Tag Archives: stress & anxiety

Living with anxiety

By Bethany Bray May 24, 2017

Anxiety disorders are the most common mental illness in the United States, affecting 18 percent of the adult population, or more than 40 million people, according to the National Institutes of Health. Among adolescents the prevalence is even higher: 25 percent of youth ages 13 to 18 live with some type of anxiety disorder.

Anxiety disorders are often coupled with sleeplessness, depression, panic attacks, racing thoughts, headaches or other physical issues. Anxiety can run in families and be a lifelong challenge that spills over into all facets of life, from relationships and parenting to the workplace.

The good news is that anxiety disorders are manageable, and counselors have a plethora of tools to help clients lessen the impact of anxiety. Caitlyn McKinzie Bennett, a licensed mental health counselor, says she regularly talks this through with her clients at her private practice in Orlando, Florida. She often uses an analogy of ocean waves with clients: Anxiety comes in waves, and managing the disorder means learning coping tools and strategies to help surf those waves rather than expecting the waves to disappear entirely.

“Anxiety can be a long-term thing,” says Bennett, who is also a doctoral student in counselor education at the University of Central Florida. “With clients, I try and explain that [anxiety] is the body’s response that something’s not right — based off of what’s happened to you [such as past trauma] or what’s happening currently. Then we can work to accept it, cope and be happier in your life. Some things you can’t necessarily get rid of in their entirety, and that’s OK. It’s learning to be you and have a fulfilling life with anxiety, where you’re able to feel anxious and [still] be productive and be a mother, a student, a partner. I try and normalize that [anxiety is] going to come and go. It’s OK, and it’s human.”

Anxiety doesn’t happen in isolation

Everyone experiences anxiety from time to time, such as worry over an upcoming work responsibility, school exam or first date. Anxiety disorders, however, are marked by worry and racing thoughts that become debilitating and interfere with everyday functioning.

“It’s a normal part of life to experience occasional anxiety,” writes the Anxiety and Depression Association of America on its website (ADAA.org). “But you may experience anxiety that is persistent, seemingly uncontrollable and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.”

A number of related issues fall under the heading of anxiety disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including specific phobia, panic disorder, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder and others. According to the DSM-5, anxiety disorders “include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat.”

Racing thoughts, rumination and overthinking possibilities — from social interactions to decision-making — are central to anxiety. In addition, people with anxiety often struggle with insomnia or sleeplessness and physical symptoms such as a racing heart, sweaty palms and headaches, says Bennett, an American Counseling Association member who is currently leading a study for her doctoral dissertation on the effects of neurofeedback training on college students with anxiety. Adolescents sometimes turn to self-harming behaviors such as cutting or hair pulling to cope with anxiety. In adults and adolescents, anxiety can manifest in physiological issues such as stomachaches or irritable bowel syndrome. Although adults may channel their anxiety into physical problems, they’re also generally much more capable than adolescents and children of identifying and articulating the anxious thoughts, ruminations and social struggles that they’re facing, Bennett says.

Bennett worked with a 14-year-old female client whose anxiety had manifested as the behaviors of obsessive-compulsive disorder (OCD), including avoiding the number six, leaving her closet door open a certain way and struggling with crossing thresholds. Bennett worked with the client to identify her triggers and find coping mechanisms, such as connecting with friends and her Christian faith.

“A big part of her improvement was creating the awareness of what was happening,” Bennett says. “Typically there’s a large, irrational fear. With her, she was afraid that her mom was going to die. She would focus on it so much that it would cause her to start the [OCD] behavior. … For her, it felt so real. It was so scary for her that she felt compelled to do these behaviors to keep her mom alive, so to speak.”

Bennett worked with the young client to confront her fears in small doses through exposure therapy, such as listening to a song at volume level six and talking through how she felt afterward. This method allowed Bennett to first address the client’s OCD behaviors and then — once trust was built and the client had progressed — move on to work through the bigger, deeper issue of her fear of her mother’s death.

“It helped her to feel safe enough and have the confidence to work through some smaller things and move on to work on bigger things,” Bennett says. “For her it was talking it out, normalizing that for her and drawing attention to [her anxious behaviors].”

Christopher Pisarik is an associate professor in the Division of Academic Enhancement at the University of Georgia and a licensed professional counselor (LPC) who works with students in need of academic support. He says that stress and irregular sleep and eating patterns — which are often ubiquitous parts of college life — can go hand in hand with anxiety.

“Sleep is a big one — if they’re just not sleeping, or sleeping too much,” says Pisarik, who also treats many college-age clients at his private practice in Athens, Georgia. “This is really, really common — clients who can’t get to bed until 4 a.m., and then they can’t get to class, and it snowballs. Their thoughts just race with worry. … Sleep seems to be a big diagnostic indicator [for anxiety], and not being able to go to bed. [I ask clients,] ‘What are you thinking about, and can you stop thinking about this? Is that what’s keeping you from getting back to sleep?’ They get tired and fatigued, and it’s perpetuated.”

In addition, anxiety is often coupled with — or is an outgrowth of — other mental illnesses, most commonly depression. Counselors will need to treat a client’s anxiety alongside other diagnoses, Bennett says. For example, a client with schizophrenia will have hallucinations that provoke extreme anxiety. If the counselor doesn’t address the client’s anxiety, those symptoms will get worse, explains Bennett.

“Depression and anxiety are like brother and sister,” she adds. “They play off of each other and exacerbate the symptoms. You need to work through both. I don’t think I’ve ever worked with anyone who solely experienced anxiety.”

Stephanie Kuhn, an ACA member and LPC at the Anxiety Treatment Center of Greater Chicago, agrees. She regularly sees client anxiety paired with other issues such as specific phobias, insomnia, chronic pain issues, depression, panic disorders and OCD.

“It’s never really one thing,” Kuhn says. “It’s never just anxiety.”

Pumping the brakes on racing thoughts

The first step for many people who struggle with anxiety is to create awareness of their thoughts and then learn to manage those thoughts with a counselor’s help. Although the strategy of identifying negative self-talk and addressing one’s thoughts is old hat to most counselors, it may be an entirely new concept for some people, especially younger clients, says Pisarik, an ACA member who uses cognitive behavior therapy (CBT) in his private practice. Clients with anxiety often polarize, exaggerate or catastrophize details in their minds as they ruminate over them, he explains.

“Even being able to identify anxious thoughts is big,” Pisarik says. “They just assume it’s normal to walk around [feeling] anxious because of these thoughts. … It gives them a language and a real usable and rudimentary skill they can use in the moment when they’re walking in [to a stressful exam]. They can identify that their inner narrative isn’t healthy.”

For example, a college student might come to a counselor expressing worry about an upcoming exam in a class that he or she needs to pass for a major in pre-med. The student might have allowed negative and catastrophic thoughts to snowball: “If I get a C on this test, I will never get into medical school, which will derail my entire career plan and make my parents angry and disappointed.”

“For … a student who is 20 years old and [still] learning to think critically, it would be easy to blow everything out of proportion and catastrophize everything,” Pisarik says. “I am really big on helping them understand negative thinking and false cognitions, and getting them to self-monitor and renarrate [their unhealthy thoughts].”

Following the CBT approach, Pisarik says he would talk such clients through their thought patterns to identify and restructure their negative thoughts about the exam. He would also suggest that they focus on and remind themselves of prior successes, such as other exams or classes in which they earned A’s and B’s.

“I would try and systematically educate the client [about] what type of thinking that is,” Pisarik continues. “There are many doctors out there who got C’s and got into medical school, and probably [who] got C’s in medical school. I will explain that they are catastrophizing this … [and] try and get them to think about it in a different way, evaluate it carefully and create a different narrative about it. Are there people who have gotten C’s and gotten into medical school? If it stops you from getting into medical school, would that be the worst thing in the world?”

“It takes a consistent effort to practice and challenge one’s thinking,” adds Pisarik, who co-authored the article “A Phenomenological Study of Career Anxiety Among College Students.” The article will be published in the December issue of The Career Development Quarterly, the journal of the National Career Development Association, a division of ACA.

CBT works well for anxiety because “it lets people see that their own thinking and their behaviors are not productive for the way they want to live or the life they’re living right now,” says Kuhn, who uses both CBT and exposure therapy with her clients at the Anxiety Treatment Center of Greater Chicago. “It’s giving people an outside perspective — getting them to look at their own thoughts and behaviors objectively rather than letting those anxious thoughts take over everything, making it harder to function.”

One way Kuhn works with clients on challenging their unhealthy thoughts is by asking them to identify the best, worst and most likely outcomes of situations they are ruminating over. “I ask, ‘Would [the outcome] matter in a week, a month or a year from now?’ Typically the answer is no,” Kuhn says. “After we go through that, we reframe the original thought [and] transform it into something more rational, more realistic.”

Both Pisarik and Kuhn encourage their clients to keep thought logs to track anxious thoughts and the situations that triggered them. This exercise increases self-awareness, helps identify triggers and creates an opportunity to discuss how the client might change the negative narrative.

“Writing helps a lot because it slows people’s minds down, and they can go back and read about it,” Kuhn says. “Creating that awareness is the only way to understand yourself, understand what you’re worried about and be able to accept it and push it away.”

In addition to using thought logs, Pisarik gives his clients a list of automatic negative thoughts, or ANTs, to check themselves against. The collection lists the most common types of unhealthy, anxious thoughts and types of thinking, including catastrophizing and either-or thinking (polarizing).

Kuhn has a particular phrase that she often repeats with clients: “Handle it.” She acknowledges that it’s not the most empathic of mantras, but it does help to focus on the manageability of anxiety. With clients, she works toward a goal of “being able to sit with the uncomfortableness [of anxious thoughts] and tolerate the stress.”

Kuhn says her style when working with clients matches her personality: “Let’s go forward and hit our fears hard instead of tiptoeing around them.”

Exposure therapy, which introduces things in small, controlled increments in session that make a client anxious, is another good way to focus on handling anxiety, Kuhn adds. Whether the scenario is a fear of speaking up in class or a fear of being rejected by a loved one, exposure therapy can help clients learn to live with the issue and the anxious feelings that come with it.

“When I talk to people about ‘handling it,’ it’s creating that awareness and understanding [of] themselves that they’re able to manage or take on more than they think they can,” Kuhn says. “Anxiety a lot of the time makes us believe that we can’t handle the tiniest things. That’s why our body has created or learned how to respond to things in an overactive or hypersensitive way.” This is most commonly experienced in our fight-or-flight response, she says.

Managing worry and taming anxiety

From CBT and mindfulness to a focus on wellness and coping strategies, professional counselors have a wide range of tools to help clients who struggle with anxiety. Here are some ideas and techniques that can be particularly useful.

> Controlling the controllables. Kuhn says it can be helpful for clients to talk through and identify what is out of their control during situations that make them anxious. “A lot of times, anxious clients want control over everything, and that’s just not realistic,” Kuhn says. “It’s important to go over what’s controllable and what’s not. That creates awareness and a pathway to reevaluate [their] own thinking and behavior. I like to call it ‘controlling the controllables.’ I talk with clients about this a lot.”

Kuhn often uses an exercise with clients in which she draws a target with concentric circles. Things that clients can control, such as their own thoughts and behaviors, go in the center circle. Things that they partially control, such as their emotions or what they focus on sometimes, go in the middle ring. Things that are out of their control, such as what other people think or do, go in the outside circle. In a simpler alternative, Kuhn draws a center line down a piece of paper and works with clients to list what is and isn’t in their control in situations that make them anxious.

> Creating common ground. Kuhn says she also talks openly with clients about how common anxiety is, alerting them that they are among literally millions of Americans who are battling the same challenge. “I let them know they are not alone. It creates a universality,” Kuhn says. “To let people know that they’re not the only ones suffering like this can help. … It does create a common ground for people not to feel ashamed of [their anxiety] or feel like they can’t talk to someone about it. Just creating that education typically makes people feel a ton better.”

> Acknowledging and naming worry. Journaling and making lists to document anxious thoughts can help clients address and reframe the everyday rumination that accompanies anxiety. Kuhn offers two variations on this intervention: worry time and the worry tree.

With “worry time,” clients set aside a dedicated amount of time (Kuhn suggests 30 minutes) every day to write down any anxious thoughts that are troubling them. Clients don’t need to engage in long-form writing to complete this exercise, Kuhn says. Making a bulleted list or jotting thoughts down on sticky notes will work just as well. When the designated time is up, clients put all the notes in a box or container that they have set aside for this purpose. This action signifies that they are leaving those thoughts behind and can move on with the day.

“They have to leave those thoughts or sticky notes there and be done with them,” she says. “Obviously more [anxious] thoughts will come, but you have to remind yourself to leave them behind.”

With Kuhn’s “worry tree” intervention, clients create a flowchart of their anxious thoughts. With each item, clients ask themselves whether their worry is productive or unproductive (see image, below). “Is it something that you can actually do something about?” Kuhn asks. “If it’s unproductive, then you need to just let it go. Do something you enjoy or focus on something else to reset [your mind].”

 

> Mind-body focus and exercise. Mindfulness, meditation and other calming interventions can be particularly helpful for clients with anxiety. Kuhn recommends the smartphone app Pacifica, which prompts users with breathing, relaxation and mindfulness exercises, for both practitioners and clients. Kuhn, who has a background in sports counseling, and Pisarik, who is a runner himself, also prescribe exercise to anxious clients. Exercise boosts serotonin, a neurotransmitter connected to feelings of well-being, and comes with a host of other wellness benefits. In addition, exercise allows a person to get outdoors or disengage from work and home activities and other people for a brief period to “have time to hear your thoughts and challenge them,” Pisarik says. “You have to hear your thoughts if you’re going to challenge them.”

> The butterfly hug. Beth Patterson, an ACA member and LPC with a private practice in Denver, teaches deep breathing exercises to anxious clients to help them become grounded, focusing on the flow of energy through the body. She also recommends the “butterfly hug” technique. With this technique, clients cross their arms across their chests, just below the collarbone, with both feet planted firmly on the floor.

Clients tap themselves gently, alternating between their right and left hands. This motion introduces bilateral stimulation, the rhythmic left-right patterns that are used in eye movement desensitization and reprocessing. “It’s phenomenally self-soothing,” Patterson says. “Doing that with deep breathing really helps with anxiety. I love the idea that you’re hugging yourself. Even just doing that helps.”

> Walk it out. Along with deep breathing and grounding, Patterson also recommends walking and movement for clients who are feeling anxious. She instructs clients to focus on the feeling of each foot hitting the ground instead of their anxious thoughts. As with the butterfly hug, this action creates bilateral stimulation, Patterson notes.

Bennett also uses walking as a way to help clients refocus their thoughts. She will take clients out of the office during a session for a “mindful walk” up and down the block. During the walk, they talk about what they’re sensing, from the sunshine to the breeze to the smell of flowers. Bennett says this allows her to work with clients “in the moment,” recognizing and refocusing anxious thoughts as they come. Afterward, they process and talk through the experience back in the office.

“It’s a lesson that [anxious] thoughts are going to come up for you, and you can refocus on your sense of touch or hearing,” Bennett says. “Thoughts will come up, and it’s really easy to attach to those thoughts and become anxious, but we can acknowledge the thought, be accepting of it in the moment and refocus. Change and connection can come that way.”

> This is not that. Clients commonly transfer anxiety-provoking personal issues onto relationships or situations in other facets of life, including the workplace, Patterson says. For example, Patterson worked with a client who had a very domineering, controlling mother, and this client felt triggered by a female boss in her workplace. Patterson introduced the client to the mantra “this is not that,” and they worked on reframing the anxiety the client experienced when she felt her boss was being controlling.

“She had to work through it in a beneficial and compassionate way for herself and really remember ‘this is not that,’” Patterson says. “Our minds are brilliant, but they’re binary computers. When something happens, it will immediately associate it with something else it knows. If a co-worker is being overly competitive, it might trigger feelings about sibling rivalry. This [mantra] offers a great opportunity to work through family-of-origin issues [with clients] when you see them replicated in the workplace.”

> Abstain from negativity. Another empowering tool clients can use is to become conscious of and then avoid unhealthy or toxic situations and people who trigger their anxiety, Pisarik says. He advises clients to “stay away from groups of people or individuals who they know will engage in negative self-talk or negativity. If you’re feeling anxious already, the last thing you want to do is to go and talk to that toxic person.”

Similarly, he commonly advises anxious students to avoid waiting outside the room where they’re about to take a big exam, surrounded by 30 classmates who might be saying that they are going to fail, they didn’t study enough, they don’t feel prepared and so on. Counselors can coach anxious clients to think ahead and prepare ways to remove themselves from these types of situations, regroup and redirect their thinking, Pisarik says.

> Lifestyle choices. Counselors can also educate clients on the connection between anxiety and lifestyle choices such as sleep patterns, exercise and diet, Pisarik says. For young clients especially, this also includes social media use, he notes.

Pisarik says he frequently talks with his college-age clients about their alcohol consumption, drug use, irregular diet and other aspects of the modern university experience. “The lifestyle of a college student is absolutely conducive to generating anxiety,” he says. “While they are college students, I get that — their job is to have fun and sleep whenever [they] want. But building some sort of healthy routine is important, [including] getting enough sleep and making sure they eat well. I tell them to try and maintain the diet they had at home. … If you’re struggling with anxiety to begin with, any one of those [elements] can add to it, and those are really easy fixes.”

For Bennett, conversations with clients about lifestyle also include questions about smoking and caffeine use. Both tobacco and caffeine can make a person shaky or make his or her heart and mind race, which can trigger or exacerbate anxiety, she points out.

In addition to social media use, Pisarik also asks clients about their social engagement, such as participating in sports or other hobbies. Clients who struggle with anxiety often isolate themselves, he notes, so he works with them to identify social outlets, from volunteering to joining a school club. This sense of connection can reduce anxiety, he says.

> Narrative therapy and externalization. Patterson finds narrative therapy helpful when working with clients with anxiety because it allows them to externalize what they’re feeling. When clients uses phrases such as “I am worried” or “I am anxious,” Patterson will gently redirect them by saying, “No, you’re Susan, and you have a problem called worry.”

“Externalize the problem,” Patterson explains to clients. “Externalize it and dis-identify it. See it outside of yourself. … ‘I can deal with that because it’s not who I am.’ … If you’re carrying it around as if it’s you, you can’t do anything about it. The truth of the matter is, it’s not you.”

Counselors can also help clients with anxiety to focus on a time in their lives when they faced a similar challenge and got through it, Patterson says. She asks clients questions to help them probe deeper. For example: How did you handle that challenge? What worked, and what didn’t work?

 

Working with clients on medication

Anti-anxiety medications are commonly prescribed in the United States. Their prevalence means that counselors are likely to encounter clients who are taking medication to control their anxiety symptoms.

Regardless of their feelings about the use of psychotropic medications, practitioners must treat and support clients who are taking such medications the same as they would any other client, Kuhn says. “I never treat someone differently based on their medication. They get the same CBT therapy that anyone else would get,” she says, adding that the most important thing is to ensure that clients don’t feel judged by the counselor.

Kuhn has seen anti-anxiety medications work well for some clients. “It can take that little edge off that they need to get through the day and be able to function,” she says. At the same time, she also has clients who express a desire to be able to stop taking their medication eventually.

Pisarik notes that for anti-anxiety medication to work well, clients must remember to take it faithfully, keep track of how it makes them feel and schedule the repeated appointments needed to monitor and adjust dosage levels. Each of these elements can pose a challenge to college-age clients. “It’s a lot of work, and [college students] often lack the discipline and time to get it right,” Pisarik says.

Bennett agrees, suggesting that even though professional counselors are not the ones prescribing medications, they still need to discuss and explore medication use with their clients. She also stresses that practitioners should be knowledgeable about the different kinds of medications that clients may be taking and their possible side effects.

Bennett sometimes conducts conference calls with her clients and the medical professionals who are prescribing them medications so that she can help clients ask questions and otherwise be a support to them. “We [counselors] don’t prescribe, but at the same time it’s very important to collaborate with whoever is prescribing the [client’s] medication,” she says. “Be supportive and involve the client in conversations: How long have you taken it? Have you noticed any side effects? Has it been helping? Talk about how often they’re supposed to take it and if they’re adhering to that. There can be stigma about taking medications, so it’s important to normalize it. … It’s comforting too for the client to know that you’re on their side, and part of that is collaboration [about medication].”

 

See the person, not the anxiety

Given how common anxiety disorders are, it’s likely that any counselor’s caseload will be filled with clients presenting with symptoms of anxiety. It is important, however, for counselors to treat each client as an individual and to tailor the therapeutic approach to meet that client’s unique needs, Bennett emphasizes.

Building trust and a healthy therapeutic relationship are key in treating anxiety because clients can feel very vulnerable as they talk about what makes them anxious, Bennett points out. That is why it is critical to get to know these clients as individuals rather than through the lens of their anxiety.

“Don’t assume that because they’re anxious, they’re going to think and behave like other people with anxiety,” Bennett says. “Meet them where they are and find out what’s most effective for them based off of their interests. It can be empowering for clients to integrate their own interests and life experiences into the therapeutic process. Not only does this create buy-in for the client, but it can also help in creating a safe space to begin exploring the vulnerabilities that come along with anxiety. … Hear their story, find their strengths and give them a voice in the process. It’s important to honor them as individuals.”

 

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To contact the counselors interviewed for this article, email:

 

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

Letters to the editor: ct@counseling.org

 

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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.

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