch” in my office,” Karisse says of her new blog. “I would also like to incorporate aspects of counselor wellness into the blog, as self-care is an area of interest for me.”

It’s of interest to a lot of people as well, so we look forward to her sharing her experiences with our readers. Please know that all experiences posted to this blog have been anonymized to protect patients’ confidentiality.

Please give Karisse a warm Psych Central welcome today, over at her blog Lessons from the Couch!

More than one third of U.S. adults currently are obese, according to the Centers for Disease Control and Prevention. Physicians and other health care professionals urge us to lose weight or risk becoming vulnerable to a host of diseases, including diabetes, high blood pressure and heart disease. Weight loss has become a national conversation.

On an individual basis, most of us either have tried to lose weight or are actively engaged in maintaining a healthy weight.  Why we struggle with weight and how best to lose weight are hotly debated topics.  The nation’s current weight struggles have been attributed to a range of biological, societal and personal problems such as unhealthy school lunches, media advertising, too much corn and corn syrup in our diets, sugar substitutes, lack of willpower, overreliance on fast and prepackaged foods and many more.

But what gets in the way of your ability to lose weight?

Is it lack of time to prepare healthy meals?  Lack of willpower to stick to a healthy eating and exercise routine?  The intense influence of advertisements urging you to eat unhealthy foods?  Lack of interest? Not knowing how to lose weight?

The answer, according to a new survey of psychologists suggests that when it comes to dieting, weight loss and weight gain, emotions play a central role and may be the primary obstacle to weight loss.

Have you ever felt guilty after eating a cookie and then decided to eat the whole box, since you’d already blown your diet? Have you felt low and skipped exercise? Then you’ve experienced emotions interfering with your weight loss.

If we were merely cognitive beings, we’d eat the cookie, evaluate how it affects our daily calorie intake, and make adjustments to get back on track.

But we’re not merely cognitive beings. According to the survey of more than 1,300 licensed psychologists, conducted by the Consumer Reports National Research Center, understanding and managing the behaviors and emotions related to weight management is essential to weight loss.

In fact, emotional eating was considered a barrier to 43 percent of people who wanted to better manage their weight.  And it’s not just emotional eating.  Emotions can interfere with maintaining a regular workout routine and making healthy food choices.

Getting Help for Weight Loss

So what can you do, if you’ve tried to eat healthy and exercise regularly and found that it’s just not working? 

More than 70 percent of the psychologists who provide weight loss treatment identified several key treatments and strategies for addressing the underlying emotional issues related to weight gain.  Those strategies considered “excellent” included:

• Cognitive therapy: a treatment that helps people identify and address negative thoughts and emotions that can lead to unhealthy behaviors
• Problem-solving:   Finding alternate solutions to setbacks, changes and obstacles
• Mindfulness:  Using strategies to allow thoughts and emotions to come and go without judging them, and instead concentrate on being aware of the moment

Also considered important in helping clients to lose weight and keep it off were the following:

• Motivational strategies
• Keeping behavioral records
• Goal-setting

Although weight problems may be caused by an array of biological, emotional, behavioral and environmental issues, it has become clear that stress and emotions play a central role in our ability to manage our weight.  Without strategies to recognize emotional triggers and respond to our emotions effectively, we are likely to continue to struggle with our weight and health.

There are two kinds of overreactions: external and internal. External overreactions are visible responses that others can see (for example, lashing out in anger, throwing your hands up and walking away from a situation).  Internal overreactions are emotional responses that remain inside of you that others may or may not be aware of.  Examples of internal overreactions are replaying a situation over and over in your head, wondering if you said the right thing, or overanalyzing a comment made by a friend or loved one.

In her book Stop Overreacting: Effective Strategies for Calming Your Emotions, author Dr. Judith P. Siegel suggests asking yourself the following questions to assess whether you have a problem with overreacting.

Do you often:

• Regret things you say in the heat of emotion?
• Lash out at loved ones?
• Have to apologize to others for your actions or words?
• Feel surprised at your seemingly uncontrollable reactions?
• Assume the worst about people and situations?
• Withdraw when things get emotionally overwhelming?

If you answered “yes” to the questions above you may may struggle with overreaction.

Here are 5 suggestions to help you stop overreacting:

1. Don’t neglect the basics. Lack of sleep, going too long without food or water, lack of recreation and play can leave your mind and body vulnerable to exaggerated responses.  For many of us (myself included), it’s easy to let our own basic self-care take a back seat to the noble cause of taking care of others. Ironically, it is your loved ones who are most likely to end up on the receiving end of your emotional overreactions. Prioritizing your own self-care will help minimize overreactions.

2. Tune in and name it. A stiff neck, pit in stomach, pounding heart, tense muscles can all be signs that you’re in danger of overreacting, of being hijacked by intense emotions. Becoming more aware of physical cues actually helps you to stay ahead of, and in control of your response. Naming your feeling activates both sides of your brain allowing you to reflect on your situation instead of just reacting to it.

   Recently, my teen daughter was expressing some intense hurt feelings about our relationship. While she was talking, I noticed a hot feeling rising in my stomach, and defensive thoughts. Tuning in to my own body allowed me to slow down my own response so I could hear what she was saying and to respond calmly.

3. Put a positive spin on it. Once you’ve identified and named the sensations in your body, you can intervene in your thoughts. When we have intense emotions it’s easy to go to a worst-case scenario as an explanation for whatever you’re reacting to (e.g., “they’ve never liked me” or “she always criticizes me.”)  Watch for all-or-nothing words like “always” and “never” as clues that you’re heading toward a worst-case scenario.

   If someone offends you, consider the possibility that the insult is not about you. Maybe the neighbor who snapped at you was just given a pay cut at work and is feeling discouraged, or the person who cut you off in traffic is rushing to the hospital to see the birth of his first child. Make up a backstory that makes sense and puts a positive spin on whatever is triggering your emotional response.

4. Breathe before responding. When you feel like flying off the handle, take a deep breath. Deep breathing slows down your fight or flight response and allows you to calm your nervous system and choose a more thoughtful and productive response. Try taking a deep breath next time someone cuts you off in traffic. In my recent Facebook poll, overreacting while driving was the most commonly cited scenario for overreacting. Just imagine if all drivers took a breath before responding, making hand gestures, or yelling obscenities. The world would be a kinder place.
5. Identify and resolve emotional “leftovers.” Notice patterns in your overreactions. If you find yourself repeatedly revisiting an intense emotional or behavior response, there is likely a historical component that needs to be addressed.  In my therapy practice, I worked with a beautiful, smart woman who often became tearful and depressed when she heard about friends getting together without her. She felt extremely insecure and rejected.  Her heightened sensitivity to being excluded by other women in her neighborhood, even though she had many friends and was usually included in social gatherings, was fueled by emotional leftovers in her past. She felt emotionally abandoned by her parents and ostracized by peers when she was young, which heightened her sensitivity to rejection as an adult. Through therapy she was able to heal the earlier relationship wounds, allowing her to respond in a more balanced way to present social situations.

Remember, not all intense responses are overreactions. In some instances, a quick and extreme response is necessary to protect ourselves or our loved ones. I recall a time years ago when my oldest child was a toddler riding his trike down the street. He was riding ahead of me because I was pregnant and a lot slower than usual. I noticed a car slowly backing out of a driveway as my son was riding toward the driveway. I found myself sprinting toward the car, screaming at the top of my lungs with arms flailing frantically, trying to get the driver’s attention and avoid a horrible tragedy. Luckily, the driver noticed me and stopped her car just short of my son and his bike. My exaggerated response was necessary to save his life and was not an overreaction.

(c) Can Stock Photo

In this video, Ask the Therapists Marie Hartwell-Walker, Ed.D. and Daniel J. Tomasulo, Ph.D., TEP, MFA talk about finding the right therapist. How do you go about finding the right psychotherapist? Are there things you should look for in a therapist? Or other things to watch out for as warning signs?