A few months ago, he was under scrutiny for standing up to the Rockets’ lawyers and officials. He requested that his anxiety issues be treated the way other players’ physical illnesses and injuries are treated. For instance, NBA players are expected to fly frequently to cities where their games are played. White’s anxiety disorders makes it so that sometimes he is unable to do so. He requested to be able to travel by bus, and if he is delayed he doesn’t want to be fined the same amount as players who miss practice because they overslept.

Both parties struggled to reach a resolution, but after many discussions and meetings, the Rockets and White were able to reach a compromise in some areas. He was reassigned to the Houston Rockets’ D-league team, the Rio Grande Valley Vipers.

White’s story is of interest to many who are afflicted by mental illness. He is not in denial of his challenges, but he is not being quiet about it either. He has taken on the cause to help decrease the stigma society continues to place on mental health issues.

The Anxiety and Depression Association of America reports that there are “40 million American adults who suffer from anxiety disorders and only one-third of those suffering from an anxiety disorder receive treatment.” Anxiety itself has found its way into everyday language by many who experience stress. Yet, there are still many people who have no idea that anxiety disorders can be paralyzing and should not be trivialized.

Many individuals are embarrassed about their illness because they fear discrimination or that it’ll be a stumbling block in their careers or jobs. White has taken the risk and has decided that his basketball career is important, but becoming a “poster child” to decrease the stigma is more significant.

If you personally are struggling with mental illness or have a loved one who is, how are you handling it?

• Acknowledge it.

  Mental illness does not discriminate against race, gender, age, religion, or economic status. However, many sufferers may be in denial because they believe that asking for help, taking medication, or seeking therapy is a sign of weakness and irresponsibility. They don’t want to admit they have a problem and will only accept help when their normal functioning has deteriorated significantly, and they can no longer afford to suffer alone.People in prominent positions may be embarrassed to admit they have a mental illness. I’m not necessarily talking about movie stars or other celebrities. I am referring to individuals who have been able to succeed in life despite their mental adversities. They need to speak up to help normalize the disrespect many still receive due to their mental ailments.

• Speak up.

  When people share their struggles, others will become aware and even be surprised that their friend, boss, best friend’s daughter or spouse also is experiencing emotional and mental pain. Successful men and women with a mental illness can be an example to society and can contribute to the idea that a mental disorder does not define the person. The media seem to highlight the negative situations and many sufferers feel embarrassed and despondent. Thus, they choose to continue their silence.

• Connect with others.

  A dear friend has found that when he shares the challenge of having a son with mental health struggles, others connect emotionally with him. They trust him and are able to share their own journey with him. Your story of having been there may make a difference to someone who is feeling hopeless.

Society needs to understand that a person can be “normal” and still have mental health challenges.

Royce White is a hero. We need more heroes to stand up and speak up for mental health. Depression and ADHD are becoming more accepted as those in the limelight continue to talk about their experiences. Even people not in the public eye can tell our stories and help someone.

Will you be a hero for someone else? Take a stand. It will be worth it!

While the above questions are obvious appeals, they are not the only way that OCD sufferers seek reassurance. Indeed, the very nature of OCD centers around making certain that all is well. The disorder is characterized by unreasonable thoughts and fears (obsessions) that lead the sufferer to engage in repetitive thoughts or behaviors (compulsions). Obsessions are always unwanted and cause varying degrees of stress and anxiety, and compulsions temporarily alleviate these feelings. Compulsions are always, in some way, shape, or form, a quest for reassurance; a way to make everything okay.

A good example is the case of someone with OCD who is obsessed with a fire starting because he or she left the stove on. The compulsion of continually checking the stove is a recurring attempt to reassure oneself that the stove is indeed off and nobody will get hurt. Another OCD sufferer may fear germs (obsession) and wash his or her hands until they are raw (compulsion). The compulsion of hand-washing is an effort to make sure that his or her hands are clean enough so that there will be no germs.

My son Dan suffered from OCD for a few years before we even knew anything was really wrong. In retrospect, I realize he had a lot of reassurance-seeking behaviors. While he never asked the “Are you sure?” questions, he would often apologize for things that did not warrant an apology. If we went to the supermarket together he would say, “Sorry I spent so much money,” when, in fact, he had only picked out a few items. I, in turn, would reassure him that he hadn’t spent much at all. Dan would also thank me over and over again for things that most people might say “thank you” for only once, if that. Again, I would reassure him by saying, “You don’t have to thank me,” or “Stop thanking me already.” My responses to Dan in these cases gave him the reassurance he needed to feel certain that he hadn’t done anything wrong, had behaved appropriately, and all was well.

Of course hindsight is a wonderful thing and I now know that how I reacted to Dan at these times was actually classic enabling. I did him more harm than good. My reassuring Dan that all was well reinforced his misconception that he had to be certain, to have no doubt at all in his mind. While I helped reduce his anxiety at the moment, I was actually fueling the vicious cycle of OCD, because reassurance is addictive. Psychotherapist Jon Hershfield says:

If reassurance were a substance, it would be considered right up there with crack cocaine. One is never enough, a few makes you want more, tolerance is constantly on the rise, and withdrawal hurts. In other words, people with OCD and related conditions who compulsively seek reassurance get a quick fix, but actually worsen their discomfort in the long term.

So how can those with OCD “kick the habit?” It’s not easy, as sufferers continually wrestle with the feeling of incompleteness, never truly convinced that their task has been completed. There is always doubt.

But there is also always hope. Exposure Response Prevention (ERP) Therapy involves facing one’s fears and then avoiding engaging in compulsions. Using the stove example again, the sufferer would actually cook something on the stove and then shut the burner(s) off. He or she would then refrain from checking the stove to make sure it was off. No reassurance allowed. This is incredibly anxiety-provoking initially, but with time it gets easier. And while it is difficult to watch a loved one go through “withdrawal” it is imperative that family members and friends learn how not to accommodate or enable the sufferer.

Without reassurance, how will those with OCD achieve that need for certainty that they so desperately desire? Indeed, how can all of us make sure that nothing will ever go wrong? How can we control our lives, and the lives of those we love, so that nothing bad will ever happen?

The answer, of course, is that we can’t. Because as much as we’d all like to believe otherwise, much of what happens in our lives is beyond our control. Through ERP therapy, OCD sufferers will focus on the question “How can I live with uncertainty?” as opposed to “How can I be certain?” And instead of dwelling on the uncertainties of the past and the future, those with OCD can begin to live life to the fullest by concentrating on what matters most – the present.

Dan liked him too. He drove to his appointments alone, and while I spoke with the therapist on the phone a few times, we never met. Dan was sharing very little about his obsessive-compulsive disorder (OCD) with us at the time, but he did tell me and my husband that he was very pleased with his psychologist and thought he really understood him; he felt better after every session. What more could we ask for?

Eight months later our son was so debilitated by severe OCD he could not even eat. As I became more educated about the disorder and its proper treatment, I realized that not only had Dan’s therapist not known how to treat OCD, the “talk therapy” he used had exacerbated Dan’s illness.

His next therapist worked at the world-renowned OCD residential treatment program Dan attended. Our son spent nine weeks there and bonded big time with this psychologist, who definitely knew how to treat OCD. His stay at this program became complicated, one of the issues being Dan’s unhealthy dependency on his therapist. Our son became unable to think for himself. He deferred instead to his psychologist’s recommendations as to how he should live his life, even when they conflicted with Dan’s lifelong dreams. When I tried to discuss the situation with Dan, he said, “It’s hard not to be attached to someone who has saved your life.”

I know bonding emotionally with health care providers is not unusual, but I wonder if it might be more of an issue for those with OCD. We know OCD sufferers often deal with social scrupulosity, a type of hyper-responsibility. Those with social scrupulosity obsess over hurting others’ feelings, and often believe that giving their opinion, or being assertive in any way, will cause harm. Could this translate into excessive loyalty? How could you question your therapist, or even worse, leave him or her, if you think this way? How could you even think that this person, whom you probably really like and admire, might not be the best one to help you?

These are just two of many situations when I think it’s best to move on. While in the first example we were oblivious to his therapist’s shortcomings in treating OCD, I have no doubt if we’d suggested looking for another health care provider, Dan would have insisted on staying with his hometown one. In fact, when he first left for college fifteen hundred miles away, he opted for phone calls with this therapist instead of searching for a new one (another mistake).

In contemplating the second scenario, I would think that the staff would have recognized, or at least considered, that Dan was dealing with social scrupulosity, yet that was not the case. We had to forcibly remove our son from this residential treatment program.

It can be an ordeal for those with OCD to find the right therapist, and Dan’s experiences illustrate just a few of the many issues that might arise. That is one of the reasons families need to become educated about OCD and its proper treatment: their support in finding a therapist often is critical. Children and teens, as well as adults whose OCD is severe, likely will require a loved one to make that initial call. If you’re lucky, you will have some qualified health care professionals to choose from. Unfortunately, that is not always the case when it comes to treating OCD.

OCD is complicated, and sometimes it can be difficult to recognize when your current therapist is not helping you. Again, this is when the support of family and loved ones can be beneficial, as they can step back, be objective, and talk to you about moving on, if necessary. Also, it is important to keep in mind that when you do find the right therapist and are together for a long time, your relationship will likely evolve. Dan’s last therapist was a great fit for him, and they worked together for four years. Toward the end of their time together, they rarely needed to address Dan’s OCD, instead concentrating on the many issues facing today’s young adults.

While it can be easier to stay with a therapist who is not working for you than starting from scratch with a new one, I believe it is still necessary to move on when, for whatever reason, you are no longer making progress toward recovery. You might like, respect, and admire your therapist, but if your OCD is not improving, I think it is time to search for another. Because, at least in my opinion, merely liking your therapist is not enough.

They talked about Dan’s fears, thoughts, and feelings every other week for four months. That amounted to approximately ten sessions of the wrong kind of therapy, though we didn’t realize it at the time. Dan then left for college in worse condition than before he started therapy.

Dan’s therapist had employed traditional talk therapy, a type of psychotherapy that delves into the root of your problems. At the very least, it involves examining why you feel or act the way you do. As we now know, this type of therapy typically does not help those with obsessive-compulsive disorder and, in fact, often exacerbates the OCD. Why is this so?

I believe that talking to someone with OCD about why they feel the intense fear and anxiety that is characteristic of the disorder is like talking to someone with asthma about why they can’t breathe. “So why do you think your airways constrict like that?” Ridiculous, right? The answer is obvious. “Because I have asthma and that’s what asthma is.”

OCD is a neurologically-based anxiety disorder and that’s why those with OCD have anxiety. OCD, like asthma, is not something that can be talked away. While OCD sufferers’ experiences might help shape their obsessions or compulsions, talking about their past, or their fears, usually is not helpful, and often will increase their anxiety. Focusing on their distressing thoughts and then subsequently being reassured by a therapist only empowers the OCD.

Additionally, a therapist might even feed right into the OCD. For example, someone suffering from “fear of harm” obsessions (fear of harming loved ones, or anyone, for that matter) might have a therapist who wants to explore whether the patient really does want to hurt someone. (It is important to note here that those with OCD never act on these obsessions.) This approach can be devastating to the OCD sufferer; it only compounds his or her fear and uncertainty. OCD sufferers ruminate enough on their own; they definitely don’t need any assistance in that department.

That’s not to say there isn’t anything to talk about in therapy when it comes to OCD. There’s plenty, as this disorder and the therapy for it can be quite complicated. At times it might be beneficial to talk about general problems that arise from having an anxiety disorder. Issues pertaining to family, work, or school, as well as feelings of low self-esteem and isolation, are common examples of concerns OCD sufferers might have. Also, when establishing a list of anxiety-provoking thoughts and actions as part of an appropriate treatment plan, the sufferer’s fears will be discussed.

It is important to distinguish these matters from talking about the details of someone’s OCD and why they feel the way they do. The specifics of why one is compelled to drive around the block 50 times to make sure he or she hasn’t hit someone, or why sufferers must mentally review their entire day to make sure they didn’t say anything wrong, are not significant. Therapists must realize that OCD is a disorder with a specific treatment, and not some character flaw that needs to be fixed by delving into a person’s life.

I have heard first-person accounts from OCD sufferers who have found themselves in the midst of talk therapy, and have realized it’s not what they need. While some end this therapy because they find it tormenting or see that it is making them worse, others will continue with it because they believe the experts know best.

I find this heartbreaking — those who seek help are harmed instead. We need to keep spreading the word to OCD sufferers and therapists that Exposure Response Prevention (ERP) Therapy is the front-line treatment for OCD, and the ticket to freedom for those who suffer from this disorder.

Or maybe you’re a bundle of nerves. You are so anxious you just want to hide. You’re nervous about your job. You’re scared to speak up even when you know you should and could. You are so anxious that you are anxious about being anxious.

Or maybe the issues are about relationships. You don’t have one or the one you have isn’t the one you want. You and your partner are fighting all the time. Every day seems to be “same fight, different day.” Trust has become a huge issue. Neither one of you can relax into your relationship. You each wonder where the love and sweetness and tenderness have gone.

And then there are family issues: The mother you can’t get along with. The father who expects too much or too little of you. Siblings who are mean-spirited, favored, or so self-centered that you feel constantly taken advantage of. Parents who are fighting. Parents who are splitting. Family you are expected to like but who are entirely unlikeable – and here comes another painful family event.

Any of these types of issues can stretch a person beyond his or her ability to cope. Any of them can challenge the most creative, caring, and responsible person, You’ve tried your best. You’ve tried to look at a brighter side, to be rational, to be smart about whatever it is. But you still can’t figure things out. You still feel alone in your troubles and without the inner resources or the outer supports to change things. This is when people often go to therapy. You wish you could. But you have no insurance and you know it can be costly. The situation seems hopeless.

It’s not. Serious, yes. Hopeless, no.

Inexpensive and Alternative Treatment Options

There are many ways to get the help you need, therapist or no. Before you give up on the idea of getting some therapeutic help, consider these alternatives.

Sometimes therapy is free or low-cost.

Depending on your problem, there may be funded or subsidized therapy available to you. Many communities have women’s centers that offer free services to women who are being abused. Many have free services for adolescents. And an increasing number of communities have men’s resource centers to help men with anger management, relationship or vocational problems. Go online and check.

Employee Assistance Programs (EAP).

Many businesses and companies offer a limited counseling benefit. Usually the company provides three to six sessions. If you need further help, the counselor will refer you to a local therapist. Check with your human resources department to see if there is an EAP counselor at your workplace. Often even a couple of focused sessions is enough to offer some relief.

Sliding scales and free slots.

Many mental health clinics and many therapists in private practice have sliding fee scales so that people can pay what they can afford. Ask your doctor if he or she knows who offers this service. Call some of the therapists in your area and ask. Many therapists keep a number of slots at a lower rate as their way of giving to their community.

Support groups.

Often a support group can be very therapeutic. By talking to people with a similar problem, you will feel less alone. Often there are people in the group who are a little ahead in their healing and who can offer you good practical advice as well as emotional support. Local hospitals, libraries, churches, and schools often offer support groups for grief, parenting issues, managing chronic illness, etc.

PFLAG (Parents and Friends of Lesbians and Gays) offers support to those supporting family members and friends who are coming out. There are also support groups online and in the community for gays, lesbians, and transgendered people who need information and advice.

Parent education classes.

Not all problems are mental health issues. Parenting is difficult. Often people new to parenting or new to a stage of parenting could just use some additional information and the reassurance and advice that can come from parents who have been there and done that. Often such groups are offered through the school system or through local parent centers.

12-step Groups.

Alcoholics Anonymous, Al-Anon (for families of problem drinkers) and Alateen (for teenage family members) offer support to people who are struggling with alcoholism and to their families. Other spinoffs include Overeaters Anonymous, Narcotics Anonymous, Clutterers Anonymous and Parents Anonymous. If you think a 12-step program is for you, search your issue and “anonymous” and you are likely to find a group.

The National Alliance on Mental Illness (NAMI) has chapters throughout the U.S. They often offer support groups for those struggling with mental illness as well as for family members.

Online support groups.

Name a problem and there is probably an online support group for it. Here at PsychCentral, there are over 100 such forums and groups. Members are not professionals. They are people who are grappling with the same issue you are. Their compassion and understanding can help you feel less alone. Often members offer experience and wise suggestions.

Are you a veteran? Every branch of the service has a program for military personnel and their families. Call your local Veterans Administration office for information.

Are you a teen? Many high schools have free counseling available through the guidance department. Often the guidance counselors are themselves counselors and can be very helpful with both individual and family problems. Sometimes they know which therapists in town have free or nearly-free services and where you can go for further help.

Are you in college? Check to see whether the health services at your school include a mental health department. Often the health insurance you pay for at school can enable you to see a local therapist for at least a few sessions.

Hotlines and warmlines.

There are important hotlines and warmlines in almost every country. In the U.S., the National Suicide Prevention Lifeline (1-800-273-8255) is available 24/7. The Boys Town National Hotline is also available 24/7 for teens (girls as well as boys). Google “hotline” and your problem and you are likely to find a number to call.

Houses of worship.

Spiritual leaders often have had training in counseling as well as in the practices of their faith. See if your church or synagogue or house of faith offers such help. If your spiritual leader isn’t comfortable dealing with secular problems, he or she may be able to refer you to someone who can.

Journaling or writing letters you will never send can be an important method for self-help. Don’t get put off by having to put something down. You’re the only one who is going to see it. Writing out what troubles us often helps us put our feelings into perspective. Often enough, a solution will come as you work to make your problems clear.

Bibliotherapy is a fancy name for reading a book. Whatever your problem, someone else has probably written about it to share their journey of healing. Sometimes we learn best from reading how someone else did and did not address issues. Search for your issue at one of the major online bookstores and you can find what you are looking for.

Prayer, meditation, chanting.

Anything that helps you relax and get out of yourself for a bit can do wonders for your state of mind. Turning your problems over to God, your higher power or the universe can help relieve the pressure and begin the healing.

Get off the screens and go outside.

Mother Nature is a great therapist. Stop spinning about your problem with online friends who are in the same spin and go for a long walk instead. Open your senses to the outdoors and you may be able to cut your problems down to a more reasonable size.

Talk to a trusted friend or family member.

You know who they are. Many of us have a friend or relative who is wise and loving and supportive. Don’t waste your time on anyone else. People who are critical or judgmental will make you feel worse. Reach for the people in your life who will listen with their hearts and who will validate your strengths.

Take care of yourself.

Getting enough sleep, eating right, and making sure you get a little exercise each day can do wonders for your troubles. You may not feel like doing any of it. But doing it, whether you feel like it or not, can help you start to feel a bit better. You will have taken a step toward self-care and self-love that is the basis for any therapeutic action.

Sound familiar? The thought of taking a pill that alleviates your symptoms but whose known side effects can sometimes be worse than the condition itself may leave you thinking that your options are limited. Think again.

Husband-and-wife doctors Richard P. Brown and Patricia L. Gerbarg, of Columbia University and New York Medical College, respectively, have written a book to help treat common stress and mood conditions without medication, as well as boost performance in different activities and improve personal relationships. In The Healing Power of the Breath: Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions, you’ll read about breathing techniques meant to help you in myriad ways. And, it seems, they work.

The authors present their instructional steps in detail, along with a helpful CD accompanying the book that features 10 breathing exercises. Their core practices of “Coherent Breathing” (“recharging part of the nervous system while quieting the defensive, energy-burning parts”), “Resistance Breathing” (creating resistance to the air flow to enhance Coherent Breathing) and “Breath Moving” (moving the breath and awareness to different parts of the body) make up what they refer to as “Total Breath.” They also encourage incorporating slow physical movements into one’s practice.

These techniques may sound familiar to some readers as their foundation is drawn from “yoga, Buddhist meditation, the Chinese practice of qigong, Orthodox Christian monks, and other sources.” However, the authors explain which techniques work well with different conditions, as well as the types of obstacles you might encounter along the way and how to overcome them.

Research conducted by others and results of the authors’ own experiences with patients indicate that these types of mind-body techniques are also useful in assisting people recovering from life-changing events. Presented are survivor stories from the attacks on the World Trade Center, the tsunami in Southeast Asia, the earthquake in Haiti, the war and genocide in Rwanda, the war and slavery in Sudan, and the oil spill in the Gulf of Mexico. Your memory will be jogged and your compassion renewed as you read how survivors were able to find solace and calm simply by breathing and moving in specific ways. The authors also claim that their techniques can “improve disaster-preparedness and community resiliency.”

If you are one of those lucky individuals who does not feel stress from day-to-day living and has not experienced a large traumatic event, the authors believe their techniques can still improve your daily activities. ”Breath practices can relieve the anxiety and tension that interfere with performance in any arena,” they write. “They promote better integration of the mind, body, and emotions, enabling artistic expression to flow and optimizing physical movements to conserve energy and reduce wear and tear on joints, muscles, and tendons.”

Of course, individuals may feel different levels of effectiveness depending on their type of stress, trauma, or activity. But unlike medication, breathing techniques do not require a trip to the pharmacy for a drug with questionable side effects. You don’t have to be concerned that your insurance plan will not cover them, as they wil not empty your wallet save for the cost of the book that teaches them. The Healing Power of the Breath just might be the best prescription never written for you by your physician.

The Healing Power of the Breath: Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions
Shambhala, June, 2012
Paperback, 240 pages
$12.21

Grace had grown up in a religious home. She was familiar with the above proverb. She understood it as a reminder to maintain pure thoughts to be a better person. Unfortunately, she was challenged by obsessive-compulsive disorder (OCD), and every time she read verses such as this, her anxiety and guilt would torment her.

Honesty and integrity were often talked about in her home. Impure and blasphemous thoughts were against her religious beliefs. She had learned that if she were to sin, she could take steps to be forgiven. A broken heart, contrite spirit, and confession were essential.

Her troubles began in middle school. She was taking a history test and inadvertently looked at her neighbor’s test. Her guilt drove her to tears. Because of her values, she had to come clean. She did, and failed her test. This seemed to be the beginning of her cascade of constant guilt caused by her thoughts.

When a kid at school would announce someone had stolen his lunch money, she’d quickly look in her pockets, school bag, and desk to ensure she was not the thief. Her thoughts and fears felt real. Once, when she got an A+ on an English essay, she felt remorseful. Her mom had proofread her paper for spelling and grammar errors. She believed she had cheated. Getting rid of her guilt was more important than passing her class. Praying and confessing were a must so she could feel peace.

“Somehow my honesty issues subsided while I was in high school. But before I began college my troubles reappeared. This time my thoughts morphed into something disgusting that drove me crazy,” she told me.

Grace’s thoughts didn’t match her values. She couldn’t accept the thoughts and images in her mind of actually harming someone. She began to miss school and stay in her dorm all day. She’d spend hours “figuring things out.” She questioned her worthiness.

The truth about thoughts is that every single human being — regardless of whether he or she suffers OCD — has intrusive, disturbing thoughts at one time or another. When non-OCD sufferers have a distressing thought, they may be surprised. They may say to themselves, “Whoa! That was a weird thought.” They acknowledge it and move on.

On the other hand, when people who struggle with OCD have “random” perturbing and unpleasant thoughts, they panic. “Why in the world would I think such an awful thought? Where did that come from? What does this thought mean about me? I’m not this terrible person!”

OCD sufferers begin to reassure themselves in many ways to decrease anxiety and guilt. Their thoughts are troublesome because they are incongruous with their moral character. After all, the scriptures tell us to have pure thoughts, don’t they? However, prophets and biblical writers did not have OCD in mind.

OCD is a neurological and behavioral issue. It does not relate to religious beliefs, despite the symptoms. In truth, OCD often attacks whatever matters most to the person. In Grace’s case, as a devout, religious person, her OCD symptoms were related to that area of her life. She believed that thinking hideous thoughts would lead her to frightening actions. She began to question her self-worth. Depression began to surface because she couldn’t get rid of her “sins” despite her repeated repentance and confessions.

Prayers, hymns, and certain words became rituals. She began to avoid situations, places, and people to avoid triggering any tormenting thoughts. Her “OCD mind” kept telling her of the daunting consequences she would face in the future if she were not able to control her thoughts. She could not bear the thought of seeing herself living in eternal damnation.

The guilt Grace experienced was a biological consequence of her “OCD mind.” She had grown up learning “we must resist temptation,” but this wasn’t working for her. She had not learned that the guilt she felt was due not to sinning, but to OCD.

As Grace began treatment, through cognitive-behavioral therapy that included exposure and response prevention therapy, she discovered that finding reassurance and hating her thoughts were the stumbling blocks in her progress. It took some time, but she finally understood that resisting her sinful thoughts was not the answer. She learned that it’s impossible to control one’s thoughts. She learned that some of her thinking errors were contributing to her suffering.

For instance, most people who experience obsessions such as Grace’s have the belief that their thoughts equal their actions. This thinking error is called “thought-action fusion.” She believed that thinking something was just as bad as doing it. Grace had a constant need to assess her behavior and question her thoughts. She would spend hours figuring out the reason for her evil thoughts and how to undo them. She gained the experience and insight that thoughts are just that: thoughts. They come and go, and mean nothing themselves.

The road to modify her thinking habits was not easy. But she knew that what she had been doing all these years hadn’t worked. She realized that OCD had gotten in the way of enjoying her life and religion. For as she thought, she was not.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction gives a taste of the Prinsen’s gutsiness at the outset, as she begins by acknowledging that she herself has played a part in her family’s difficulties. In this, her first book, the author tells the searingly honest and remarkably brave story of her family’s battles with mental illness, charting the ongoing chaos they’ve faced following Sean’s service in Bosnia.

After his discharge, Prinsen tells us, her husband returns home to the States and is given a prescription for narcotic pain medication to help him cope with the pain of a neck injury he suffered during military training. It is here that things begin to quickly spiral out of control, as Sean becomes addicted to his pills and begins to self-medicate with additional over-the-counter medications and alcohol. His behavior throws the entire family into disarray.

“Alcoholism is an enigma,” Prinsen writes, “— as complex as it is puzzling. It follows no rules and has no boundaries. Like a giant vacuum, alcoholism goes after everything and everyone in its path. It is a family disease — everyone in the family gets sick.”

Because Sean is reluctant to speak about the trauma he experienced in the military, or to share the truth about his depression with anyone, Prinsen assumes that her husband is simply suffering from addiction. It takes many years for her to understand and recognize the nature of PTSD and to connect the dots between the trauma Sean experienced in Bosnia and his subsequent depression and substance use.

“For so long, in the early stages of Sean’s addiction, I didn’t understand the destructive interplay between Sean’s PTSD, his depression, and his substance abuse,” she writes, explaining:

… Only he understood the desperate need to escape from the crippling flashbacks and the intrusive thoughts that blindsides him without warning, bringing with them the full force of the emotions that he felt in the original traumas. Only he understood the exhausting anxiety that kept him on high alert for ‘danger’ 24/7 and the need for something — anything — to keep that anxiety at bay. Only he understood how the pills helped him get through a night that would otherwise be plagued by the alternating horrors of nightmares or insomnia.

Sean’s PTSD continues to go undiagnosed, until he finally reaches crisis point. One night, in 2007, Sean suffers a complete breakdown and attempts what is known as “police-assisted suicide.” He becomes threatening and aggressive, arms himself with a loaded weapon, and calls the police to the house, almost as a challenge.

Prinsen recalls the horrific events of this evening, as she and her two young children are forced to witness Sean’s breakdown and frightening behavior, fearing not only for his life, but for their own. Sean survives, is arrested, and is subsequently jailed. Then, incredibly, after his release, the same thing happens again exactly a year later, as he suffers a repeat breakdown and once again challenges the police to come and get him, putting his family’s lives at risk in the process. By this point you’d be easily forgiven for wondering why on earth Prinsen doesn’t just leave, but it’s here that the relevance of the book’s title becomes clear. Prinsen adopts the military philosophy of “No One Gets Left Behind” and refuses to abandon Sean, no matter what anyone else tries to convince her, or how tempting it might sometimes seem. Looking back, she realizes that she plays a codependent role in the relationship, too.

But Prinsen doesn’t let her husband off the hook lightly, either, and always holds him fully accountable for his actions. “It took me many more years to fully grasp the reality that abuse isn’t just physical,” she writes. “Sean was a master at manipulating my emotions to get just what he wanted, and as difficult as it is even today to say the words — that is abuse.” Sean also used threats of suicide and self-harm to keep her from leaving or setting healthy boundaries, she tells us, recognizing it as a form of abuse. His “screaming, the holes in the wall, the slammed doors, and the broken objects” are also “definitely abuse.”

Later, Prinsen recounts, with brutal honesty, how she at times longed for her husband’s demise:

Sean stayed in our home, but I was finally starting to understand that Sean would never get help until he hit rock bottom. He needed to fall hard if he was ever going to get up again. I did something then that I’ve since found out is common behavior for the loved ones of addicts: I began to systematically pray for my husband’s downfall. I didn’t want him to get hurt. I didn’t want him to injure someone else and live with the regret. I didn’t want him to suffer lifelong consequences. I just wanted him to suffer enough to want to get help for himself.

It is rare to find these sorts of frank admissions in a personal memoir, let alone a first book, and it is this fearless honesty that makes Prinsen’s story so powerful. One can only imagine how difficult it must have been for her to put all of this into writing, knowing that her husband, friends, and family would all be able to read it. At one point in the story she finds herself wondering, “What will people think when they see this in the newspaper?”

In addition to sharing her own raw experiences, Prinsen also follows every section of the book with a short factsheet, providing the reader with a brief summary of the fundamental topics covered and links to further resources. These factsheets might easily have seemed disruptive or out of place, but Prinsen keeps them concise and informative.

The author also raises some vital ethical and political issues, questioning the morality of a government that puts soldiers in situations that destabilize their mental health, then prosecutes them as criminals. “How can we expect our veterans to come back to their homes and be ‘normal’ again after they have seen humanity at its worst?” Prisen recalls thinking angrily as she and Sean walked out of court one day. She feels sick when considering that Sean, who had never had any trouble with the law before he was deployed to Bosnia, was now a twice-convinced criminal. “What kind of a country is this to condemn and shame its own soul-wounded soldiers in such a way?” she asks. “Why don’t we just help them?”

Blind Devotion lives up to its name as a remarkable testament to the unquestioning power of love against all other odds, including the most destructive forms of mental illness. This is a story of survival, with protagonists who are determined to conquer their personal demons and triumph, no matter what. Prinsen’s writing will appeal to every reader, regardless of whether or not they’ve had to deal with PTSD. For the hundreds of thousands, if not millions, of military families who can relate to her experiences firsthand, hearing Prinsen speak about them so openly and shamelessly will surely be a relief.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction
Hazelden, September, 2012
Paperback, 348 pages
$14.95

Why Shame is so Painful

Whereas guilt is a right or wrong judgment about your behavior, shame is a feeling about yourself. Guilt motivates you to want to correct or repair the error. In contrast, shame is an intense global feeling of inadequacy, inferiority, or self-loathing. You want to hide or disappear. In front of others, you feel exposed and humiliated, as if they can see your flaws. The worst part of it is a profound sense of separation — from yourself and from others. It’s disintegrating, meaning that you lose touch with all the other parts of yourself, and you also feel disconnected from everyone else. Shame induces unconscious beliefs, such as:

• I’m a failure.
• I’m not important.
• I’m unlovable.
• I don’t deserve to be happy.
• I’m a bad person.
• I’m a phony.
• I’m defective.

Chronic Shame in Addiction and Codependency

As with all emotions, shame passes. But for addicts and codependents it hangs around, often beneath consciousness, and leads to other painful feelings and problematic behaviors. You’re ashamed of who you are. You don’t believe that you matter or are worthy of love, respect, success, or happiness. When shame becomes all-pervasive, it paralyzes spontaneity. A chronic sense of unworthiness and inferiority can result in depression, hopelessness, and despair, until you become numb, feeling disconnected from life and everyone else.

Shame can lead to addiction and is the core feeling that leads to many other codependents’ symptoms. Here are a few of the other symptoms that are derived from shame:

• Perfectionism
• Low self-esteem
• People-pleasing
• Guilt

For codependents, shame can lead to control, caretaking, and dysfunctional, nonassertive communication. Shame creates many fears and anxieties that make relationships difficult, especially intimate ones. Many people sabotage themselves in work and relationships because of these fears. You aren’t assertive when shame causes you to be afraid to speak your mind, take a position, or express who you are. You blame others because you already feel so bad about yourself that you can’t take responsibility for any mistake or misunderstanding. Meanwhile, you apologize like crazy to avoid just that! Codependents are afraid to get close because they don’t believe they’re worthy of love, or that once known, they’ll disappoint the other person. The unconscious thought might be that “I’ll leave before you leave me.” Fear of success and failure may limit job performance and career options.

Hidden Shame

Because shame is so painful, it’s common for people to hide their shame from themselves by feeling sad, superior, or angry at a perceived insult instead. Other times, it comes out as boasting, envy, or judgment of others. The more aggressive and contemptuous are these feelings, the stronger the shame. An obvious example is a bully, who brings others down to raise himself up, but this can happen all in your mind.

It needn’t be that extreme. You might talk down to those you teach or supervise, people of a different class or culture, or someone you judge. Another tell-tale symptom is frequent idealization of others, because you feel so low in comparison. The problem with these defenses is that if you aren’t aware of your shame, it doesn’t dissipate. Instead, it persists and mounts up.

Theories about Shame

There are three main theories about shame.

The first is functional, derived from Darwinian theory. Functionalists see shame as adaptive to relationships and culture. It helps you to be acceptable and fit in and behave morally in society.

The cognitive model views shame as a self-evaluation in reaction to others’ perception of you and to your failing to meet certain rules and standards. This experience becomes internalized and attributed globally, so that you feel flawed or like a failure. This theory requires self-awareness that begins around 18 to 24 months old.

The third is a psychoanalytic attachment theory based upon a baby’s attachment to its mother and significant caretakers. When there’s a disruption in that attachment, an infant may feel unwanted or unacceptable as early as two-and-a-half to three months. Research also has shown that a propensity for shame varies among children of different temperaments.

Healing Shame

Healing requires a safe environment where you can begin to be vulnerable, express yourself, and receive acceptance and empathy. Then you’re able to internalize a new experience and begin to revise your beliefs about yourself. It may require revisiting shame-inducing events or past messages and re-evaluating them from a new perspective. Usually it takes an empathic therapist or counselor to create that space so that you can incrementally tolerate self-loathing and the pain of shame enough to self-reflect upon it until it dissipates.

You can raise your self-esteem to heal your shame with my e-book, 10 Steps to Self-Esteem: How to Stop Self-Criticism, available at www.whatiscodependency.com/ and online booksellers.

They aren’t feeling motivated to study. They don’t like their classes or they like their classes okay but still can’t find the time or energy to do the assignments. They sleep through their alarm clock. Even if they do get to class, they nod off or forget to take notes. They report feeling anxious or depressed or overwhelmed or sick or just all-around miserable.

Why, they ask, are they in school? What’s the point?

There are times that asking a question implies the answer. If you wonder if it would be a good idea to take time out from school, you probably already know the answer. You know you aren’t being the student you could be. You know you are wasting a substantial amount of money. You wish you could find the motivation and ambition you once had but now clearly don’t. It’s probably time to take time out.

Taking a break doesn’t have to mean you are giving up. A break is just that – a break. Sometimes there are good and respectable reasons for taking a year or two or more away from academics. College won’t go away. Your credits usually won’t evaporate. Going home doesn’t mean you are stupid or inadequate or crazy. There just may be other priorities or other issues that make leaving school a smarter, wiser idea than staying in.

5 Good Reasons to Take a Break

• When you’re not sure why you’re there. College these days is an enormous financial investment. If you don’t have clear goals, it’s reasonable to ask yourself why you are taking loans and using up your parents’ savings to be there. A “gap year” program or a couple of years of work experience might help you set clearer goals for yourself, including your goals for your schooling.
• When you find you’re unprepared for higher-level work. Sadly, not every high school adequately prepares its students for college-level work. Even if you got all As you may not have the education you need to compete at the college level. If you find the work too challenging, it may well be that the problem isn’t your IQ. You may not have the fundamental information and skills needed to understand the material or to express yourself adequately in writing. If that’s the case, it makes sense to take time out to take some remedial classes at your local community college or to get a tutor to bring you up to speed.
• When a family crisis distracts you. Some people are able to compartmentalize their life at school from their life at home. But many more can’t. If someone you love is fighting cancer; if your parents are going through a divorce or are in some other crisis themselves; if one of your siblings is in serious trouble or ill or a much-loved relative has recently died, you may find it difficult to concentrate on classes and assignments. It might be better to go home than to be constantly distracted by worry or overwhelming feelings of loss. Feeling helpless to help or feeling guilty for being away isn’t going to do much for your GPA. Take a semester to put things in order or to feel like you’ve done what you could and you’ll do much better when you return.
• When you are making a major life decision. Big decisions sometimes need all of our attention, not a distracted part of it. The decision to marry or to break up, the decision to change your major when you’ve already invested three years, the decision to leave school and to take a big opportunity instead – whatever life-changing matter is before you may matter so much that you need time to figure it out without academic demands pulling for your attention.
• When you are so stressed out by school that you are miserable. If the idea of studying gives you a panic attack; if the thought of going to the library makes you so depressed you can’t leave your room; if you get no joy out of reading the materials or listening to the lectures but only feel scared, anxious, or generally irritable, you may be in no shape to take on school for now. By all means, talk to your teachers and take advantage of any counseling services available to you. Sometimes a little help can send someone in a more positive direction. But if every attempt at getting help isn’t helpful, maybe you need to go home to take stock, to get involved in some therapy, or maybe just to mature a little more before starting college.

Know Yourself

Yes, there are some people who can manage 18 credits, active participation on a varsity team, a lively social life and a deeply meaningful love relationship without missing a beat. Good for them. Would that everyone was so lucky. But many people need to take life in smaller chunks. It doesn’t have to be seen as a failure or as a character flaw. Different people are just different.

If you do go home, use the time wisely. It’s not a time to hole up in your old bedroom feeling sorry for yourself and sucking your thumb. It’s a time to rest, regroup, and reconsider your options. Get some experience, training, or remedial education. Get a job and pay down some of your loans or save up for your return to school. If time management was part of the problem, then get some practical coaching. Depressed or anxious? Get yourself into counseling to learn better coping skills. By taking care of yourself, you’ll be in a better position to decide when and if higher education is for you.

Related Articles

Not Ready for College? Alternatives for the Unsure
Ready or Not: Immature and Headed to College
Help! I’m in the Wrong College!

Our Inner Dialogue Affects Our Thoughts and Feelings

How we manage our thoughts when they come into our mind (our “inner dialogue”) directly affects how we feel and what we do. If we use this to our advantage, we can have a potent tool to manage our state of mind and have more control over ourselves. Alternatively, we can give in to “natural” instincts and thought patterns and see what happens when they take over.

Jeremy, 42, was bright and outgoing — though as a boy he was shy, insecure and lonely. In high school he was convinced that any girl he liked would be out of his league and would not like him. He coped with these painful feelings by using his imagination, comforting himself with sexual scenarios in which any girl he liked would fall in love with him. Jeremy was never inappropriate with anyone and kept these fantasies a secret.

As an adult, Jeremy was active socially and happily married with a satisfying sex life. Still, he continued in the vivid fantasy life he had as a boy, habitually imagining scenarios about various women who crossed his path,Though Jeremy’s self-image seemed positive, unconsciously he carried with him the deeply ingrained, buried sense of himself as rejected and unlovable, and continued to use the power he found in his mind to abolish this perception of himself. Jeremy never sought help for this issue, since he believed that fantasizing was harmless, and that he was no different than other men.

Jeremy frequently fantasized about Zooey, a single co-worker at the same firm. He had made a commitment to himself never to let on t her about these fantasies, knowing that doing so could put him at greater risk for acting on them. Jeremy described his relationship with Zooey as neutral. There had never been any flirtation between them and Jeremy never felt any special connection with her other than a private attraction.

Eventually, Zooey decided to leave the firm for another job. As the two of them were saying goodbye, Zooey suddenly confessed to Jeremy that she had been fantasizing about him over the last several years. To his surprise, Jeremy found himself excitedly blurting out that he had actually been fantasizing about her too. At that juncture Zooey reached out to him to say goodbye, kissing him on the lips. Despite having breached his own boundaries, Jeremy rationalized to himself that he was still safe, since he had informed Zooey that he was happily married.

Previously, Jeremy’s fantasies had seemed safely compartmentalized. However, Zooey’s unexpected confession instantly dissolved the fragile line separating fantasy and reality, making Jeremy’s fantasy suddenly come true. In this confusing zone where the two worlds blend, acting in ways previously contained to the fantasy world can feel instinctive. After all, one has already “been there” in one’s mind.

Jeremy found himself drawn into in an excited, infatuated state that felt irresistible. Following the farewell incident, he and Zooey exchanged various texts and phone calls, a new occurrence. Jeremy said that he didn’t want to have an affair, and had no intention of doing so. Nevertheless, he was reluctant to follow his therapist’s recommendation to cut off contact entirely and make the ending of his relationship with Zooey final.

What is anxiety? Psychologist Tamar E. Chansky defines it as “the first reaction of a sensitive system that is wired to keep us alert to danger and protected from harm.”

Irrational thoughts often spur those first reactions. In order to manage anxiety, she says strategies are needed to react appropriately, including “shrinking the risk and being willing to approach the situation” to figure out what is really happening.

Chansky first describes four general steps people can use to help overcome anxiety. She then follows those up with strategies to help slow that initial fight or flight reaction.

The four steps are:

• “Pause and Re-label or don’t believe everything you think.”
• “Get Specific or narrow down the problem to the one thing that really matters.”
• “Optimize or re-think what’s possible and broaden your choices.”
• “Mobilize or don’t just stand there, do something.”

Most of the strategies are simple to understand and implement.  For example, to optimize choices, the read is told to “consult the possibility panel.”  This involves creating a “board of directors” to offer advice.  Anyone can be a member of the possibility panel in your brain, whether or not you know them.  It might sound a little strange to create a “mental” panel of advisers. Chansky says, “Just stepping out of your own spin of ideas for a moment to contemplate getting other opinions instantly frees you up.”  Since anyone alive or dead can be on the panel, this activity can also be kind of fun.

Are you afraid of trying new things?  Chansky suggests trying a strategy which she calls “practice brings confidence and mastery.”  Instead of believing “that you just should know how to do something [new]… think how you would teach someone else to do it, then sketch out a practice routine for yourself.  Create a script, practice in the mirror, [and] practice with a friend.”  This commonsense advice might not be new, but she also includes other strategies that might not be as familiar. The reader has a good chance to find a strategy that will help.

After covering the four steps, Chansky discusses “additional tools to free yourself, like generating an accurate list of your strengths. Another one is called disappointment proofing, which discusses how to create “safe, resilient expectations” and “cultivating empathy, compassion, and gratitude.”

The last part of the book consists of shortcuts to help you “find your way through the detours of life.”  Those “detours” include anger, jealousy, loss, shame, procrastination, perfectionism, failure, and criticism.

For each of the detours, Chansky lists the beliefs that keep people stuck in that emotion. She offers a list of “better beliefs” and specific strategies to help confront the beliefs causing the emotional bottleneck. For example, a bottleneck belief for “shame” is “All of me is bad, damaged, and unacceptable.”  A better belief is “This is not who I am; this is what happened to me.”

Another strategy to help change a belief about shame is called re-labeling.  Chansky explains that “shame makes us feel like we are damaged [but] that is a feeling, not a fact.”  To recover from shame, it’s necessary to figure out what our “enduring value” is aside from the shame.

One very useful aspect of the book  is that each chapter also includes advice about how to help others struggling with anxiety.  Her suggestions can “help you become the voice of reason for those you care about.” When a friend is worried, don’t say “everything will be okay.”  Instead, “remind them of something similar that happened to you that turned out okay” to help them “focus on the finish line.”

The only section of the book which seems cursory is the chapter on anxiety disorders. Chansky covers a lot of ground touching on generalized anxiety disorder, panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, and social anxiety disorder.  Even though she crams all those disorders into one chapter, some people might still find it valuable. After reading Chansky’s descriptions, a reader have a pretty good idea if they suffer from normal anxiety or have an anxiety disorder.  She gives some suggestions for “cracking the code” of each disorder, as well as summarizing treatment options for each.

I believe that this book could become a standard reference in the field with therapists assigning it to clients.  Anyone who suffers from anxiety could find it useful, because Chansky offers so many strategies to try.  Chansky’s strategies provide concrete methods to use when feeling anxious.  You may find some strategies more useful than others. However, by adding just one new strategy to your repertoire of habits, you may help yourself feel less anxious.

Freeing Yourself from Anxiety: The 4-Step Plan to Overcome Worry and Create the Life You Want
Tamar E. Chansky, PhD
Da Capo Lifelong Books, Jan. 31, 2012
Paperback, 336 pages
$10.51

According to the International Association of Reiki Professionals (IARP), “Reiki is [a] subtle and effective form of energy healing using spiritually guided life force energy… [p]racticed in every country of the world.” While often considered to be spiritual in nature, Reiki is not “[a]ffiliated with any particular religion or religious practice.”

Reiki is increasingly offered in hospital, hospice, and private practice settings, applied to a variety of illnesses and conditions. Those who receive such treatments report relief of symptoms from numerous health challenges, including mental health issues. Research shows that reiki primarily helps in the reduction of stress, anxiety and depression, as well as relief of chronic pain — the last of which can bring on anxiety and depression, or make episodes worse.

Many Studies, Varying Quality

There are now sufficient peer-reviewed, published research results available to begin to sort out Reiki’s effectiveness in various areas. The Center for Reiki Research has intensively examined a group of them through their “Touchstone Process,” “…a uniquely rigorous peer review method for analyzing a group of scientific studies” [using Reiki]. Its end product is a set of critical summaries derived from an impartial and consistent process…. [T]he process incorporates existing best practices for scientific review…” (CRR)

This process looks at all aspects of the study design and how each investigation was actually carried out. Results are analyzed, and study strengths and weaknesses are determined. The Touchstone Process has produced a group of nearly three dozen carefully analyzed studies. The CRR draws some conclusions about Reiki’s effectiveness from only the studies they have examined that they judge to be of at least satisfactory or better quality. (CRR)

In addition to the CRR/Touchstone studies, a varied body of research on Reiki demonstrates its effect on mental health. For example, Joe Potter, a Reiki Master in the United Kingdom, has been conducting an ongoing investigation into Reiki’s effectiveness. An online search in PubMed lists dozens of studies involving Reiki or other healing touch methods, investigating a broad range of conditions in many different populations.

Some investigations were conducted on animals, which helps eliminate some questions of bias and design control among Reiki recipients. Some studies used “sham” Reiki as a form of control (nonpractitioners administered a “Reiki-like” treatment), and others involved distance Reiki (Reiki delivered from too far away to permit touch). Each of these variables lends something importing to understanding the efficacy of the treatment itself.

Demonstrated Effects on Stress, Depression, Anxiety and Pain

Potter reports that “[s]tress was the most common word written by clients as a description or part description of their condition during their first session. Here 20.27% of the total client group treated used this word on their initial visit for Reiki treatment….” In animal studies, Reiki treatment produced clear signs of reduced stress as indicated by changes in autonomic, biological measurements such as heart rate (Baldwin, Wagers and Schwartz, 2008) and certain cellular signs of stress-related damage (Baldwin and Schwartz, 2006). In a study of nurses with “burn out syndrome,” biological indicators of a significant relaxation response were found as a result of Reiki treatment (Diaz-Rodriguez et al., 2011). When nurses administered Reiki to a group of patients with acute coronary syndrome, physiologic indicators of a significant relaxation effect were recorded. (Friedman et al., 2011)

Shore (2004) followed patients being treated for mild depression and stress. After six weeks of treatment and for up to a year afterward, those who had received Reiki showed both immediate and long-term improvements in depression, stress and hopelessness. In a small study, complete elimination of typical postoperative depression was seen in heart surgery patients given Reiki during surgery (Motz, 1998).

Pain often causes depression and anxiety. Reducing difficult-to-treat chronic pain can have a substantial effect on psychological well-being. Some studies have found Reiki to be effective for pain, anxiety and depression relief. However, their design or conclusions are unclear as to whether Reiki’s emotional benefits were a result of pain reduction or a separate phenomenon. Nonetheless, research demonstrated Reiki’s positive results for both pain and anxiety or depression.

Dressing and Sing (1998) found that among cancer patients, Reiki brought about significant levels of pain relief, anxiety and depression reduction, improvements in sleep quality, relaxation and general well-being. This effect was stronger in men than women. These benefits remained when checked after three months. Among abdominal hysterectomy patients, Reiki helped reduce pain and anxiety, particularly in a preoperative setting (Vitale and O’Conner, 1998).

Investigating Effects of Gentle Touch, Distance

Research shows that gentle touch in a safe environment aids stress reduction and pain relief (for example, Weze et al., 2005). Since Reiki generally involves a similar type of touch, the results of Reiki studies often can be confounded by the known impact of gentle touch vs. the effects of Reiki itself. Studies that include sham Reiki treatment groups, as well as those that involve a distance Reiki group, have been important to help sort out the relative effects of Reiki versus gentle touch – or even the effects of the presence of a “therapist,” real or sham.

Reiki is becoming an increasingly accepted presence in hospitals and clinics. (The Center for Reiki Research website lists 70 institutions at the time of this article that include Reiki in their offerings.) It is seen as an effective and cost-reducing method to improve health outcomes and quality of care. Hospital staff, such as physicians and nurses, are adding Reiki treatments to their work. Scientific validation of Reiki’s effectiveness have helped bring this method to the mainstream, where it is able to aid patients in all realms, including those with mental health challenges.

References

Baldwin, A. L.. Reiki, the Scientific Evidence. (Fall, 2011). pp. 29-31.

Baldwin, A.L., Schwartz, G.E. (2006). Personal Interaction with a Reiki Practitioner Decreases Noise-Induced Microvascular Damage in an Animal Model. Journal of Alternative and Complementary Medicine, 12(1):15–22, 2006. In Center for Reiki Research, Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Baldwin, A.L., Wagers, C. and Schwartz, G.E. (2008). Reiki improves heart rate homeostasis in laboratory rats. Journal of Alternative and Complementary Medicine, 14 (4): 417-422. Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Center for Reiki Research (CRR). Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Diaz-Rodriguez, L., Arroyo-Morales, M, Fernández-de-las-Peñas, C., García-Lafuente, F., García-Royo, C. and Tomás-Rojas, I. (2011). Immediate effects of Reiki on heart rate variability, cortisol levels, and body temperature in health care professionals with burnout. Biol Res Nurs, 13: 376 originally published online 5 August 2011. In Center for Reiki Research, Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Dressin, L.J., Singg, S. (1998). Effects of Reiki on pain and selected affective and personality variables of chronically ill patients. Subtle Energies and Energy Medicine, 9(1):53-82.

Friedman, R.S.C., Burg, M.M., Miles, P., Lee, F. and Lampert, R. (2010). Effects of Reiki on Autonomic Activity Early After Acute Coronary Syndrome. Journal of the American College of Cardiology. 56: 995-996. In Baldwin, Fall, 2011.

International Association of Reiki Professionals (IARP). Definition of Reiki. Retrieved June 22, 2012, from http://www.iarpreiki.org/

Motz, J. (1998). Hands of Life. New York: Bantam Books.

Potter, Joe, Research Report, Introduction and General Findings. Retrieved July 21, 2012 from http://www.reiki-research.co.uk/

PubMed. Retrieved July 24, 2012 from http://www.ncbi.nlm.nih.gov/pubmed

Shore, A.G. (2004). Long term effects of energetic healing on symptoms of psychological depression and self-perceived stress. Alternative Therapies in Health and Medicine, 10(3):42-48.

Vitale, A.T., O’Conner, P.C. (1998). The effect of Reiki on pain and anxiety in women with abdominal hysterectomies. Holistic Nursing Practice, 20(6): 263-272, 2006. In Center for Reiki Research, Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Weze C, Leathard H.L., Grange J, Tiplady P, Stevens G. (January, 2005). Evaluation of healing by gentle touch. Public Health. 119(1):3-10.

This quote on the inner jacket sleeve of Dr. Gordon Livingston’s book, The Thing You Think You Cannot Do, spells out the book’s central idea. It also suggests questions that might arise in most readers’ minds. What if we  didn’t feel fear? How much more could we accomplish for ourselves and our society, if we could just push past our fears?

Livingston tells us upfront that roughly ten percent of Americans – 22 million — experience clinical depression. Medication and/or psychotherapy can help, but the real antidote is hope and courage.

Livingston, a psychiatrist and writer, sets no easy task for himself in this short and easy-to-read book. Many of the greatest minds of all time have wondered how to obtain these lofty and elusive virtues. Livingston’s approach may not be unique, but it is cleverly crafted. It is as if he’s examining a cut diamond, facet by facet. He divides the book into thirty very short chapters, looking at fear and courage from many angles and explaining his vision through real life situations.

By the book’s end, the reader gains a deeper understanding of how Livingston sees fear as well as courage. This analysis empowers readers to work at controlling their anxieties and strive toward more courageous and certainly more self-fulfilling actions.

In the early chapters, Livingston explains some working concepts to better understand fear. We’re all going to die and we know it, which worries us and causes us to avoid situations that put us at risk. Anxiety with its symptoms of a racing heart, sweaty brow, and general panic is related to fear. However, what triggers it remains a mystery. Both fear and anxiety can result in poor decision making, isolation, and failure to reach a person’s full potential.

“It is within ourselves, where we confront our deepest fear and insecurities, that we find our own forms of courage and cowardice,” writes Livingston. “Like any virtue, bravery is manifest in our habitual actions. Fidelity to an idea, risking ourselves to stand up for the powerless, refusing to crumble beneath the weight of time, all require a steadfastness that is uncommon in a culture dominated by glamor, celebrity, and instant gratification.”

Popular culture urges us to live in moment and grab ephemeral pleasures. Happiness is immediate, easy to obtain and easy to control. However, these actions often end up like an injection of Botox. The user may get rid a few wrinkles for a while, but it doesn’t stop aging. The wrinkles return.

Fear has consequences not only to us as individuals, but to society overall. Livingston repeatedly illustrates that through his examples of the 9-11 terrorist attack and the Vietnam War, in which he served.  After 9-11, fear spurred ostracism of not only Middle Eastern people, but people who resembled them and that area of the globe. This fear also spawned two costly, ill-conceived wars against Afghanistan and Iraq. It also prompted Americans to look at U.S. soldiers as heroic and courageous, which is completely opposite how Vietnam War veterans were treated.

Packed with insights and illuminating examples, Livingston’s book does tend to meander. At times, he strays a little too far off the trail with personal stories and examples.  For instance, in a chapter titled “Sometimes Courage Is Hope Against Hope,” he lifts a chunk out of a young woman’s diary during her difficult battle with a fatal, autoimmune disease.  He prefaces the eight pages of quoted material by telling us a little about Allison Caldwell and her passion for life. While the young woman’s story is moving and and her generosity is astounding, Livingston doesn’t elaborate on how Caldwell’s story supports his overall theme.

Aside from this and a few other stories that don’t quite hit the mark, this book is sound. It should inspire readers to push past their fears and take the high road that leads to greater happiness and fulfillment. “The journey begins within,” as Livingston tells us, and he offers us a good map to find it.

The Thing You Think You Cannot Do: Thirty Truths About Fear and Courage
Dr. Gordon Livingston, M.D.
Da Capo Lifelong Books, April 10, 2012
Hardback, 224 pages
$12.94

Challenge: Uncontrollability

“Bipolar disorder can feel uncontrollable,” according to Sheri L. Johnson, Ph.D., professor of psychology at the University of California-Berkeley and director of the Cal Mania (CALM) Program. Symptoms, such as mood changes, can seem to appear suddenly and without provocation. And they can diminish daily functioning and ruin relationships, said Sheri Van Dijk, MSW, a psychotherapist and author of The DBT Skills Workbook for Bipolar Disorder.

Strategies: While bipolar disorder can seem unpredictable, there are often patterns and triggers you can watch out for. And even if you can’t prevent symptoms, you can minimize and manage them.

One way to monitor changes is to keep a mood chart, Van Dijk said. Depending on which chart you use, you can record everything from your mood to the number of hours you slept, your anxiety level, medication compliance and menstrual cycle, she said. (This is a good chart, she said.) For instance, you can anticipate a potential depressive episode if you see that your mood has been progressively sinking in the last few days, Van Dijk said.

Practicing healthy habits is an effective way to lessen the hold emotions have on you. Make it a priority to get enough sleep, going to bed at the same time and waking up at the same time, Van Dijk said. Create a calm bedtime routine, avoid substances such as alcohol – which disrupts sleep – and don’t exercise in the evenings, said Johnson, also co-author of Bipolar Disorder: A Guide for the Newly Diagnosed.

Sleep deprivation can trigger mania, and “it makes you more susceptible to being controlled by your emotions, such as irritability,” Van Dijk said. On the other hand, sleeping too much can cause lethargy and also reduce your ability to manage emotions, she said.

Exercise helps to reduce depressive symptoms. Eliminating caffeine can reduce irritability and anxiety and improve sleep, Van Dijk said. She suggested cutting out caffeine for two weeks and paying attention to any changes. Some people also find that certain foods exacerbate their mood swings. You can check by cutting out specific foods from your diet, and watching the results, she said.

You also can use a variety of strategies to stave off the negative consequences from your symptoms. For instance, if impulsive spending is a problem, gain control by having a low limit on your credit cards, Johnson said. When you’re experiencing early signs of mania, have someone else hold onto your checks and cards, Johnson said. If you do overspend, return your purchases, she said. You can even ask a friend to go with you, she added.

Challenge: Medication

“There is no ‘one size fits all’ medication that helps everyone with bipolar disorder,” Johnson said. Lithium is typically the first line of treatment. But for some people the side effects are especially troublesome, she said. Finding the right medication (or combination of medications) can seem like a daunting process.

Strategies: Learn as much as you can about mood-stabilizing medications, Johnson said, including their potential side effects. “Find a doctor who will work with you to make adjustments based on your experiences with the different medications,” she said. Expect that it might take several tries to figure out the best medications for you.

Many of the side effects dissipate after the first two weeks, Johnson said. Changing the dose schedule helps to minimize side effects. For instance, if you feel groggy, your doctor might suggest taking your medication in the evening, she said.

Support groups are another valuable tool, Johnson said. (She suggested looking at the Depression and Bipolar Support Alliance website for a group.) For instance, individuals in these groups are usually familiar with compassionate doctors in the area, she said.

Challenge: Relationships

Bipolar disorder is hard on relationships. The very symptoms – swinging moods, risky behaviors – often leave loved ones feeling confused, exhausted and like they’re walking on eggshells, Van Dijk said.

She also sees loved ones have difficulty distinguishing between the illness and the person. They might invalidate the person’s feelings and either blame everything on the illness or believe the person is making conscious choices when it is the illness.

Strategies: Bipolar disorder is difficult to understand, Van Dijk said. “Different affective episodes, [such as] depression versus hypomania, result in different symptoms, and one episode of depression or hypomania can be different from the next within the same person,” she said.

So it’s incredibly important for loved ones to get educated about the illness and how it functions. Individual therapy, family therapy and support groups can help. Refer loved ones to self-help resources and biographies or memoirs of people with bipolar disorder, Johnson said.

Getting a handle on your emotions also improves relationships, she said. Working on assertiveness is key, too, she said. Individuals with bipolar disorder tend to have a tough time being assertive. Therapy is a good place to learn assertiveness skills. But if you’d like to practice on your own, Van Dijk suggested using “I statements”: “ I feel _____ when you ______.” She gave the following example: “I feel scared and hurt when you threaten to leave me.”

Challenge: Anxiety

According to Johnson, about two-thirds of people with bipolar disorder also have a diagnosable anxiety disorder.

Strategies: Johnson stressed the importance of using relaxation techniques and not using avoidance behaviors. As Van Dijk explained, “the more you avoid things because of your anxiety, the more your anxiety will actually increase, because you never allow your brain to learn that there’s nothing to be anxious about.”

Psychotherapy is tremendously helpful for managing bipolar disorder and the above challenges. If you’ve been prescribed medication, never stop taking it abruptly – this boosts the risk for relapse – and communicate regularly with your doctor.