Happy New Year/National Hangover Day!

I joke, but it must be true! Hangovers can be particularly brutal because they can come with so much mental, physical, and emotional turmoil.  Most commonly, those who suffer from severe symptoms find that their hangovers come with lots of anxiety.  People feel badly about themselves, ashamed of their behavior, and generally feel negatively about life when in this state.

Hangovers can cause extreme anxiety as a symptom of the withdrawal from alcohol or other substances.  Alcohol is a depressant, which means it slows the central nervous systems and blocks the brain's ability to produce stimulating chemicals.  The withdrawal from this state of depression turns the system up-side-down.  If we think of depression and anxiety on a spectrum, with depression at the far right and anxiety at the far left side, you can picture a pendulum swinging from one extreme to the other.

While withdrawing from alcohol, the body overcompensates by "swinging" to the left, toward anxiety.  The central nervous system is very activated and the brain is producing stimulating chemicals, but the body and brain are tired, unrested, and confused.  Especially for those who suffer from anxiety naturally, this can be a powerful and awful experience.

Tips for getting through a hangover:

1. Take it easy on yourself. If you are turning your anxiety inward, meaning you are thinking bad thoughts about yourself, know that they are chemically induced.  Have a mantra and repeat it - "these thoughts aren't real and I'm ok." Don't make any big decisions or sweeping judgments while in this state - that may not be possible but try not to act on any of them!

2. Despite your urge to eat the entirety of the fast food menu, eat something good for your body.  A salad with veggies or some fruit can get you on your way back to health.  Alcohol also dehydrates the body so drink lots of water.

3. If you can bear it, exercise.  Exercise stimulates all the right chemicals in your brain to release and ease your body and mind.  It can also speed the release of toxins so that you can feel better faster.  Even a brisk walk can make you feel better since some say that fresh air is a cure to hangovers.

Happy New Year!  Take good care of yourselves.

Depression's Best Friend Anxiety

Depression and anxiety go hand in hand. At times they are confusing bedfellows, but it is nearly impossible to have one without the other. For example, a woman says, "I feel depressed and can't get out of bed. Then my husband comes home and I just want to bite his head off. I'm such an awful person." This person isn't awful, she's suffering from a complex combination of anxiety and depression. Her anxiety may be manifesting as lashing out (or acting out behaviors) and one of depression's lesser known side effects is irritability, which can lead to such thoughts and behaviors.

SPOTTING DEPRESSION

The obvious definition of depression is "a depressed mood for most of the day and a diminished interest or pleasure in activities" in the words of the Diagnostic and Statistical Manual-IV-TR (DSM). Another tricky depression antic is that it can be symptomatic in the form of low self-esteem or low self-image. You may hear someone saying things like "there's no excuse for the way I've messed up my life," or "it's my fault that I didn't go to work because I'm lazy." The DSM also points out "excessive and inappropriate guilt" as a symptom. This might manifest in an "I can't get over it" attitude or an "I'm totally unworthy of anything fun or good" campaign.

Other signs may be excessive crying, severe change in appetite, sleeping all the time or not sleeping at all, feelings of worthlessness, indecisiveness, lack of concentration, recurring thoughts or images of death, and at it's worst, ideas of suicide.

SPOTTING ANXIETY

Anxiety can take on many forms like panic attacks, fears about being in public or socializing, and reactions to traumatic events, but in terms of depression, general anxiety can also be the perfect compliment to its counterpart, depression. Anxiety often produces excess chemicals in the brain that leave us feeling on edge, in hyper drive, overwhelmed, fatigued, unable to concentrate, irritable, tense, and not sleeping like we should.

TREATMENT

It is important to understand the interaction of depression and anxiety on the mind and body to understand how to treat it. When a person is in a state of arousal (anxiety), the body and the brain work hard to calm the system, but over time those biological functions become overworked and no longer soothe our anxiety. We have to learn how to "override the system" in order to control our anxiety - namely, taking long deep breaths (in the nose, from the belly, and out the mouth), and changing our thought patterns when we become anxious or depressed.

Next time you think, "I'm such an idiot," and you can feel yourself turning red, feeling keyed up, or your heart beating quickly, stop and take 5 deep breaths while telling yourself something realistic about the problem. "I'm only human, and humans make mistakes." "This won't matter in one week's time." "I'm very smart, I just rushed and made a mistake that I can fix." Or, try to externalize the anxiety: "Anxiety is attempting to intrude on my mind and body right now, but it will not overtake me. I know how to breathe through this."

If you are feeling depressed, my best advice to you is to be kind to yourself and seek help. If you can lie in bed for an extra hour, and you feel like you need to, then do it. If you want to comfort yourself in some way to not feel so badly and it won't hurt you in the long run, I encourage it. We are taught to be so hard on ourselves and it is very important to fight the urge to push yourself to your limit all the time. Loved ones are the best antidote to depression, even though it may seem scary or impossible to share what you are going through. If you sincerely and repeatedly reach out to loved ones and still feel alone, seek help online, find a local support group, or get in touch with an organization who helps people in your situation. It is important that you feel understood and connected when experiencing depression and anxiety.

If your depression is to the point of suicidal thoughts or urges or thoughts of harming anyone, you should immediately seek help from a professional! Better yet, seek help from a professional before your symptoms are life-interfering. You do not have to wait until you are incapacitated to ask for help. 

Therapy Demystified: It's All in the Relationship

In the presence of darkness, we break, we wound, and we crumble inside; in the presence of kindness, openness, and love we heal with one another. When asked what my "style" of therapy is, I spout an eclectic mixture of therapies like "psychodynamic, supportive, and relational psychotherapy," but I truly believe that the most important element that can lead to healing in a therapeutic relationship is the connection between the therapist and client.  This is not a typical connection, because it is not reciprocal; it is only intended to serve the client's interest. But it can be even more powerful in healing broken hearts and wounded souls because of the commitment of the therapist to the client.

Many esteemed researchers have come to the same conclusion through different avenues.  Scholars like John Bowlby, Alan Schore, Daniel Siegel, and Robert Karen would liken this connection in therapy to healing wounds from lost or ruptured attachments in childhood and adulthood.  There is neurological research proving that being in connection with another person can actually create new neurocircuitry, or pathways, in the brain in order to form new attachments to others (Schore, 2003). The authors of Relational-Cultural theory discuss connection as a "growth fostering relationship" leading to a fuller, happier life, as opposed to disconnection as "empathic failures" and missed opportunities (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Jordan, 1997; Miller & Stiver, 1997).  The arrival at this conclusion, that people heal in relationship with one another, is empirically undeniable.

But what does this look like in the therapy room?  Many will experience it as discomfort at first because it feels unusual to have someone in front of you who needs nothing from you and is there to openly explore your psyche.  I hope to alleviate some of that discomfort for those of you who are reading because therapists are humans too and we are both engaged in the process of relationship building the moment you walk in the door.

The experience "in the chair" can be enlightening for some in that it brings up feelings that are universal throughout the person's life.  For example, a person comes to therapy with severe social anxiety.  He tells the therapist this piece of information and the therapist responds by saying, "what a brave move you have made coming here since you are so scared to leave the house."  The client may feel discomfort, vulnerability, and like he is being seen and heard, feelings he is uncomfortable with in the outside world and in the therapy room.  The question is, what do you do with those feelings?  Is the therapy room safe enough to explore those feelings of discomfort?

It is the therapist's job to make sure there is as much safety as possible for the client.  In order for there to be safety, the client must understand that the therapist will be non-judgmental and genuinely caring.  She must also know that the things she says are confidential and will be kept safe with the therapist.  The client must also know that the therapist is taking care of herself and will continue to do so throughout the relationship.  For example, the client must know that his therapist will show up on time, will hold to their agreements, will have taken care of her own needs so that she is present, follows her code of ethics in order to maintain a practice, and is working in the best interest of the client.

This is not to suggest that the skills therapists learn from other empirical research is useless.  There is skill involved in exploration and presence while witnessing such important work.  However, we heal through one another and it should be known that if you are experiencing emotions like discomfort, tension, frustration, resentment, happiness, or any other feeling, especially toward the therapist, they should be welcomed in the therapy room.  They are incredibly helpful keys to unlocking closed doors in our minds and discovering how we behave in the outside world.  They can also lead to healing old wounds and finding new ways to open one's heart to others.