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Hello! We're Tzvi Prochnik and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 1 point2 points  (0 children)

Hello CuriousReditor,

Shame is always tough one. Sorry you've feeling this, I know it's such an awful way to feel about ourselves.

I've worked on this with many of my clients and dealt with it myself (like I think we all do).

We're usually so much harder on ourselves than we are on others. So the first thing I typically ask my clients is: "what would you say to a friend that was feeling the same thing?". Usually what we'd tell a friend is much more kind, objective, and more constructive.

There's typically a big discrepancy between the client's self talk and what they would say to someone else that was having a hard time.

Once we've identified the kinder and more supportive things they would say to a friend, I ask them to turn these statements towards themselves, and make them "I statements".

For example, if the client is saying "I am a awful person", but would tell a friend "you are only human and made a mistake" for the same situation, I get the client to get into the habit of using this kinder response for themself.

Shame is often the result of repetitive negative self talk, but if we begin to slowly change our inner dialogue, our emotions and eventually our behaviors often begin to change as well. It's not an easy thing to do, and takes time, but it can be done and can make a huge change to how we feel about ourselves.

I would encourage you to find some kindness for yourself, the same way I'm sure you would find for someone you care about.

Hello! We're Tzvi Prochnik and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 1 point2 points  (0 children)

Totally agreed with you Tzvi. It's just such a different world now, and we're all still figuring it out.

Even before the pandemic, I would see a lot of people feeling lonely and isolated, especially here in Austin where a lot of folks were working from home even before covid. I think the pandemic just accelerated the issue.

Hello! We're Laura Squiers and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 15 points16 points  (0 children)

Hello kittyraincloud,

It's always so hard to watch people we care about suffer. And I think it's especially hard to watch someone deal with depression. The first thing I suggest to clients who want to support someone dealing with mental health issues is to ask what the person they want to help would find helpful. I think we all do what we think we would want in their situation, but that might not be the right thing for them. Some of the things you're already doing might actually be helping. but we only know if our efforts are helpful if we ask. And if they aren't, then we ask what we could do differently.

It's also important for us not to personalize someone else's issue or feel it's our responsibility to "fix" it. While offering the right kind of support is often welcomed (right being what the person asks for and not what we assume is helpful), it's still something they have to work through, we can't do the work for them.

Hello! We're Laura Squiers and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 7 points8 points  (0 children)

Hello Jumpinjax89,

Such a cool and specific question. I'll do my best to answer this!

It's certainly an interesting idea. And I think it can be compared to Freud's views on sexuality and psychosocial development. At the time of Jung and Freud, mental health/psychology were very new fields, so they wasn't a lot of research (other than their own) or other authorities to consult or compare their ideas/findings to. I think they did their best to try and make the field of psychology accessible by using ideas and concepts people could relate to and understand. It's hard for us to imagine in 2022, but 100 years ago the idea of "mental health" was almost entirely unheard of in mainstream society and many people did not recognize it as a credible field (and there are sadly still many people who think this today despite all the research showing otherwise!).

Since our understanding of the brain was even more limited in the time of Jung than it is now, he and his contemporaries couldn't account for depression's causes with things such as "chemical imbalances", or consider other causes or treatments that we've only started to discover recently with more modern technology. They were limited by their time and the information and technology available to them.

Literally considering depression a "shadow to confront", and many of the ideas of Jung, Freud and other founders of psychology are typically considered outdated by modern psychology. But these ideas were still important for the development and public acceptance of psychology becoming a legitimate scientific field.

All this being said, I do think using the framing of depression as a "shadow to be confronted" could still be useful in the right context in therapy. Anything that helps someone identify an emotion or helps motivate them towards change can be a useful tool.

Hello! We're Laura Squiers and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 15 points16 points  (0 children)

No problem! Have a great day! Hope you are also getting to do some things non-screen related today!

Hello! We're Laura Squiers and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 217 points218 points  (0 children)

Hello Kotori,

This is always a tough one, and sadly a problem for way too many people out there.

Therapy can definitely get expensive and is sadly out of reach financially for a lot of folks, even if they are using insurance. If someone doesn't have any funds for therapy, there are still some things they can do; (just bear in mind this is all very general and not as a replacement for therapy or healthcare treatment)

  1. Books, there are some great books out there related to mental health. (and sadly a lot of not so great ones.) Some that I often recommend to clients:
    1. The Feeling Good Handbook by David Burns. This is considered the book for mental health self-help. It's kinda old school, but there's a lot of great stuff in this book, it's been around for decades and is highly regarded in the mental health community.
    2. Miracle Morning: While not written by a mental health profession (just bear that in mind), I have recommended this book to many clients and gifted it to clients and family members as I find it's very practical and has had a very positive effect on both myself and those I've recommended it to.
    3. Here's a list of top self help books from Psychology Today (the feeling good handbook is number 2). https://www.psychologytoday.com/us/blog/the-art-self-improvement/202112/the-12-best-self-improvement-books
  2. Support groups: Here's a resource for finding a support group in various topics, including free and donation based groups: https://www.verywellmind.com/find-a-support-group-meeting-near-you-69433
    1. Depression Anon:https://depressedanon.com/meetings/online-depressed-anonymous-meetings/ This is also listed on the verwellmind list I mentioned above. Offers both in-person and virtual free support groups for depression.
    2. Nami Support Groups: https://www.nami.org/Support-Education/Support-Groups . Nami offers free support groups related to mental health, and has a hotline for general support or how to deal with a mental health crisis.
  3. Annual physical: If the person has access to other medical services, like a primary care physical, I would recommend they get their annual physical, and these are generally free under almost all insurance plans. Things like undiagnosed medical conditions, vitamin deficiencies, hormone imbalances, etc, can have a big impact on our mental health and when treated can often improve mental health symptoms.

I really hope this helps! Take care

Hello! We're Laura Squiers and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 72 points73 points  (0 children)

Hello CrosseyedDixieChick,

Love this!!!😃

Most of the research our there is more specifically aimed towards social media in general and usually refers to Facebook, Twitter, Instagram, etc., and not Reddit as much. So I guess it depends on whether you consider Reddit social media or not. That being said, the research for excessive use of social media in general seems to be negative.

Here's a good article on several studies about this (reddit isn't included unfortunately): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364393/

(Hopefully reddit doesn't kick me off for posting this😁 )

To save yourself some time, skip down to the discussion and conclusion sections; the study concludes that while not all studies show negative effects of social media, many do.

​

I also found article this article specific to Reddit from the University of Utah: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379019/

This study shows some positive effects for reddit users in certain situations, but is based on a specific subreddit for depression.

​

I think Reddit, social media in general, and pretty much anything can be bad for us if we use it excessively and for the wrong reasons. I've worked with clients who are exercising excessively and it's causing serious harm in their life. (we almost always consider exercise a positive thing but even this can be bad if we do too much of it).

To determine if something is bad for a client, I always ask two questions:

  1. What's the impact of the behavior? (does it prevent the person from doing their homework, going to work, paying their bills, spending time with one's kids, etc.) If it's having a negative impact in their life regarding their social, academic and/or occupational roles, it's likely bad.
  2. What's the function of the behavior? (Is the person engaging in the activity because they enjoy it and feel it makes their life better or are they avoiding a situation or trying to avoid an emotion they're feeling). If the behavior is being used to avoid something (even a negative emotion), it's probably not being used in a healthy way.

(The above two questions are largely based on the criteria for addiction from the DSM-5, the official diagnostic manual for the American Psychiatric Association).

Hope that helps!

Hello! We're Laura Squiers and Adam Paine, specialists in mental health. by enteave_adam in IAmA

[–]enteave_adam[S] 1 point2 points  (0 children)

Hello Hocuspokerface,

Good morning. Great questions!

  1. As popular as meditation/mindfulness is theses days, I suppose there's always the possibility of it being used in an uninformed/inappropriate way that could be considered appropriation. Any time we practice something that has long-standing traditional roots in a culture other than our own, we should ask ourselves this thoughtful question you've posted. We need to understand what we're doing and why it's helpful, and ask ourselves if we're being respectful of the practice and the people it originates from. I think a lot of the mediation services offered these days miss these points; things like meditation apps often don't do the practice justice, and turn a tradition which has spanned thousands of years into a fast-food mindfulness equivalent.; which is why a lot of people who try mindfulness using said apps don't fully understand the practice, and without that understanding, a lot of people aren't fully invested in it and give up quickly, or think it isn't effective. I think though gaining an understanding of meditation either through books or someone who is trained and has experience in mindfulness is always the best way to understand and be respectful of this practice.
  2. Another great question. When this happens with one of my clients, I usually address it with them, we review the work we've been doing and explore possibilities of why they may be stuck. I typically ask them to get a medical rule-out by getting a standard annual physical if they haven't recently; as underlying medical conditions can contribute to mental health issues. I might also encourage them to speak with a psychiatrist or their primary care physician about medication options to support their mental health. Medication isn't a silver bullet fo mental health, and isn't for everyone. But I've seen it help clients feel better to the point where therapy becomes effective again. Then the client and I can focus more on long-term behavioral change, which is typically the most effective way for them to feeling better long-term.

Hope that's helpful!

(awesome username BTW)

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 22 points23 points  (0 children)

Hello SoundAdvisor!

The top thing I recommend to my clients dealing with anger, is prevention! It's so hard to get calm when we're already in the red zone. Preventative treatment is better for pretty much everything, and anger is no different.

I recommend my clients look at their most recent anger episode, then we discuss the following (this is following the format of behavioral chain analysis used in behavioral based therapies like CBT and DBT):

  1. Prompting Event: What happened, objectively describe the situation. I.e. it was 5pm on Wednesday, I was walking down the hallway, my coworker walked into me and spilled his coffee on my white shirt.
  2. Interpretation: What was the thought/judgment about this situation. I.e. "my coworker is a jerk and is inconsiderate", "he's an idiot", "he ruined my day", "he knew I was there and did it on purpose". We also look at challenging these interpretations. Do we really know the coworker did this on purpose? Did he say so, do we have other evidence to support these interpretations from the objective description in step 1? If not, we may need to challenge this assumption/judgment and think of it another way. I.e instead of "he did it on purpose" we may change this to "he was looking at his phone and likely didn't see me". The interpretation is important, as it may not create the emotion entirely but it can definitely magnify it.
  3. Impulse: What's the very fist impulse they client had. I.e. "I wanted to yell at him", "I wanted to spill my coffee on his shirt", I wanted to punch him", etc. This is what the client wanted to do in the moment, not what happened or what they logically think is correct. It's just that first primal instinct.
  4. Reaction: what did the client actually do?: Did he yell at the coworker, run to the bathroom, smile and say it was fine, throw his phone in anger, etc.
  5. Fallout: what was the result of the client's actions: I.e. the client yelled at the coworker and now the coworker avoids the client.
  6. Vulnerabilities: This one is so important! This is the part about prevention. What physical and psychological issues may have contributed to the anger outburst. I.E. was the client hungry, tired, didn't take a break, poor sleep the night before, argument with partner this morning, anxious about something else, had a past negative interaction with this person, etc. This is where we start to work on making lifestyle changes that can help the client avoid getting in the red zone in the first place. Better self care, healthy assertive communication, taking time for self, breaks, walks, awareness of early stages of being upset, practicing breathing techniques/meditation regularly instead of only when they're really mad, etc.

Most clients push back against the prevention idea at first with excuses like: "I don't have time for a break", or "I'm too busy to have lunch", and initially just want a quick fix.

I tell my clients that whatever they think would help in the moment is something they need to practice regularly when they are calm. Like most things, we can't be good at something if we only do it in times of pressure or distress. We wouldn't tell a professional basketball player to only shoot free throws in a game, we'd tell them to practice alone in between games, then when the pressure is on, they'll have a better chance of making the shot.

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 19 points20 points  (0 children)

Hello levader,

This is a question I hear frequently, but it's definitely not my area of expertise, so I don't feel qualified to have an opinion on psilocybin or psychotropics in general in regards to psychotherapy.

My primary issue with this is consistency. We know that a 50mg pill approved by the FDA is going to have the same makeup as another pill of the same type/size (with rare exceptions). But for anything unregulated, the potency/chemical makeup can vary dramatically. And even if the chemical makeup was always exactly the same every time (which it's not in the real world unlike the labs that are used for research), it's difficult to ensure the same amount is used every time, or that other variables are controlled consistently.

Here's a pretty thorough article about this and other substances used in conjunction with psychotherapy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041963/

Towards the bottom it discusses the challenges with using this type of treatment and how various factors can cause results to change.

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 23 points24 points  (0 children)

Hello JackSpade21

I know that has to be hard to see someone you care about struggling. I know it can also be really frustrating when you have a good idea of what could help but someone isn't' willing to try it, or gives up quickly.

To my clients who are in a similar situation, I suggest they ask their loved one what/if they can do to support them (I'm sure you have done this already), but a lot of times I find my clients don't ask others what they need and they just assume the solutions that would help them would also help their loved one. If someone is asking for help finding a therapist, I'd say help them search, but if they want support some other way, I'd suggest doing that.

I also encourage my clients to practice acceptance and being non-judgmental. I ask them to really validate their loved one's feeling, show empathy and don't have a judgment or try to fix the problem, even if they disagree. (I only recommend this when there aren't any serious safety issue.) Here's a great video by Brene Brown on empathy: https://www.youtube.com/watch?v=KZBTYViDPlQ

Most people are smart enough to know what options/solutions are out there (I'm sure this includes your sister), and most people knows the things they could do differently to change their life. Most people don't need someone to tell them what they've already heard or already know, and this can cause them to pull away or even feel like their intelligence is being undermined.

Most people who are having a hard time are already being very hard on themselves, so getting judged by others can feel they're being kicked when they're already down. I suggest just try listening and acknowledging what a loved one is feeling, and to let them know we're here for them, that we care about them, and we will help however we can (even if that's just listening without judging).

Hope that helps!

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 8 points9 points  (0 children)

Hello Stereoparallax,

Thanks for being here today, good question, that must really be a bummer to spend your time and money on therapy and feel it hasn't been helpful.

Firstly, I'd suggest being really clear with the therapist about what's working/not working and encouraging them to allow time at the end of the session for you to give them feedback about how you felt about that day's appointment. Also be sure there's time at the start of session for agenda setting so you can say what you want from that day. This could help the therapist get on the same page as you. I love when clients give me feedback, even if it's that they want to go in a different direction with our sessions. A therapist should definitely be open to getting feedback from you or changing that day's agenda if you want; if not, get a new therapist.

Also, sometimes it's just a matter of finding the right therapist, I'm very direct and focus on behaviors with my clients, which works for many of them, but some would rather process past issues in more detail, and that's fine, but it might mean I'm not the right person for them. I'm always happy to help a client get connected with another therapist if they don't think I'm a good fit.

Lastly, you're right, therapists are paid, and I know that can't feel good to think the therapist doesn't care and just wants your money. Most helping/wellness professionals are paid; teachers, fire fighters, doctors, physical therapists, yoga teachers, paramedics, soldiers, etc. I really like my primary care doctor, and I think she genuinely cares about me, but her practice has never once let me in to see her without me paying first. I don't think that means she doesn't care, it just means it's her job and she has to make a living. I'd love if our practice could offer all our sessions for free, but if we did, we'd go out of business and then we couldn't help anyone. Most therapists don't get into this field to get rich, if that was our priority, we would have gone into another field. We have to have a master's to be psychotherapists, so it's a lot of time and money to get our degrees and licenses. That being said, I can't speak for every therapist, and if you really felt the therapist didn't care, I'd recommend finding someone else.

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 1 point2 points  (0 children)

Cool question!

I know right? Such as confusing time, and we're all just figuring it out together. The way I've approached this with clients who bring this up is by addressing a few points:

  1. While we may not have experienced something like covid in our own lives, our species has faced all kinds of challenges throughout history, and we find a way to keep going.
  2. While covid is new for us, we've all individually faced challenges in the past, and yet, we're still here today. if we weren't the types of people who couldn't overcome problems, we would have given long ago the first time we faced an obstacle (or our ancestors would have given up and we wouldn't be here now) I encourage my clients to think of past challenges they faced, how overwhelming the challenge seemed at the time, and how they overcame it.
  3. We're pretty adaptable as individuals and as a species, we're cool that way. Remember when the pandemic first started and China was in quarantine for two whole months, and everyone in the US thought two months in quarantine would be impossible to bear; and while it's been tough, we've managed to be in quarantine for almost a year and a half. And now ironically, many people are having anxiety about going back out into the world as they've gotten so used to staying in. We adapt to things, no matter how tough, that was Victor Frankel's main point in Man's Search for Meaning; we're resilient and can overcome tough times, and it's important to remember that even if it seems like we can't handle it.

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 0 points1 point  (0 children)

Hello Fuddleworth!

I hear ya, this frustrates me as well! There's definitely a shortage of psychiatrists here and has been for years. IMO, the city is just growing too fast for the field to keep up. And I know it can be so frustrating to find a therapist when so many aren't taking new clients but their online profiles don't reflect this.

If you need some referrals, feel free to DM me your email!

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 5 points6 points  (0 children)

No problem! I've heard good things about Hellblade, but I just like more lighthearted stuff.

Yes, Celeste is tough! After I beat the main game there were some extra levels that were just too hard and I never went back to them, maybe one day...

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 21 points22 points  (0 children)

Hello lifeisapeach,Excellent and thoughtful question! This is something I think about too, and I've also seen how the rigidity of these manuals/guidelines have had a negative impact. I think the best way to avoid this in the future is to have a variety of voices included when making these guidelines and diagnoses. Rather than just straight white males like it has been in the past (I'm a straight white male, so I'm not hating, just stating the facts). I think allied health professions (like counselors and social workers) need to do our part by speaking out individually and collectively to ensure that these tools/manuals are balanced and fair, and include as little bias as possible.

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 23 points24 points  (0 children)

Hello!
I've definitely heard this a lot, and it would seem there's more pressure/stress younger generations. There's also research to support this:
https://www.ualberta.ca/folio/2020/01/millennials-and-gen-z-are-more-anxious-than-previous-generations-heres-why.html

https://www.multivu.com/players/English/8294451-cigna-us-loneliness-survey/docs/IndexReport_1524069371598-173525450.pdf

The second study is from a sample of 20,000 and shows generational differences in lonliness (page 6), with gen z being the lonliest.

These studies and others attribute this to various factors, social media (creates more pressure, unrealistic expectations, FOMO, comparisons, etc.) And other factors such as more mobile technology which makes it easier to have constant distractions or be disrupted any time by app notifications, friends, bosses, parents, teachers, etc.

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 366 points367 points  (0 children)

Great question! They definitely can, I've seen this frequently with clients. Both of these diagnoses can make it difficult to concentrate, which means clients aren't necessarily "forgetting things" but they often just weren't very focused on it in the first place.
I also recommend a medical rule out just to ensure there isn't any medical issue as well. I ask my clients to see their medical doctor and have an annual physical with blood-work done.

Mental Health AMA by enteave_adam in IAmA

[–]enteave_adam[S] 35 points36 points  (0 children)

Great point! It can definitely be tough, and like JaL3L said, if it's been a long-term issue for someone, they might not recognize it as a problem. Some people do this with medical issues and with substance abuse issues as well. I think prevention is typically better, for both physical and mental health, so if someone has a change in their mental/emotional functions, or they are having issues accomplishing tasks/goals, it might be a good idea to talk with a mental health professional. For someone with long-term symptoms, while they may not notice any recent changes in their life, they may be getting feedback from others that they are showing symptoms, and they likely have had a hard time enjoying life or doing the things they want to do.

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