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7860 Mission Center Ct, Suite 209
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858.354.4077

At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

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Read our award-winning blogs for useful information and tips about anxiety, stress, and related disorders.

 

Filtering by Tag: social anxiety

How Do I Know If I Need Therapy?

Jill Stoddard

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Mental Health Awareness Month: Fitness #4Mind4Body

Jill Stoddard

by Annabelle Parr

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

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Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

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The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind. 

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Mental Health America. (2018). 2018 Mental Health Month Toolkit. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Full_2018_MHM_Toolkit_FINAL.pdf

Finding the Right Therapist for You

Jill Stoddard

by Annabelle Parr

Therapy can be incredibly helpful and healing in the midst of struggle, but it’s not “one size fits all” and sometimes it can be challenging to find the right fit. If you have tried therapy before and been frustrated by a lack of progress, it’s possible you haven’t found the right therapist for you. Having some knowledge about therapy and the different options available can help when you are seeking out help.

What do therapists do?

A therapist’s role is to provide you with empathy, help you learn healthy coping methods and give you tools to manage your emotions constructively. They are there to help you connect with your personal values and get in touch with your own internal strength, while offering you compassionate support and understanding along the way. They are like “training wheels” to help you learn to engage in life in a new way.

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What don’t therapists do?

They are not there to pass judgement, minimize your feelings, or offer you advice. No advice means that they are not there to make decisions for you, such as whether or not to stay in a relationship or a job; they can, however, assign you homework to help you make progress and teach you coping mechanisms.

If you ever feel judged or like your therapist is minimizing your feelings, discuss this with them. This will allow you to discern whether you misunderstood their message or whether maybe they are not the best fit for you. It is important to talk with your therapist about the therapeutic process itself, especially if something feels off.

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Note: therapy can be helpful and it can be hard.

Therapy is challenging. It requires active work on the part of the client and it requires facing uncomfortable and painful emotions, and likely making difficult changes. As James Hollis (1998) notes, “no one enters the therapist’s office whose adaptive strategies are still working.” So sometimes, clients may feel worse before they feel better because change is inherently uncomfortable. This kind of “feeling worse” is a vital part of the growth process, not a further descent into the same struggle that brought you into the office.

If it feels like you have tried various therapies or therapists, and have not progressed despite your commitment to finding help and engaging in the therapeutic process, you may not have found the right therapist yet. Here are some things to look for when seeking therapy.

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  1. Connection with the therapist. Therapy requires that you let another person in on your innermost thoughts and feelings. This is not an easy thing to do, so it is important that you feel comfortable with the person you choose. Research shows that the therapeutic relationship itself is the most important aspect of therapy – accounting for about 30% of the variance in treatment outcome, which is more than any other factor including the technique the therapist uses. So make sure that the therapist you choose to see is someone you trust and whom you are willing to talk to. If it doesn’t feel like the right fit, it probably won’t be.
     
  2. The therapist’s areas of expertise. While the relationship is the most important piece of therapy, specialization and technique are still very important pieces of the puzzle. When looking for a therapist, make sure to search for someone who has experience working with individuals dealing with your particular concerns. Otherwise, you may end up wasting time and money working with someone who might not conduct a proper assessment, or who does not have experience working with your particular issue. Ask them about their experience working with others who have concerns similar to yours, including the techniques they use and the degree of progress and healing that they typically see in their clients.
     
  3. Evidence based treatments. There are lots of different treatment options out there; a good place to start is searching for a therapist with true training in modalities that are supported by solid research (such as Cognitive Behavioral Therapy or Acceptance and Commitment Therapy). Ask questions about their training and choice treatment modalities, what a typical session will look like, how your individual needs will be addressed, whether you will receive homework, what will be required of you in the process, how your progress will be evaluated, and what steps will your therapist take if they find that your progress has prematurely plateaued.

If you are struggling and considering reaching out for help, this knowledge can help you navigate choosing a therapist and can help you recognize sooner rather than later if it’s not the right fit. If you have tried therapy before and have been frustrated by a lack of progress, you are not alone. Remember, effective help is available when you know what to look for.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com

References: 

Hollis, J. (1998). The eden project: In search of the magical other. Toronto, ON: Inner City Books.

Don’t Believe Everything You Think: Cognitive Distortions

Jill Stoddard

by Annabelle Parr

Whether you recognize the term or not, at some point you have dealt with a cognitive distortion. These are thoughts that feel like the truth, but they describe an emotional reality rather than an objective one. For those struggling with stress, anxiety, or depression, often chronic and significant cognitive distortions play a big role in the struggle.

Dr. David Burns (1980) outlined 12 of the most common cognitive distortions in his book, Feeling Good: The New Mood Therapy. Dr. Burns’ list is adapted below with examples. As you read through the list, see if you recognize examples of any of these distortions in your life.

1. All-Or-Nothing (Black and White) Thinking: You see things in black and white terms, refusing to see any gray area.
Distortion: If I’m not nice to everyone all the time, I’m a jerk.
Reframe: I’m allowed to be assertive and set boundaries. I don’t have to be nice to someone who is being disrespectful to me. Standing up for myself doesn’t make me a jerk.

2. Overgeneralization: You see one or several negative events as a sign of an endless pattern of defeat.
Distortion: I got a bad grade on this math test, so I will never get a good grade on a math test.
Reframe: I got a bad grade on this math test. Maybe I didn’t understand the material or studied wrong. I will talk to my teacher to better understand my mistakes, and hopefully I will do better next time.

3. Mental Filter: You exclusively notice the negative aspects of a situation and magnify them out of proportion. At the same time, you filter out/fail to notice the positive aspects.
Distortion: My presentation went terribly. I lost my train of thought because I got nervous, and I forgot a key point I wanted to make.
Reframe: I stumbled over my words a little bit, but no one besides me seemed to notice. I also forgot a key point I wanted to make. But I got good feedback and everyone seemed engaged during my presentation. Next time I will practice a little bit more, but overall it went pretty well.

4. Minimizing/Disqualifying/Overlooking the Positive: You turn positive experiences or comments into negative ones by deciding that they don’t count for some reason. You overlook positive things about yourself or your environment. You don’t just filter out positive things; you actually turn them into negatives.
Distortion: He only invited me to come to his party because he feels sorry for me and knows I’m a loner.
Reframe: He invited me to come to his party because he wants me to come.

5. Mind Reading: You assume that someone is thinking or reacting negatively to you even though you do not know what they’re thinking.
Distortion: She didn’t wave at me because she doesn’t like me.
Reframe: She didn’t wave at me. She probably didn’t see me, or maybe she had something on her mind.

6. Fortune Telling: You think that something bad is going to happen even though you do not yet know what the outcome will be. This causes you to worry, overreact, or give up too soon.
Distortion: Even though things are going well now, I think he will eventually break up with me and I am afraid I will get hurt. Maybe I should just break up with him now to avoid getting hurt.
Reframe: Things are going well now. I’m not sure what will happen in the future. But for now I will try to be present and enjoy what is.

7. Magnifying/Catastrophizing: You exaggerate the importance of something, or you imagine that something that might happen would be terrible or earth shattering, when it would not actually be as bad as you imagine or you could cope despite it being difficult.
Distortion: I can’t accept the promotion because then I will have to give presentations. I’m terrified of public speaking, and I will get too scared and embarrass myself in front of everyone and then probably lose the job anyway.
Reframe: If I accept the promotion, I will have to give presentations. Lots of people are scared of public speaking. I might make a mistake and I might feel embarrassed or scared, but that’s part of being human. It won’t be the end of the world.

8. Emotional Reasoning: You assume that your feelings reflect the truth, even though your feelings are based on erroneous thinking.
Distortion: I feel like a failure, which means I am a failure.
Reframe: I may feel like a failure right now because I am still looking for a job, but job hunting takes time. I am not a failure.

9. Should Statements: You have a list of rules set in stone about how you or others “should” behave, but these rules are arbitrary or unrealistic. You feel guilty or inadequate when you “break” a rule, or get angry or frustrated when others do so.
Distortion: I should have enough time and energy after work to play with the kids. I feel guilty if I let them watch TV while I finish up some work instead, and I feel frustrated with my spouse when he/she does the same. 
Reframe: I want to have enough time and energy after work to play with the kids. But sometimes I will be too busy or tired. I will do my best to spend quality time with them, even if sometimes that means cuddling on the couch watching TV while I finish up some emails. On those nights when I really can’t find the time, I will give myself (and my spouse) grace.

10. Labeling: When someone makes a mistake, you don’t objectively evaluate the mistake. Instead you label the person – “I’m a failure” or “They’re an idiot.”
Distortion: He forgot to lift the toilet seat again! He is so inconsiderate. Or I forgot my kids had a half day today. I’m a terrible parent!
Reframe: He forgot to lift the toilet seat again. He must have had something else on his mind. Or I forgot my kids had a half day today. Today was really busy and I had too much on my mind. Maybe I need to write down half days on my calendar from now on.

11. Personalization: You think that things that others do or things that happen to you are personalized reactions to you, even if this is not the case.
Distortion: My friend didn’t return my text because she thinks I’m annoying.
Reframe: My friend didn’t return my text. Maybe she is really busy or has something going on in her life I don’t know about. Sometimes I forget to return texts too.

12. Probability Overestimation: You overestimate the likelihood of something bad happening.
Distortion: If I drive, I will get in a car accident, so I am not going to get my driver’s license.
Reframe: Accidents can happen anytime, but the odds are not high. Most people drive every day and nothing bad happens.

Cognitive distortions are not constructive, but experiencing a distortion every now and again is simply part of being human. However, when you are not able to reframe your distortions, or when cognitive distortions begin driving your behavior, they can become a problem.

Cognitive Behavioral Therapy (CBT) works to help clients notice, address, and alter these destructive thoughts. When you believe your own destructive thoughts, you may also tend to avoid certain situations on the basis of a false belief. CBT also works to help clients slowly learn to approach rather than avoid such situations. Having a warm, empathic therapist come alongside you throughout this process is healing. She can model compassion for you, helping you learn to have compassion for yourself, while still challenging you to see things in a new and healthier way.

If you find yourself feeling overwhelmed by cognitive distortions, stress, anxiety, and/or depression, you do not have to struggle alone.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

5 Myths About Anxiety

Jill Stoddard

By Trevor McDonald
edited by Annabelle Parr

People are talking about mental illnesses, like anxiety disorders, more often and more openly. Social media and access to digital content has helped facilitate the conversation. However, there is still a stigma surrounding mental illness, and while easy access to content can help reduce shame, stigma and misunderstandings about mental illness, it can also spread mistruths and foster outdated myths. This hurts those who suffer from mental illnesses as well as those trying to understand and support them. So let’s clarify some things about anxiety.

According to the National Institute of Mental Health (NIMH), anxiety disorders are the most common American mental illness, affecting 40 million adults – 18% of the population. Despite this substantial figure, the Anxiety and Depression Association of America (ADAA) estimates that only 33 percent of those suffering will receive treatment.

Anxiety is a blanket term. We all know what it feels like to feel anxious. But when we talk about anxiety as a mental illness, we may be referring to any number of disorders, from generalized anxiety disorder to social anxiety disorder to panic disorder to a specific phobia. Though all of these things fall under “anxiety,” each manifestation looks and feels a bit different.

Fortunately, anxiety disorders can be treated. Having a supportive network that includes mental health professionals and ideally, understanding loved ones, is critical. The first step toward encouraging and facilitating treatment is dispelling myths and providing education for both those struggling with anxiety and the people around them. Here are five of the biggest myths about anxiety disorders:

1. “You don’t really have anxiety. Everyone gets anxious/nervous!” Of course, everyone feels anxious or stressed sometimes. But according to the DSM V, when someone has an anxiety disorder, they feel excessively anxious about a number of things more often than not, and it significantly impairs their ability to function in a major area of their life. We must understand that there is a big difference between feeling anxious about a particular event or challenge, and feeling the chronic anxiety that comes with an anxiety disorder. Furthermore, it’s important not to toss around statements such as “I’m so OCD” when all we mean is that we like our desk organized. Minimizing an anxiety disorder in these ways undermines the challenge that something like generalized anxiety disorder or OCD can pose to people who are struggling with them.

2.  “You can get over anxiety with yoga, taking a walk, or meditation.” While taking a holistic approach to wellness is smart, and such activities can help with the symptoms of anxiety, taking a yoga class won’t “cure” an anxiety disorder any more than it will spina bifida. Though it can be tempting to offer advice to try to help those struggling with anxiety, it’s important not to minimize their experience or assume that you have a solution to offer them. Only a mental health professional should be offering any kind of “prescription” or suggestion for treatment.

3. “Anxiety means a person is weak, or they must have had a really bad childhood.” The former is never true; the latter could be part of the foundation for an anxiety disorder, though this is certainly not always the case. Trauma can kick start an anxiety disorder, but it’s not the only source. A big reason people with mental illnesses don’t talk about their condition is because they don’t want to be seen as weak or feeble, even though they’re not. It takes tremendous strength to live with any disorder. Invisible disabilities can be especially trying because people can’t “see” the disorder a person is battling.

4. “Anxiety isn’t that big of a deal.” Everything is relative. Anxiety disorders exist on a spectrum. If you know someone with anxiety, you can’t gauge how severe their disorder is. But unless you are a therapist, psychiatrist, or doctor, it’s not your job to gauge the severity of someone else’s anxiety. What you need to know is that anxiety is a big deal to the person suffering from it, no matter where they fall on the spectrum. Further, unlike a broken leg, anxiety can’t be seen on the outside.  So someone may appear perfectly put together on the outside, but is suffering in silence on the inside.

5. “I won’t be able to relate to someone with anxiety.” This myth is usually based on a person’s fear that they won’t know what to say when someone is struggling with anxiety. It’s human nature to want to “fix” things, but anxiety can’t be fixed that easily, especially by a non-professional. Remember that it’s not your job to “fix” someone’s anxiety or make it go away. All they really need from you is empathy. And listening well is far more important than knowing what to say. So when talking to someone with anxiety, let them lead the conversation, don’t judge them, and don’t try to fix it. Let them know that you want to understand and that you hear that they are struggling.  You might also offer to help them connect with professional help.

We’ve come a long way in our understanding of anxiety disorders. Psychological research has given us a solid understanding of anxiety and how to treat it effectively. Of course, there is always more to learn, but now the bulk of our work lies in sharing our understanding with the community and eliminating the damaging and unnecessary stigma that still surrounds mental illness. Working to un-learn false claims and myths of the past is a big step in the right direction. Doing your part to educate yourself and others will make a big difference in the lives of everyone with an anxiety disorder.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.