Increasing Your Self Esteem

Have you ever wondered why you question everything about yourself (looks, occupation, amount of friends), but don’t know how to stop? This is a common issue I encounter in my practice and probably one of the hardest hurdles to get over. How can someone who seems to have everything, feel like they are worthless? It’s hard to imagine, but happens more often than you think.

What is self esteem? Self esteem is your self worth. Self esteem is essential to our survival and without it, life is difficult and, at times, can be very painful. Now let me be clear, when high self esteem gets into the narcissist range, that is due to very low self esteem, but that is a topic for another day.

Our self esteem is established early on in life, from our childhood. When parents/guardians tell their children, “you are smart” “you can do anything and be anything you want” “you are funny”, etc… it sets the stage for your self esteem to flourish. Children then go into the world trying and sometimes succeeding and sometimes failing, but either way, the child has the confidence to keep going. If you were not told good things about yourself early on in life, it can impact how you see yourself as an adult. Does it always have to be this way, the short answer is no. But it takes work and effort to make the changes you need to see yourself as worthy.

How can you increase your self esteem? Well, it’s very simple and very difficult. The short answer, is to stop the negative self talk, to reframe what you say to yourself. Sounds easy, but you have to consistently do this until you start believing it. Below, I list out some steps to help you on the road to increasing your own self esteem:

1. Name your inner critic - you can call it, Debbie downer, the black cloud, whatever you feel describes is. And understand that this critic is not you. This critic is someone outside of yourself telling you all the things that are wrong with you.

2. Silence the critic - every time you hear the critic say something negative, stop it. Tell the critic “this isn’t what I think, it’s the critic telling me I wrong or bad.

3. Understand what the critic is trying to tell you - What is the function of the critic in this moment? For example, let’s say someone is going to a party and is not talking to anyone. Why? Well, the inner critic is saying “they won’t like you, so don’t engage anyone that way you won’t be rejected.” By understanding why your inner critic is saying what it’s saying, it is easier to shut it down.

4. What are you losing by listening to the inner critic - Figure out what does it cost you by listening to your inner critic. In the example of the person at the party, by not shutting down the inner critic, the person at the party will be missing out on meeting new people and possibly making new friends.

5. Take away your inner critic’s role - You do this by not giving your inner critic the power over you. Not everyone you meet will be someone who you would like to form a friendship with, and vice versa. This is no way means that they are a bad person or you are, but that they may not have much in common. It’s ok not to be liked by everyone, it’s ok to fail at something, it’s ok to have a bad hair day. You are not a failure because of those things.

There are many other strategies for increasing your self esteem and with practice and patience you can achieve your goals. I suggest you read the book Self Esteem, by Matthew McKay for an indepth look at how you can increase your self esteem and understanding why you have struggled with it.

When the Seasons Change, So Can Your Mood

The change of seasons can be exciting for some, but can be a difficult time for others. Autumn can bring orange and gold leaves, pumpkins, hot apple cider and pumpkin pie, which for many, can be a welcome change from the dog days of summer. With all the joy and fun of the season, we also have longer nights and shorter days, and unfortunately, that can bring mood down drastically. Studies have shown that approximately, 10-20 percent of the population get SAD (Seasonal Affective Disorder). SAD is very common for people ages 20-60+ and is even more common for people who live in the northern states of the US.

What is SAD? SAD usually begins in late fall and ends in late spring/early summer. Now you may be asking yourself, “what is the difference between this and depression?” There are differences, most notably, SAD will end during the warmer months, whereas, depression will typically last year round. The symptoms of SAD resemble those of depression, so it can be difficult to diagnose. Some symptoms include:

1. A change in appetite, especially a craving for sweet or starchy foods

2. Weight gain

3. A heavy feeling in the arms or legs

4. A drop in energy level

5. Fatigue

6. A tendency to oversleep

7. Difficulty concentrating

8. Irritability

9. Increased sensitivity to social rejection

10. Avoidance of social situations

These symptoms tends to come back at the same time of year, and tend to go away when the weather gets warmer. It’s also important to distinguish whether your symptoms are from SAD or have arisen due to changes in your circumstances (like losing a job or moving).

Now, let’s talk about treatment. SAD is most likely caused by a lack of sunlight, so the best treatment is to increase your exposure to sunlight. You might be thinking, “that’s great, but I live in cold climate, how can I get sunlight?” Your doctor can try light therapy, which is either the use of a light box or a light visor that mimics the sun. Light therapy is usually done for 30 minutes per day throughout the fall and winter. Please note, that stopping this type of therapy too soon can bring back your symptoms. There are mild side effects of light therapy and those tend to occur if the treatment is done late in the day. Other treatments can be used in conjunction with light therapy, including medication, vitamin D, and/or talk therapy.

Not everyone is aware of SAD, so it’s always a good idea to check in with neighbors, friends, and family. Who knows, with with light therapy, hot apple cider, and pumpkin pie might just be the perfect recipe to feeling better.

Technology and Mental Health

Recently, I began thinking about how much technology has impacted our everyday lives and what impact it has had on us. Think about your technology usage daily, whether it's television or your cell phone, we spend an average of 24 hours per week on the internet. Think about that for a minute, 24 hours a week on the internet alone. But has it had a negative or positive impact on your mental health? The answer is both.

Let's take a look at Facebook. Facebook is a great way to reconnect with people that you may have lost touch with, it's a great conduit to help people find each other. It's also great to promote events you may have and I've found is that Facebook is a great place for support groups. Yes, you read that correctly, support groups. Name it and I bet there is a Facebook group for it. I found this out first hand when I was in need of support when my son went off to boot camp. I connected with other parents who sons were in the same boot camp company as my son and we encouraged each other for the 13 weeks. It was a great support and it was, at that time, I saw social media in a whole new light. When used for that purpose or to keep in touch with friends and family, Facebook can be an excellent tool.  It can help one not feel so alone and that there are people out there who care.

Now, there are also some downfalls that come with social media (Facebook, Twitter, Instagram, etc...). According to the American Psychiatric Association, young adults have a higher risk of depression and anxiety based on their use of social media platforms (https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2017.1b16). To me, this isn't surprising. How many of us have looked online and saw friends having fun on vacation or dancing the night away, while the rest of us are at home in our pajamas surfing the internet. Social media can give the illusion of a perfect life, with a perfect relationship and perfect friends. But what you are seeing is just a snapshot of their life, a moment in time.  Most people only show the good, not the struggle they may be going through. While looking at our friends online, it's easy to let the negative thoughts intrude and lower our mood. The key is to understand that what you are seeing online, in many cases, is not the full story and so it's important to keep it in context. The danger happens when young people measure their worth based on how many likes they have or how many friends they have.

There are some things that you can do to help mitigate some of the negative feelings you may have due to over usage of social media.

1. Limit the amount of time you are on social media and stick to that. You'd be surprised at how free and content it makes  you feel.

2. Take a break from your phone or computer for extended periods of time. We are all so available to everyone that there really is no down time or time to decompress. Taking a break on the weekend is a good start.

3. Do not use any electronics at least two hours before bed. It has been shown that the blue light from phones and computers can impact sleep.

4. Go outside. Spend some time out in the sun as vitamin D increases your mood. While you're outside, go for a walk, exercise can also increase your mood.

5. Most importantly, spend time with friends and family. In this age of technology, we have become disconnected from human interaction. I've seen families sitting at the same table, all on their phones and not talking to each other.

They key is that all things should be done in moderation, too much of a good thing can be bad.

Misconceptions about therapy

When in graduate school, I never thought that there was a "stigma" about psychotherapy and how some people may not see the value in it. The longer that I have been a therapist, the more I have found that there is a stigma and my goal is to help others see the benefits.  Friends and family are good to talk to about problems and may provide a level of support; however, they have a vested interest in your happiness and they may also have some judgement. Have you ever told a friend about problems in your relationship and she may have said, "oh my god, what a jerk. You should leave him!". While that may provide you temporary support, it may not be sound advice for the long term, as you may have made up with your partner and your friend may have a negative opinion of your partner because of the information you have shared. Psychotherapists provide an outlet for you to share your most personal thoughts and issues in a non-judgemental environment.

Here are some common misconceptions about therapy:

1. You are weak if you ask for help. This is probably the most common misconception, due to people believing that you must be able to handle all of your problems on your own and asking for help means you are weak minded. This is far from the truth. Therapists are there to help  you navigate through life and teach your skills to be able to handle whatever may come to you. It's a place for you to share ideas and thoughts without fear of judgement or ridicule. It's weak not to ask for help.

2.  Therapists are there to give you advice. Therapists are not advice givers. Let's say that again... Therapists are not advice givers. Therapists are there to help you see your options, to hold a mirror up and show you what you are giving to the therapist. In many cases, that's all it takes to help the client make the change that is needed. Have you ever heard, "I'm great at giving advice to my friends, so I would make a great therapist." Well, giving great advice is much different than being a trained therapist.

3. All therapists are the same.  Just like most things, each therapist is different and has a different approach to therapy. One may be a MFT (Marriage & Family Therapist) or a Psy. D. (Psychologist) or a LCSW (Licensed Clinical Social Worker) and each has different training and expertise. There is not a one-size-fits all in terms of therapists, it's like any other occupation, you may fit with one and not with another. It's ok to shop around to find the one that fits with you; you may not connect with one therapist, but that doesn't mean you won't connect with another. The point is to keep looking, you will find one that you will connect with.

4. My therapist will solve my problems.  Therapists do not solve their clients problems, what we can do is help our clients figure out their own solutions. The goal for therapists is to give their clients the tools they need to navigate their life and resolve issues that will inevitably come up. Another goal for therapists is to get clients to the point where they don't need us.

The above is just a sample of the common misconceptions regarding therapy. Overall, therapists are team mates with their clients and together they determine the best treatment plan. Life can be difficult and there may be times when you may need help and it's not weak to ask for help, it's actually strong. Together we can all squash the stigma of mental illness.

Healthy Relationships

How would you know if you were in a healthy relationship? What is a healthy relationship? Or why can't I have a happy/healthy relationship? Many factors go into have a fulfilling and loving relationship and what I find is the hardest thing for couples to come to terms with is that both people are responsible for the relationship. Yes, you heard that right, both people are responsible for the relationship. Your job is to take care of your partner and if your partner's job is to take care of you (emotionally). If you come to a point where you don't want to take care of each other's emotional health then you don't want to be in the relationship. It's that simple. You both chose each other for a reason.

We all bring in our "baggage" into any relationship that we are in, whether it's how we grew up, our lack of affection shown by our parents, or past relationships. The key is how do we overcome these obstacles and not bring that into our current relationship. When I work with couples, I determine if they are securely attached or insecurely attached. Attachment is essentially how we were tended to when we were babies and young children. Securely attached children will be able to play by themselves but know that their caregiver is close by in case they need anything, so the child is content. They have been tended to as infants and young children, secure in the fact that if they cried or were scared their caregiver will be there. Insecurely attached children don't have the comfort of believing that their caregiver will be there for them, so they become anxious, and at times, they lack the ability to trust. Think of a young baby who is crying in their crib, where he/she turns red and screams on the top of their lungs. Essentially, that baby is crying for his/her life, babies depend on their caregiver to live, it truly is life or death. If they are not tended to, the baby becomes insecurely attached, which affects their lives. They can't trust that the person who loves them will take care of them.  Now what I describe above is a simplistic explanation of Attachment, but I think it's helpful for my clients to know why we do the things that we do.

It's false to think that only securely attached people can have healthy relationships, in fact, insecurely attached people can have a "secure functioning relationship." The main goal to having a secure functioning relationship is to understand where your partner comes from and the effect their childhood has had on them and you must take care of your partner. If you take care of your partner then your partner will take care of you, it's really that simple. The key is to figure out what is going on with your partner, beneath the anger. It's not about the socks on the floor or the dishes not being done. It's about counting on your partner and not getting what you need. Relationships are complex and take work, but in the end the connections you make and the joy and fulfillment is worth it.

For more information on attachment, please go to:

https://www.simplypsychology.org/attachment.html

Why Am I Anxious?

I've heard the symptoms many times: can't catch your breath, heart beats very fast, you're worried, it feels like you can't sit still, and it feels like the world is crashing in. What you're feeling is anxiety. Let's take a look at the neuroscience of what it is.... in short anxiety is the body's reaction to a perceived threat (real or imagined). It's when the autonomic nervous system kicks in to overdrive and reacts with a fast heart rate, digestion slows, and the brain loses much of it's blood and rational thinking. The reason is that the body is under threat and during this threat we need to RUN, so our blood needs to go to our extremities and our heart, so we can escape. When our ancestors were under threat, they didn't stand there and think, "hmmm there's a bear, should I run?" No, our ancestors didn't have that kind of time, so their body automatically took off or prepared to fight. Fortunately, we don't have many bears chasing us through the streets of Los Angeles, but we do have constant stress, which turns on the fight/flight or freeze reactions, thus we live in a constant state of anxiety. The constant stress does cause the fight/flight or freeze response, since the brain can't delineate whether it's a real threat or not.

What are some things that you can do to help alleviate the symptoms? The most important thing to remember is that you will not die. You may feel like you are when the anxiety takes hold, but it's important to understand that you won't. When anxiety takes hold, stop, sit down, close your eyes, and take 10 deep, slow, deliberate breaths.  I know it's hard to do in the moment, but do your best. If you can, sit up straight, close your eyes, and slowly tap each leg with your hand, alternating tapping on each leg. It's also important to tell yourself that you are safe, everything is ok and this will pass. Keep saying that until the feeling moves through.

Understanding what anxiety is can be helpful to understanding how to manage it. More people than you can imagine suffer from this, but it is manageable. It's important to work with a professional who can arm you with tools to use before, during, and after an anxiety attack. Help is available, you just need to reach out.

Peace and blessings,

Kim

Am I depressed or just sad?

How do you know if it's depression or just sadness. Do you sometimes wonder about that? How can you tell the difference and once you've figured it out, what can you do about it. You would be surprised to know that depression is common in the United States. It is estimated that 16.1 million Americans suffer from depression currently.

Sadness is a feeling that passes; it could be due to watching a movie that brings up emotions or an argument with someone you love. But sadness leaves, it doesn't stick around. It could last days or even a couple of weeks, but it fades away. You may cry and even stay in your home for a few days due to your sadness, but the key thing to remember is, unlike depression, you move through the sadness fairly quickly and it doesn't impact your daily life. 

On the other hand, depression, more specifically, clinical depression doesn't stop one day after it begins or even in a few weeks. No, depression lasts for an extended period of time. There are various types of depression, including Major Depressive Disorder and Persistent Depressive Disorder, just to name a couple. You may be asking yourself, "ok,  but how would I know these feelings are depression and not just sadness?" The simple answer is: if you have clinical depression, you will feel some of these symptoms  hopeless, helpless, anhedonia (loss of interest in pleasurable activities), isolation, weight loss or gain, excessive crying, insomnia or sleeping too much, loss of energy or fatigue, inability to concentrate, and suicidal ideation. For people diagnosed with depression, just the idea of getting out of bed and getting dressed is a struggle.

Treatment for depression varies just as much as the symptoms, but the biggest takeaway is that there are treatments available. In my practice, I utilize CBT (Cognitive Behavioral Therapy) and other interventions to help alleviate symptoms and get my clients back to a level of functioning that is comfortable for them. Exercise is great to help elevate your mood. If you aren't ready to go to the gym, then just go outside and walk to the corner and back. Every little bit helps. Get Vitamin D, ideally from the sun for about 15-20 minutes daily or if that isn't possible, a Vitamin D supplement works. A support system is very important, ideally surround yourself with friends and family who are positive and understand what you are going through. I have found that the more support a depressed client has, the sooner they feel better. Talk therapy is important as you move through the depression. Therapy can address the root causes of the depression and assist you in developing healthy coping skills. If after trying various interventions and you are still struggling to make it through the day, medication is available to help. Anti-depressants are an effective way to lift the cloud, so that other interventions will be more helpful. The most common anti-depressants are SSRI's (Selective Serotonin Reuptake Inhibitors) such as Prozac, Lexapro,  Celexa, Paxil and Zoloft just to name a few. These work by limiting the reabsorption (reuptake) of the neurotransmitter serotonin into the presynaptic cell. In other words, antidepressants leave more serotonin in the synapse of the brain, thereby, elevating mood. There are side effects, but they are much less than the first generation antidepressants.

While depression can make you feel alone, there is help available and a light at the end of the tunnel. Getting an evaluation by a clinician whether it be a therapist or Psychiatrist is the first step to emotional freedom. It's not weakness if you ask for help, it's a sign of great strength and compassion for yourself.