Tag Archives: stress & anxiety

Survey says: America is stressed out

By Bethany Bray March 14, 2017

Infographic by the American Psychological Association, APA.org

In five months between fall 2016 and January 2017, the overall stress levels of American adults increased from 4.8 to 5.1 on a 10-point scale, according to recent surveys by the American Psychological Association (APA).

Fifty-seven percent of the more than 3,000 people surveyed in January said America’s current political climate is a “very” or “somewhat significant” source of stress; 66 percent said the same about the future of the nation; and 49 percent reported that the outcome of the presidential election was a “very” or “somewhat significant” source of stress.

The percentage of Americans who reported experiencing at least one symptom of stress in the past month, including headaches or feeling nervous, overwhelmed, sad or anxious, increased from 71 percent in August 2016 to 80 percent in January.

Notably, APA’s August 2016 poll recorded Americans’ lowest overall stress level in 10 years of polling.

APA commissions an annual survey to compile statistics on stress and causes of stress in the United States. It completed an additional survey in January to gauge stress levels specifically in the wake of the recent presidential election.

Although the data indicated an increase in overall stress, it’s not all bad news. Forty-one percent of poll-takers said they were “significantly” or “somewhat better” at managing their stress compared with 10 years ago, whereas 39 percent said their ability to manage stress had stayed the same through the past decade.

Seventy-one percent said they have someone whom they can ask for needed emotional support but feel they still need more; 51 percent responded that they could use “at least a little more” emotional support than they currently receive.

 

 

Other notable findings:

  • Between August and January, the percentage of Americans who said that personal safety is a “very” or “somewhat significant” source of stress increased from 29 to 34 percent. This is the highest response since the question was first asked in 2008, according to APA.
  • Sixty-nine percent of blacks, 57 percent of Asians, 56 percent of Hispanics and 42 percent of non-Hispanic whites said that the outcome of the election was a “very” or “somewhat significant” source of stress.
  • The percentage of Americans saying that acts of terrorism are a “very” or “somewhat significant” source of stress increased from 51 percent to 59 percent from August to January.
  • The percentage of Americans saying police violence toward minorities was a “very” or “somewhat significant” of stress increased from 36 percent to 44 percent during the same time period.

 

Infographic by the American Psychological Association, APA.org

Infographic by the American Psychological Association, APA.org

 

 

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Find out more, including further breakdowns of the data by demographics, age, race/ethnicity and other factors, at apa.org/news/press/releases/stress/index.aspx

 

From NPR: “Feeling way more stressed out? You’re not alone

 

 

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Counselors, have you noticed clients presenting more signs of stress in recent months? Share your thoughts by leaving a comment below.

 

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

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The Counseling Connoisseur: Mini-mindfulness moments

By Cheryl Fisher November 17, 2016

I wake up in the early morning to the sound of birds chirping delightfully outside my window. I quietly make my way to my yoga room, where the gentle flow of the tabletop waterfall cascades rhythmically, inviting me to my morning meditation. I inhale deeply, letting the stream of thoughts flowing in my mind pass gracefully in and out of consciousness. I then exhale any tension or tightness my body may be holding as I sit in my deep meditation for a delicious 40 minutes.

BEEP BEEP BEEP! The sound of my alarm wakes me from my dream. I roll out of bed, grab my robe and fumble to let the dogs out, stubbing my toe along the way. Following a few expletives, I scoop the dog food into the metal bowls, toss them to the floor and make my way to the steaming shower that must quickly wash away the lingering fog from my still-sleepy brain.

I jump into my clothes, paint on some semblance of a face and pull up my hair. I grab a glass of juice, a packet of instant oatmeal and a yogurt, which will serve as my breakfast and lunch when I make it to the office. I secure the dogs and (as I exit the house) take a deep breath (holding it for the required four seconds), offer a blessing for the day on the exhale and haul it to my Jeep because I am now five minutes late for work!

Research continues to remind us of the role of mindfulness in our experience of overall wellness. Yet, a culture of “busy” permeates, sabotaging earnest attempts at a peace-filled, mindful lifestyle. Jon Kabat-Zinn, in his groundbreaking book Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness, writes, “There is something about the cultivation of mindfulness that is healing, that is transformative and that can serve to give our lives back to us.”

A practice of mindfulness extends beyond the individual practitioner and benefits those who surround her or him. Thich Nhat Hanh, Buddhist monk and author of many books, including Planting Seeds: Practicing Mindfulness With Children, offers, “When you are solid, happy and full of photo-1478980236323-01c287f81aedcompassion, you will naturally know how to create a happy family or school environment, and how to water the positive qualities in your children, other family members, students and colleagues at work.”

Although most of us would agree that this sounds divine and long to attain a lifestyle that promotes full presence, many of us struggle with the basic logistics of beginning a mindfulness practice. To devote the suggested 40 minutes a day to meditation would require many of us to eliminate sleep. I am a huge advocate for daily meditation, but I find that a 20-minute practice following my hour at the gym is about all I can devote to it daily. However, there are numerous ways that we can create moments of mindfulness throughout our day.

1) Add intention to routine activities. Routine activities can take on contemplative practice when we set our intention on being fully present in the moment. Walking the dogs, making the bed, even emptying the dishwasher can become moments of mindfulness (if we put the distractions of our phones away). For example, a morning shower is filled with sensory experiences if we allow ourselves to be present to the sensations of the water cascading down the body. We can use that time to do a body scan and note where tension is being held, then allow the warm water to release the tightness and relax our muscles.

2) Breathe through the mundane. Traffic lights are notorious stressors. We can, however, repurpose those few minutes by taking deep breaths, setting aside our agenda for the day, turning off the radio and becoming fully present in our bodies.

3) Seek consciousness through coloring. Adult coloring books have become the latest craze because they allow the individual to focus on a single task. The activity incorporates creativity and color and allows for a few moments of relaxed consciousness. Grab a book and color during breaks at work.

4) Practice jigsaw meditation. Jigsaw puzzles are another way to promote a focused meditation. Dollar stores carry small puzzles that can be placed in break rooms at work, promoting collective consciousness with colleagues. Taking a few quiet moments to focus on this task may be just what the doctor ordered to relieve stress during the day.

5) Delve into devotion moments. Opening a book with inspirational quotes can offer moments of reflection and contemplation. My recent favorite such book, The Meaning of Life by Bradley Trevor Greive, provides brief reflections captured in combination with precious pictures of animals.

6) Make time for teatime. Taking a break for a cuppa tea has long been one of my favorite routines. Tea has been a staple in China for centuries, first being used for medicinal reasons and later for more social purposes. British afternoon tea was offered to break up the extremely long time between breakfast and the fashionably late dinner, which were the only two meals served. Still, a good cup of tea in the afternoon can provide a soothing, fragrant mini-escape from a stressful day.

7) Embrace the Zen of nature. Years ago, I purchased a mini-Zen garden, filled with sand and miniature rocks, for my office. I use a small rake and create swirls and twirls in the sand as I release the tension of the day. I know other colleagues who enjoy the art of bonsai and trim their tiny trees during breaks. Nature is a sacred space that connects with us in meaningful ways. Gardening, taking nature walks, watching a sunrise or sunset — just being present to the outdoors can significantly reduce our stress levels.

8) Blow bubbles. Bubble therapy is one of my personal favorites. It requires one to take a deep breath and skillfully exhale in a way that will not burst the bubble. After a particularly stressful day, I like to take my huge bubble bottle outside and blow to my heart’s content.

9) Make a gratitude list. Counting our blessings appears to offer not only moments of mindfulness but also a shift in brain chemistry. Taking time to reflect on that for which we are grateful can promote an immediate reduction in the experience of external stressors — and the effects can linger long after the moment has dissipated.

10) Connect with others. Animals can provide connection and comfort in the most primal way. For me, watching goldfish pop to the surface during feeding and then swim gracefully among the miniatures in the bowl is therapeutic. However, few things beat a cuddle (and a good tummy rub) with my two 65-pound dogs. We all huddle together and enjoy the connection between human and animal. Of course, although I love my canine cuddles, my ultimate is simply sitting quietly and hugging my spouse for a few moments.

Armed with a handful of ways to incorporate moments of mindfulness, take a deep breath, exhale and enjoy being present in your day.

 

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Cheryl Fisher

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the pastoral counseling program at Loyola University Maryland. Her current research is titled “Sex, Spirituality and Stage III Breast Cancer.” She is also writing a book, Homegrown Psychotherapy: Scientifically Based Organic Practices, that speaks to nature-informed wisdom. Contact her at cy.fisher@verizon.net.

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Vote against anxiety: Managing 2016 election stress

By Bethany Bray October 27, 2016

If this fall’s presidential debates have left you feeling angry or dejected and the thought of finding out election results state by state on the evening of Nov. 8 makes you break out in a cold sweat, you are not alone.

More than half of U.S. adults who took a recent survey from the American Psychological Association reported that the 2016 election is either a “very significant” or “somewhat significant” source of stress. In addition, 38 percent of respondents said that political and cultural discussions on social media cause them stress.

Donkey and elephant symbols of political parties in America. USAEvery presidential election cycle brings its fair share of contention and mudslinging, but the 2016 race to succeed Barack Obama as president has been especially divisive. Many Americans can’t help but be affected, whether they’re interested in politics or not. For individuals who struggle with anxiety or have experienced trauma, grief or loss, the stress of election night – and the tumultuous weeks that lead up to it – can be especially hard.

“This election cycle has been so contentious, and there seems to be so much unhappiness on both sides of the ticket. A number of my clients have described feeling uncertain and unsafe about what the future will hold,” says Samantha Klassen, a licensed professional counselor (LPC) in Corpus Christi, Texas.

Don’t get overwhelmed, however. Election-induced stress can be avoided or lessened with a little intentionality. Here are some helpful reminders and tips from professional counselors for those experiencing election-induced stress:

 

Refocus

Reoccurring negative thoughts can impede your ability to function throughout the day. For those who are feeling anxious this election season, Klassen suggests trying to refocus their thoughts on something positive, such as thankfulness.

“Take time to practice gratitude for the things that are going well, both in your life and in the lives of others around you. When you are able to remember and appreciate the small, everyday moments, you build up a reservoir of positive emotions which can help mitigate some distress,” says Klassen, an American Counseling Association member and doctoral candidate in counselor education at Texas A&M University Corpus Christi. “Learn to recognize what is within your scope of influence and try to engage in activities which give you a sense of power. Remember that you are in control of how you spend your time, what you pay attention to and how much mental energy you expend on the election.”

 

Don’t go it alone

Keep in contact with supportive friends, family members, neighbors or co-workers through the next several weeks. If you decide to watch election night news coverage, try to watch with a friend or family member. “Having a circle of support can help mitigate some of the powerful emotions that arise,” says Klassen, a child, adolescent and family therapist and graduate assistant for the Supporting Pediatric Adjustment and Resilience through Counseling program at Texas A&M Corpus Christi.

 

Unplug or limit your news and social media usage

If election coverage – and the partisan banter that accompanies it on TV and social media – is making you stressed or angry, limit your consumption. Read just enough to stay informed, or set a time limit for yourself. Also, turn off your TV, smartphone and computer at least 30 minutes before going to bed, says Beth Patterson, an LPC and American Counseling Association member in Denver.

“I advise clients to limit their expose to television and their devices, and to turn them off when they are getting triggered [and anxiety flares],” says Patterson, a grief counselor who specializes in working with clients through loss and life transitions, trauma, depression and anxiety. “Doing so is even more important in this emotional election season. Although social media can be a beneficial tool for bringing like-minded friends together and sharing ideas, we all need to be vigilant about using Facebook and other sites in small doses only.”

 

Take time for yourself

When anxious feelings start to swell, be intentional about doing things that you enjoy. Counselors call this “self-care.” Perhaps it’s a favorite hobby, such as knitting or listening to a (nonpolitical) podcast, going for a run or having a cup of tea.

“When you feel particularly tense or overwhelmed, take a walk, meditate, call a friend or read or watch something funny or inspirational,” Klassen says. “Focus on something totally unrelated to the election. … Rumination can lead to more tension and impact your physical health as well.”

When you are consistently anxious, “hearing more distressing stories [such as news coverage] can keep you stuck much like a hamster who keeps going around in a wheel,” agrees Maggie Kerrigan, an LPC and American Counseling Association member in Westminster, Colorado. “Instead, consider engaging with people or activities that you find uplifting. Perhaps you find beauty in watching leaves fall to the ground or noticing how light strikes a building. Maybe you can seek out friends with whom you feel safe and who value kindness and generosity. Let yourself be drawn to something that represents the opposite of what causes your anxiety.”

 

Visualize something better

Feeling anxious or threatened – such as dread about the future if your preferred candidate doesn’t win – can trigger the human brain’s “fight, flight or freeze” response, Kerrigan says. When this happens, do not blame yourself, she encourages.

Instead, “use your imagination to guide you as to what you would really like to do with the distressful situation. … Perhaps you can see yourself escaping to someplace that represents paradise, with just the right people, politics and environment,” says Kerrigan, a therapist who specializes in working with adults and teens who have experienced trauma, childhood abuse or neglect. “When you think of what you don’t like about what is happening, only think of a small portion of what is wrong, rather than going into a long litany of all that distresses you. … Remind yourself that having these [fight-or-flight] feelings does not make you a bad person. It is what your brain is designed to do when it perceives a threat.”

 

Realize that past trauma can resurface

This fall, news coverage and political debates have included the topic of unwanted sexual advances. This can dredge up painful memories for people who have experienced similar trauma personally.

“You may not be consciously aware of an earlier trauma, but your body is acting in ways now that could suggest that something happened to you [in the past],” Kerrigan says. “It may be unusually tense, you may be holding your breath, digestion may be difficult or you are less interested in sex. It’s not uncommon to go years without knowing about the harmful things that were done to you as a child. If you suspect that this might be the case, consider finding a therapist to help you make sense of how your body is reacting.”

 

Stay in the moment

The concept of mindfulness – keeping your train of thought on the here and now – can be helpful when anxiety flares. Focus on where you are and what you are seeing, smelling and feeling. For example, when driving, think about the sound of the engine and how the steering wheel feels in your hands, Patterson says.

Notice your thoughts and let them go, she explains. “It is so important to keep coming back to the present moment, feel what you are feeling and breathe,” Patterson says. “If a client is having difficulty turning off their thoughts, I advise them to sit and feel both feet on the ground and take full, deep breaths with long exhalations. Imagine the breath going down their entire body, through the bottoms of their feet and into the ground. This releases the energy of the thoughts in our heads. Taking a walk while concentrating both on your breathing and each step is also immensely helpful.”

 

If your candidate loses

Regardless of who wins the election, you can make a difference locally by getting involved in your community.

“Remember that there are ways for you to take action, politically and otherwise, to feel like you’re making a difference in the issues that really matter to you,” Klassen says. “Also, recognize that there are checks and balances in our political system intended to limit the power of the executive branch – and that state and local elections also matter.”

“As a grief counselor,” adds Patterson, “I believe we are all experiencing a sense of loss this election season: loss of idealism, loss of a belief in the high standard to which we hold our leaders and, for many of us, the impending loss of the current president as our leader. It is important to validate feelings of loss that clients may feel if their candidates do not win. I always emphasize that clients should find meaningful and healthy ways to cope with loss, such as volunteering, journaling, making sure to get plenty of sleep and having healthy eating habits. Calling on those you know can be of support. Also, it is so important to take breaks from feelings of grief or anxiety by watching a funny movie, doing yoga, getting together for a fun evening with friends, playing with pets or getting out in nature.”

 

 

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If you do find yourself overwhelmed by anxiety, negative feelings or election-induced stress, reach out to a counselor.

If you find yourself in crisis, contact the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)’s 24-hour helpline at 1-800-662-HELP. Help is available in both English and Spanish.

 

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More information:

 

The American Counseling Association’s 2016 election counselor resource page: http://bit.ly/2eDlO2t

 

From the American Counseling Association’s government affairs team: “Your Voice. Your Vote. Your responsibility.” http://bit.ly/2dDTu1z

 

Data and tips on election-induced stress from the American Psychological Association: http://bit.ly/2dZmM8l

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

The tangible effects of invisible illness

By Cathy L. Pederson and Greta Hochstetler Mayer April 26, 2016

A variety of invisible illnesses can greatly impact both the physical and mental health of individuals. Some of these illnesses are debilitating, preventing participation in the normal activities of daily living. Examples include chronic fatigue syndrome/myalgic encephalomyelitis, Ehlers–Danlos syndrome, fibromyalgia, lupus, Lyme disease, multiple sclerosis, myasthenia gravis, postural orthostatic tachycardia syndrome (POTS), regional complex pain syndrome and Sjogren’s syndrome.

These disorders disproportionately affect women and are not well understood by the health care Branding-Images_invisibleestablishment or the general community. Lack of understanding can lead to feelings of alienation and hopelessness for those suffering from these disorders.

Such was the case for Natalie (case study used with permission). Seemingly overnight, she transformed from a vivacious teenager at the top of her eighth-grade class to being virtually bedridden with fatigue, dizziness and chest pain. She visited a series of doctors in search of relief. A few months later, at age 15, Natalie’s life changed forever when she was diagnosed with POTS and Ehlers–Danlos syndrome, neither of which is curable or easily managed medically.

POTS is a disorder of the autonomic nervous system in which blood pressure, heart rate, blood vessel and pupil diameter, peristaltic movements of the digestive tract and body temperature are affected. Natalie’s Ehlers–Danlos syndrome caused additional pain — her connective tissues were weak and her joints would easily dislocate. During her freshman year of high school, Natalie was bound to a wheelchair. But as a sophomore, her dizziness and other symptoms were better controlled, so she went roller-skating with friends. She broke her wrist and injured her neck that evening, and her fall triggered debilitating migraines.

Although not widely studied, rates of suicide are believed to be higher in people with chronic or terminal illness. It is unclear if physical illness alone leads to risk of suicide or whether having an illness increases the chances of developing depression or hopelessness, which then increases suicide risk.

Painful, chronic illnesses and illnesses that interfere with a person’s everyday functioning are believed to be risk factors for suicide, especially among older adults. Some illnesses associated with increased suicide risk are AIDS, certain forms of cancer, Huntington’s disease and multiple sclerosis.

Risk of suicide is often linked with co-occurring mood, anxiety and substance use disorders in this population. However, people with invisible illnesses may not necessarily be clinically depressed or anxious; instead they may feel hopeless about their prognosis, experience real and anticipated future losses, and suffer from chronic pain — all of which are potent risk factors for suicide. The basic science of these individuals’ physical condition is not well understood, which makes developing medications to treat them difficult. Most treatments are aimed at individual symptoms rather than the root cause of the problem.

It takes Natalie three times more energy than normal just to stand because of her POTS. Even making minor movements around the house and engaging in daily routines, including eating meals and showering, can be exhausting for her and increase her symptoms. Her quality of life is similar to those with congestive heart failure or chronic obstructive pulmonary disease.

At 16, Natalie endured weeklong hospitalizations for headaches and other POTS symptoms. Medications didn’t offer relief. An honor student, Natalie missed more than 70 days of school during the last half of her sophomore year. She was no better by the end of her junior year and eventually dropped out of high school. She was behind in her work and struggled to complete projects and tests that would have been easy for her when she was healthy. “It was heartbreaking,” said Natalie’s mother about seeing her daughter transform from high achiever to high school dropout.

Natalie’s family had done everything right. They took her to see physicians, followed all prescribed treatment regimens, put her in counseling and supported her through her illness. Unfortunately, medical help was evasive and mental health care was marginal. Over time, Natalie’s friends drifted away. She couldn’t be physically active, participate in community events or hold a job. Eventually, she confronted insidious suicidal thoughts.

Working with those who are chronically ill

Many chronic illnesses are not terminal conditions, but they can severely impact a person’s quality of life for decades. For example, imagine that you have POTS. You feel lightheaded every time that you stand, and you faint several times per day. You experience neuropathic pain that feels like bees stinging your arms and legs. Hot flashes arrive without warning, and you begin to sweat. Despite possessing above-average intelligence, you have difficulty concentrating and analyzing problems. Simply taking a shower drains your energy, and it doesn’t replenish itself. Your physical isolation and illness create feelings of being misunderstood and not belonging.

These feelings only increase when you finally venture out of the house. People congratulate you on your “recovery.” Friends tell you how good you look. Distant relatives offer advice about how to get better. Even worse, you are bullied, called a faker or are the target of other derogatory comments. Your boss suggests that you would feel better if you only ate right and exercised. Even your spouse says, “Just get over it!”

Counselors should not fall into these traps when working with these clients. For someone who is chronically ill, even hearing “you look good” might be equivalent to “I don’t believe that you are really sick.” Normal niceties take on special meaning and ring hollow for those with chronic illnesses.

For most people, a doctor’s visit will result in control of their illness and restoration of their health. This isn’t true for many individuals suffering from chronic, invisible illnesses. Not only are they grieving their loss of health because of their physical condition but, often, they also feel dismissed and even traumatized by their health care practitioners.

Many with chronic illness feel ignored or abandoned by doctors and nurses. Some individuals have even been told to stop fainting or to bring down their heart rate, as if they are making choices meant to curry attention. Many physicians aren’t educated about these debilitating illnesses, and specialists in these fields often have waiting lists that are years long. Imagine how such repeated, negative experiences might erode hope for recovery and lead to suicidal thinking. What is a patient to do? In the case of those with POTS, the incidence of mental illness is the same as is found in the general population. The seemingly paranoid behavior these individuals demonstrate related to their health can be the result of medical mistreatment and neglect, and it is often justified and understandable.

Sadly, invisible illness can put even the strongest relationships in jeopardy. As days turn to months and years, the constancy of chronic illness can wear on marriages, friendships and family relationships. Missed holidays, birthdays and other social events leave loved ones feeling betrayed and wondering if the person who is chronically ill could make more of an effort to be present. Friends and family members often doubt whether their loved one is sick. Some acquaintances become confrontational with the person who is chronically ill, whereas others turn passive-aggressive. Because a person’s hair doesn’t fall out with chronic fatigue syndrome, no skin lesions appear with multiple sclerosis and no significant weight loss takes place with fibromyalgia, it is easy to forget the internal battles being waged every day by those with chronic illness.

Counseling professionals are well-positioned to address the fallout of living with chronic illness. Counseling can provide something that those with chronic illness who are feeling suicidal desperately need but are often missing — a safe place where they can be heard, validated and comforted. Most important, counselors are particularly skilled at uncovering suicide risk, advocating for underserved populations and providing clinical management of complex cases.

In Natalie’s case, she was depressed from grieving her loss of physicality, friends and school. She had found some relief through the use of an antidepressant and went to counseling regularly. In the midst of a flare, her physician switched Natalie to Prozac, which she had taken previously, without considering the fact that it might increase suicidal ideation in teenagers. Natalie never mentioned the suicidal thoughts to her family or doctor. Shortly after titrating to 30 milligrams, the 17-year-old attempted suicide.

Consider physical illness part of the problem

Many people with debilitating and invisible chronic illnesses are told that it is all in their heads. As a counselor, you may be the first person who truly listens and tries to understand what is happening in the individual’s life. Don’t be afraid to suggest that someone who has especially dry mouth and eyes (Sjogren’s syndrome), fainting episodes and difficulty thinking (POTS), debilitating fatigue that can’t be attributed to known causes (chronic fatigue syndrome/myalgia encephalomyelitis, POTS, fibromyalgia, lupus) or chronic pain (complex regional pain syndrome, fibromyalgia, POTS) should get a thorough checkup with a good physician.

Consider working collaboratively with these physicians as a multidisciplinary team. Recommend someone who is a knowledgeable problem-solver to investigate underlying physical causes for the person’s anxiety or depression. In addition, assess regularly for suicide risk, especially during transitions in levels of care, and take all warning signs and risk factors seriously. Labeling a person’s symptoms as part of a recognized disorder will often be a great relief to the person psychologically.

Physical limitations and their effect on counseling

As a result of chronic illness, routine activities can cause debilitating fatigue. Standing, walking, showering, riding in the car and even attempting to focus on a conversation can quickly exhaust those with chronic illness. As their fatigue increases, brain fog also tends to increase.

As counselors, it is important to understand and recognize the effort it takes for these clients to walk through your office door. Offering small encouragements will reinforce the proactive effort they have taken to maintain their mental health and improve their quality of life.

Also note that many people with invisible illness are particularly sensitive to light, noises and smells. This is particularly true when they are flaring. Simple gestures such as closing the blinds or turning off fluorescent lights may help them conserve their energy for their work with you. Similarly, avoiding the use of candles, strong scents or incense can be helpful.

Differentiating the physical from the psychological

When working with clients who are chronically ill, differentiating their physical issues from their psychological issues can be difficult. Consulting with knowledgeable health care specialists is essential. Taking the time to learn about a client’s chronic illness can greatly increase empathy, provide authentic understanding and help in guiding the person to proper medical care.

Counselors should be aware that the coping skills people use to deal with symptoms of chronic illness can look like warning signs for depression or suicide. For example, coping skills to manage many invisible illnesses, such as staying in bed and avoiding the shower, may be unrelated to depression or risk of suicide.

In addition, dysregulation of the autonomic nervous system causes surges of norepinephrine that can lead to insomnia, anxiety or panic attacks. A person’s lack of appetite can be related to gastroparesis (paralysis of the stomach) or other digestive motility issues. Debilitating fatigue and difficulty focusing/concentrating are also common problems connected to many invisible illnesses.

At the same time, it is important to remember that individuals with chronic illnesses that involve functional impairment and chronic pain are at greater risk for suicide, so warning signs such as suicidal thoughts and threats, previous suicide attempts and hopelessness must be taken seriously. In Natalie’s case, she had confided her suicidal thoughts to her counselor. Unfortunately, her parents and doctors were unaware of the extent of Natalie’s overwhelming emotional pain until she attempted suicide.

Follow-up care after hospitalization is critical

Pursuing inpatient hospitalization for people at serious risk of suicide can be a life-saving step. However, the current health care environment poses challenges to accessing timely, quality care when needed, even for those at imminent risk for suicide. Inpatient stays are difficult to secure, and lengths of stay are minimal at best.

Individuals often transition from an inpatient level of care to outpatient settings before their stabilization, and this is not easy for individuals with chronic illness or their families. In addition, being hospitalized for mental health problems can be further stigmatizing and demoralizing for the person with chronic illness.

The period immediately following hospital discharge is particularly dangerous for people at risk for suicide. Counselors operating from a multidisciplinary framework can mitigate this risk (with permission of the person with chronic illness) by coordinating care with hospital staff, medical specialists and key family members.

Providing continuity of care also helps with stabilization, engagement and retention in aftercare. Long-term counseling is necessary to strengthen the person’s reasons for living and to uncover the problematic situations and underlying psychological vulnerabilities that led to the suicidal crisis.

“After 12 inpatient days and nine partial hospitalization days, I’m starting to feel confident that she is on the road to recovery,” Natalie’s mother reported. Natalie’s medications were changed, and she passed the GED test in lieu of her high school diploma. She is now on the road toward college. We hope that sharing her story can help to prevent suicide attempts in other young adults with chronic illness.

 

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Cathy L. Pederson holds a doctorate in physiology and neurobiology. She is a professor of biology at Wittenberg University and founder of Standing Up to POTS (standinguptopots.org). Contact her at cpederson@wittenberg.edu.

Greta Hochstetler Mayer holds a doctorate in counselor education and is a licensed professional counselor. She is the CEO and initiated suicide prevention coalitions for the Mental Health & Recovery Board of Clark, Greene and Madison Counties in Ohio. Contact her at greta@mhrb.org.

Letters to the editor: ct@counseling.org

 

Validating the quarter-life crisis

By Lynne Shallcross April 22, 2016

More than a decade ago in the song “Why Georgia,” musician John Mayer put words to a phenomenon that many 20-somethings sense all too well.

“I rent a room and I fill the spaces with/ Wood in places to make it feel like home/ But all I feel’s alone/ It might be a quarter-life crisis/ Or just the stirring in my soul/ Either way I wonder sometimes/ About the outcome/ Of a still verdictless life/ Am I living it right?”

Despite its inclusion in a hit pop song, the quarter-life crisis isn’t always taken seriously by society at large. “Nobody questions the midlife crisis,” points out Cyrus Williams, an associate professor in the Branding-Images_quarter-lifeSchool of Psychology and Counseling at Regent University, but the same isn’t always true of the quarter-life crisis, which Williams defines as a period of significant life and career transitions for young adults between the ages of roughly 22 and 30.

“As a culture, we all think that age 25 is the best stage of your life — these folks are happy, they’re doing everything they want and it’s a great time of life,” says Williams, an American Counseling Association member who has been studying and speaking about the quarter-life crisis for more than five years.

In the counseling session, however, the quarter-life crisis — a developmental time period of potentially high anxiety — needs to be given the same level of respect and attention as the midlife crisis rather than being dismissed out of hand, Williams says. “We really need to acknowledge and not minimize this time period,” he emphasizes.

Decisions, decisions, decisions

In their early 20s, many young adults are graduating from college and find themselves faced with a deluge of life transitions, Williams explains. There are choices and changes swirling around them in almost every major area of life.

They are deciding where to live, whether moving to their own apartment (or a shared living space) in a new city or back into their parents’ home. They want to pursue a career but sometimes find themselves stuck in entry-level jobs that don’t pay their bills or student loans. They wonder whether they should already be in a committed relationship headed toward marriage and a family. They question whether and how they will develop new friendships while hanging on to old ones from their high school or college days.

All of those issues can lead to feelings of anxiety, fear, instability and an existential crisis of “Who am I?” Williams says. “There are too many choices, too many decisions to make, and it’s scary,” he says.

This time in life can also dredge up self-doubt, says Melissa Nelson, a doctoral candidate in counselor education and supervision at Regent University who has been researching the quarter-life crisis with Williams. For example, some young adults might see that a peer has landed a successful job and become financially stable and start wondering why they haven’t been able to follow the same timetable. This can make young adults question themselves, their decisions and their abilities, says Nelson, a member of ACA. “Did I major in the right thing? Is there something wrong with me?”

It isn’t uncommon for clients in their 20s to present in the counseling session with feelings of depression and anxiety, says Katherine Hermann, an assistant professor in the Department of Counselor Education at the University of Louisiana at Lafayette. The idea of leaving a close-knit community, whether the town where someone grew up or the circle of friends an individual developed at college, can be isolating, says Hermann, who has presented on transitions in adulthood. The search for a romantic partner can also feel isolating and provoke anxiety, she points out.

Young adults in this stage may also feel a sense of betrayal, Williams says. Many of these individuals have grown up being told by parents, teachers and others that if they follow the rules and check all the boxes they’re instructed to, life will work out as it is supposed to. When things don’t fall into place that seamlessly, Williams says, these young adults feel lied to.

In such cases, Williams says, it can be helpful if counselors talk through those feelings of betrayal with clients, allowing them to express why things feel unfair and then working together to move forward past those feelings.

All of the anxious feelings that are normally experienced at this time of life can be exacerbated by social media, Williams adds. For instance, on Facebook and Instagram, people tend to post messages and photos documenting only their best experiences, which doesn’t translate to a realistic account of life. “That is one of the things that other generations didn’t have to deal with,” Williams says. “They [didn’t] have to have this in their face every day of ‘Wow, my friend is having a great life and I’m not.’”

Nelson agrees. It is easy for people in this stage of life to get caught up in comparing themselves to peers who post photos or messages related to career success, romantic adventures or starting a family. “What does that mean for an individual who doesn’t have those things yet?” Nelson asks.

One key is for counselors to talk with these clients about how social media rarely shows the day-to-day reality of people’s lives, Williams says. That simple action can help young adults begin to put things in the proper perspective, he adds.

Keep your ‘therapeutic antennae up’

With all those choices and transitions hurtling toward young adults in rapid succession, how can counselors help most? “I wish there was a magic answer,” says Hermann, a member of ACA. Short of that, developing a strong therapeutic relationship is perhaps most important, she says, along with gathering and attempting to understand the perspective of the client as much as possible.

“I think having your therapeutic antennae up is one of the most important things,” says Hermann, who adds that the client’s presenting problem isn’t always the real problem. Get to know these clients and work on the issues they present with, she says, but also be open and attentive to exploring other issues of which they may not even be aware.

Counselors should also know that these clients aren’t afraid to walk through your door, Williams says. “This generation is not like generations in the past,” he explains. “There’s not a stigma involved in mental health issues [with them]. They’ll come in to your office and they’re like, ‘Listen, I’m stressed out, I’m anxious. I need some help.’”

In return, Williams says that he stands ready to help these clients identify what they are experiencing. He specifically uses the term quarter-life crisis with young adult clients because he says it is empowering for them to hear a phrase that defines their experience. “It’s liberating for them,” Williams says. “They’re like, ‘Holy crap. OK. I get it. This is what I’m going through right now.’ So normalizing this is very important.”

Nelson agrees, adding that 20-somethings are reading magazine articles and self-help books on this topic as a way of finding support and normalizing their experience. “If we as counselors and therapists don’t do the same in normalizing this and recognizing this,” Nelson says, “then we’re not providing the comprehensive services that we need [to].”

Even if career counseling is not a counselor’s specialty, being well-versed in career counseling topics is imperative when working with these clients, Nelson says, because career issues are intricately tied to many other areas of life, from identity to finances to relationships. For example, Nelson says, paying for a house or paying for child care is tied to family and partner relationships, but it is also dependent on career decisions. That means that even if a counselor doesn’t specialize in career or academic counseling, it is critical to have a basic understanding of those areas of counseling, she says.

On the flip side, Nelson says, career counselors might have young adult clients come in for help writing résumés, only to discover that their parents are pressuring them to create the “perfect” résumé in order to find the “perfect” job. Or perhaps a counselor working with a couple in premarital counseling might find that one member of the couple is struggling with career and financial worries. Nelson suggests that counselors try to look holistically at everything going on in these clients’ lives.

Williams points out that, of course, not every 20-something is going to experience a full-blown “crisis.” But the potential is there for these various life transitions to lead to crisis if young adults don’t have the coping skills and supports in place to weather changes in a healthy way, he says.

Counselors would be wise to do assessments with these clients at the outset of counseling, Williams says, especially to help determine whether they might be experiencing clinical depression or anxiety. Then, he says, counselors should hear these clients out and try to understand where they’re coming from.

Williams often explores existential questions such as “Who am I?” and “What do I want to do with my life?” with clients in this age group. He also reminds these clients that the answer to what they want to do with their lives doesn’t necessarily have to be related to their jobs; a job can pay the bills without necessarily “satisfying” or defining every aspect of the person. Williams prefers a holistic perspective, asking clients to think about what things in life make them happy, bring them meaning and help them make sense of the world.

No one right approach

When working with clients on quarter-life crisis issues, Williams suggests that practitioners remember to keep the counseling brief. Although these clients tend to be more willing than generations past to seek out counseling, they also generally want a faster route to a solution, not years of sessions, he observes.

“They come to counseling, but they don’t stay in counseling,” Williams says. Brief, solution-focused and existential approaches are often the best alternatives with these clients, he says. At the same time, many young adult clients aren’t afraid of doing work toward arriving at the solution, he adds, so counselors shouldn’t hesitate to suggest books for them to read, questions for them to ponder or other homework for them to do between sessions.

When deciding which interventions to use with these clients, Nelson suggests that counselors familiarize themselves with the literature on evidence-based practices related to life transitions, such as the school-to-work transition or the transition of becoming a family. Because the quarter-life crisis is a newer area of study that hasn’t yet been extensively researched, Nelson says it is hard to pronounce whether one counseling approach would be more effective than another. She believes almost any evidence-based approach can be effective with these clients, although she tends to lean toward existential-based approaches.

Williams came up with an intervention that he calls the “NEEDS” approach. The “N” stands for normalize, which all three counselors interviewed for this article highly recommend trying to do with clients confronting a quarter-life crisis.

The first “E” stands for empower. Williams says counselors can do this by arming these clients with anything from books to YouTube videos that will help them feel less alone and more confident that what they are experiencing is real.

The second “E” stands for taking an existentially focused approach. Williams says this involves helping clients explore who they are, what their calling is and the “why” behind it. For example, if young adult clients are focused on landing a particular job or moving out of their parents’ house, Williams will ask them to examine the “why” behind those desires.

The “D” stands for a developmental approach, in which Williams encourages clients to explore the “long continuum” of their lives, and also the decision-making skills that are required at this time in life. The decisions that 20-somethings make can have consequences that extend into their later years, he points out. For example, some young adults make the decision to run up their credit card debt so they can rush to move out of their parents’ home, while others decide to get married and have children before they are truly ready.

The “S” stands for screening and assessment, which Williams says is a must in determining whether clients are experiencing a normal transition or if their experience has crossed over into crisis mode.

Prevention where possible

Although counselors must be prepared to help 20-somethings who already find themselves in the midst of a quarter-life crisis, Nelson says practitioners should be thinking with a preventive mindset whenever possible. For example, she says, counselors who work with college students can help those students better prepare for what lies ahead by engaging them in exercises to build their self-esteem and raising their awareness of the challenging decisions and transitions that might pop up in the near future.

University counseling centers might be able to offer graduating students continued career counseling services until they land jobs, Nelson says. If such services aren’t feasible, she suggests that college counselors ensure that their clients who are graduating leave the school equipped with referral sources. She encourages college counselors to add website resources for recent graduates “who are feeling the heat of the quarter-life crisis.”

Nelson says counselors must do what they can to arm graduating students with the tools they need before they actually need them. “Getting the information out there and the resources out there before it becomes a problem is really important,” she says.

In preparing to work with clients on issues related to the quarter-life crisis, Nelson says it is crucial for counselors to be aware of changing cultural dynamics. For example, she says, counselors should understand how social media can further complicate life transitions for young adults and how changes in unemployment rates and student loan rates can have “very real implications” during an already frightening time period for 20-somethings.

Counselors who desire to work with young adult clients should read more about this generation, Williams says. Understand what makes them culturally unique, what is significant to them and what has shaped their lives. Among the resources that Williams suggests is the 2001 book Quarterlife Crisis: The Unique Challenges of Life in Your Twenties by Alexandra Robbins and Abby Wilner.

“Cultural shifts of parenting style and expectations are one of the greatest mitigating factors in understanding millennials,” Williams says. “Concepts such as positive reinforcement rather than punishment, or self-esteem building rather than tough love, became popular during the millennials’ formative years. Millennials were revered by parents and sheltered from the world, developing unrealistic expectations of self and never learning skills necessary for survival in the ‘real world.’ Often they have been sheltered so much that they have not been allowed to learn to survive on
their own.”

“In addition to the confounding dynamics such as parental influence, millennials have come to age during a period of significant corporate downsizing, unemployment, underemployment and outsourcing,” Williams continues. “The estimated unemployment rates for young adults are more than double that of overall unemployment rates. As a result, young adults face increased financial stressors, often resulting in an inability to pay student loans, save for retirement or maintain independent living. It is estimated that approximately 44 percent of recent college graduates are currently experiencing underemployment, working in fields and positions in which they are overqualified. Like many other generations, work is a crucial aspect of one’s identity and expression of self. Consequently, when employment aspirations and ideals are not met, crises of personal identity may result.”

Hermann agrees. “Understanding the culture of this population will be important to sustained treatment success,” she says. “I think a systemic perspective is very important, and understanding the individual within [his or her] environment, especially as it pertains to relationships — family of origin, intimate, social, professional — is imperative to treatment.”

Hermann recommends two journals published by ACA divisions to counselors who might be working with this population. One is Adultspan Journal (published by the Association for Adult Development and Aging), which includes topics relevant to young adults. The other is the Journal of Creativity in Mental Health (published by the Association for Creativity in Counseling) “because of the innovative, therapeutic applications that engage and challenge clients to think differently,” she says.

Expert wisdom

To help counselors better prepare to work with clients undergoing a quarter-life crisis, Counseling Today asked these experts to weigh in with their best advice and guidance. Here are their top tips.

  • Don’t minimize the quarter-life crisis, Nelson says. “Far too often, that’s one of the reasons that an individual is there [in counseling] in the first place.” In many cases, parents, peers or co-workers have minimized what these 20-somethings are experiencing, which only ends up increasing the pressure on them, Nelson says.
  • Do focus on wellness, decision-making and the future, Williams says, not pathology.
  • Don’t make assumptions, Hermann says. “Every client has a different past and goals for the future. Focus on the individual,” she says. Although counselors develop models and frameworks to understand patterns, “every person is a unique human,” Hermann reminds her colleagues.
  • Do your research, Nelson says. Become aware of factors outside of your counseling specialty or area of practice that may be affecting young adults. “Awareness is half the battle,” she says.
  • Do make it clear to these clients that this is short-term counseling, Williams says, “because you lose Generation Y if you are going to ask them to come back for 15 sessions. They really need to see the end from the beginning.”
  • Don’t rely solely on clinical intuition, Williams adds. “I love the fact that we are intuitive, but we have instruments and science out there that can help us,” he says.
  • Do consider group therapy. “If you are working in a setting that has the ability to utilize group therapy and group counseling interventions, I would say go for it,” Nelson says. “I think that group counseling can really help that process of normalizing the crisis [and] developing a support network for individuals beyond their counselors.”
  • Do take the time to explore the individual’s relationships, including family relationships, intimate relationships, friendships and work relationships, Hermann says. “This exploration will give counselors an understanding of the individual and also the depth and capacity of [his or her] support group. In addition, so many of the changes that occur during this developmental period are connected to changes in relationships, so having a complete understanding of the relational aspects of an individual can be helpful in understanding and focusing a treatment plan.”
  • Do encourage these clients to address their relationship with their parents, Williams says. It is a relationship that has likely changed now that these young adults are in their 20s, but it is a relationship and an influence that has long been paramount to them, he says.
  • Do normalize the crisis, Nelson says. Point clients toward books or other resources to help them recognize that they are not alone in experiencing these struggles and challenges.
  • Do explore identity development with clients, Hermann says. What is meaningful to them, and how do they create meaning?
  • Do give these clients resources, books to read and homework to do, Williams says. They are typically used to being on the computer and doing research, so they are likely to engage in the homework related to their own counseling, he says.
  • Do ask questions and then address any issues that become apparent from the answers, Nelson says. “Is it stressful to pay your student loans each month? Is it stressful to be pressured by your parents to be married and to have children, and how are you dealing with that?” Nelson suggests asking. “I don’t think that counselors need to be afraid and shy away from addressing the quarter-life crisis.”

 

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To contact the individuals interviewed for this article, email:

 

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Lynne Shallcross, a former associate editor and senior writer at Counseling Today, works for Kaiser Health News as a web producer. Contact her at lshallcross@gmail.com.

Letters to the editor: ct@counseling.org