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Licensed Psychologist

How Long Does Grief Last?

From a Therapist.com Article Whether it’s for work or the rest of life, I like to make a plan and have a schedule. But no matter how hard we try, certain things just aren’t meant to happen in an orderly fashion. One of those things is grief. Logically speaking, the loss I suffered shouldn’t have been that devastating. My grandpa Roger was 92 years old when he passed away in 2020. He lived a very long, full life, and for most of that time he was healthy and happy.  But when he passed away, my grief at losing him was compounded by my grief over the COVID-19 pandemic, leading to a spiral that took a long time to pull out of. As I struggled to recover from the loss, I found myself asking the same questions I’m sure many others have. These might sound familiar to you, too.

Shouldn’t I be past this stage of grief by now?

Whenever we lose someone, the stages of grief inevitably come up. Comments like, “It’s okay that you’re angry, it’s a stage you have to go through,” or “Of course it doesn’t feel real, you’re in denial,” seem to crop up left and right from friends, concerned acquaintances, and other mourners.  The concept of the five stages of grief was created in 1969 by Elisabeth Kübler-Ross in her book “On Death and Dying.” Since then, they’ve become a refrain that most people can recite from memory. As Kübler-Ross defines them, these stages are:
  • Denial: The reality of the loss has not sunk in, and you struggle to process the magnitude of what’s happened. You may find yourself saying things like “There must be some kind of mistake.” 
  • Anger: The pain of loss combines with feelings of helplessness, leading to frustration and anger. Anger can serve as an emotional buffer; when you’re feeling angry, it draws focus away from your pain.
  • Bargaining: During this stage, you try to ease suffering by striking a deal, often with some higher power. It can also involve ruminating on past experiences with a loved one that can’t be changed. For instance, you may think, “If only I’d insisted they go to the doctor earlier, we might have caught the illness in time to save them.”
  • Depression: When the loss becomes real to you, it can feel overwhelming. During the depression stage, you experience the pain of loss acutely and fixate on everything that will now be missing from your life. You may feel helpless, sorrowful, and generally low. 
  • Acceptance: Acceptance isn’t synonymous with “moving on.” Instead, it means you’ve embraced your new reality. You can begin to imagine the future and what this new version of your life will look like.
Kübler-Ross’s colleague David Kessler, a world-renowned grief expert, introduced a sixth stage of grief in 2019:
  • Finding meaning: Kessler defines this stage as the time after a loss in which you can move forward and live in a way that honors your loved one’s memory. You’re able to look back on memories of them with more love and gratitude than pain.
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5 Ways to Be Your Own Best Friend

Originally published at Psychology Today There is a quote from Ralph Waldo Emerson that reads, “It is one of the blessings of old friends that you can afford to be stupid with them.” Our best friends take us how we are and love us through it all. And in return, we talk out our problems and often speak from a place of truly wanting the best for each other. This is something most of us have in common: We are capable of good advice for our best friends. This advice might sound like, “You deserve better,” or “Apply for the job; the worst they could say is no.” It might even be as simple as, “Let it go.” So, have you ever noticed that it’s harder to speak so lovingly to yourself? The trouble comes from the negative slant the brain favors. It may seem messed up, but often by being negative your brain is trying to help you. Say you are applying for a job, your brain is actually trying to protect you from feeling disappointment by saying, “Why bother? They won’t hire you.” You don’t apply so you won’t feel sad about not getting the job. Of course, the unfortunate side effect is you end up feeling crappy anyway and lose out on new opportunities. In this example, what would your best friend say? They might remind you of how qualified you are for the job, how much the company would miss out on by not hiring you, and if you don’t get it another job will be lucky to have you. Sounds better! How come it’s so easy to say that to someone else? Well, we wouldn’t have very many friends if we talked to them the way we talk to ourselves. Instead, we learned to be supportive, caring, and encouraging in order to maintain meaningful relationships. Here are five ways to develop positive self-talk and treat yourself like your own best friend. Read the full article

Is Depression a Symptom of COVID-19?

Originally published at PsychCentral.com Research shows there may be a link between COVID-19 and the symptoms of depression. Here’s why it happens. Whether you’ve lost a loved one to COVID-19, experienced financial difficulties, or had a hard time adjusting to all the changes, the pandemic likely impacted you in some way. If you feel like you’re living with depression resulting from all of this, you’re not alone. Between 2020 and 2021, diagnoses of anxiety and depressive disorders jumped from 36% to 41%, according to the Centers for Disease Control and Prevention (CDC). But are these symptoms of depression a result of external factors only, or is depression a residual effect of the disease? So far, the research is pointing toward both.

Mental health symptoms of COVID-19

Scientists are learning more about the new coronavirus every day. But, for now, there’s limited information about the long-term effects of COVID-19. But there’s some indication that there may be a link between the disease and symptoms of depression. One study suggested that the coronavirus indirectly creates blood clots, which can cause brain damage. Another study suggested that our body’s immune system could indirectly be injuring brain cells while fighting the virus. Indeed, increased inflammation in the body is linked to depression. The coronavirus’s effect on the brain increases the risk for mental health challenges. About 1 in 5 people will develop a mental health condition 14 to 90 days after being diagnosed with COVID-19. For 5.8% of patients, it will be their first one. Mental health symptoms that developed as a result of COVID-19 also seem to persist 6 months after recovery. There also appears to be a link between COVID-19 symptoms and common symptoms of depression. For example, the loss of taste and smell were associated with depressive and anxiety symptoms. More recent research is starting to link depression with COVID-induced headaches. For example, a study published this year found that people with COVID-19 were at a higher risk for depressive symptoms when they reported headaches. Depressive symptoms were also more likely among younger adults than older adults. Read the full article

Managing Loneliness During the Holidays and beyond

Originally posted at Beacon Lens The holidays are upon us, and the irony they bring is the potential for isolation and loneliness. Holidays’ essential identity is getting together with loved ones, but some people do not feel as connected as they would like or expect. In 2020, add COVID-19 and its quarantining dictates, and the potential for such feelings can strengthen. The holidays, therefore, present an excellent time to discuss how we can reinforce connections during a time that requires us to be apart to protect our physical health, a requirement that paradoxically can have a damaging effect on our mental health. We can, however, take charge of improving our mental health.

Loneliness and isolation and our health

What is the difference between loneliness and isolation? “Loneliness is the feeling of being alone, regardless of the amount of social contact,” according to the Centers for Disease Control and Prevention (CDC). Social isolation, on the other hand, is a lack of social connections. Put differently, one can have many social connections but still feel lonely. The physical and mental health risks of loneliness and isolation are significant. They include but are not limited to:
  • Social isolation increases the risk of premature death by 29 percent, rivalling smoking, obesity and physical inactivity.
  • Social isolation is associated with increasing the risk for dementia by approximately 50 percent.
  • Loneliness is connected to higher rates of depression, anxiety and suicide.
A 2020 report by the National Academies of Science, Engineering and Medicine (NASEM) states that more than one-third of adults 45 and older feel lonely, and approximately one-fourth 65 and older are socially isolated. Add the holidays and COVID-19 to an already preexisting condition, and the time is ripe for all of us to take action to protect our mental health.

Simple steps for better mental health during the holidays

Specific to the season and the times, there are common-sense tips that we all can practice to help manage loneliness. For example:
  • Talk to someone about your sense of loneliness and isolation. There’s stigma around loneliness so it can be hard to do. However, you may well find that you’re not alone in those feelings, and sharing them can help lessen their effect.
  • Manage your holiday/COVID-19 expectations. The holidays can fall short of expectations, but this year it may be worse. Understand that the pandemic won’t last forever, and that we’re all in this together. Indeed, many people’s holiday gatherings will likely be different this year.
  • Remember to take care of yourself, now more than ever. Sleep, exercise and good nutrition — with the proper amount of holiday indulgence — go a long way in addressing mental health.
  • Avoid social media, such as Facebook or Instagram, especially during the holidays. It’s easy to negatively compare one’s life to the “perfect” lives posted on social media, forgetting that people mostly post only the positive.

Loneliness and isolation as its own pandemic

The holidays don’t last forever, and we will get through the COVID-19 pandemic. However, loneliness and social isolation may persist, which presents a challenge for behavioral health providers. The recent NASEM report explores interventions that the healthcare system can take to address loneliness as a societal condition, such as engagement in support groups, cognitive behavioral therapy and mindfulness, social determinants of health, social prescribing and more. Social prescribing is arguably one of the more interesting interventions in that it puts a clinical lens on non-clinical solutions. While there is no hard-fast definition of social prescribing, it is generally accepted as a way to connect people to non-clinical sources of support, according to the NASEM. Specifically, it is a “non-medical referral, or linking service, to help people identify their social needs and develop wellbeing action plans to promote, establish or reestablish integration and support in their communities, with the aim of improving personal wellbeing.” Examples of secondary services that improve social concerns affecting health include housing and food insecurity services. While known to varying community-based organizations, social prescribing is not common among practitioners, but it’s a common-sense solution. An analysis of one pilot program from the NASEM report — albeit a small one — found that social prescribing reduced inpatient admissions by as much as 21 percent and emergency room visits by 20 percent. A modern world — without COVID-19 — is more connected than ever due to social media and other technology. However, studies have shown we are more lonely now than in any other time in recent history. It’s time to think out of the box as we realize more and more how non-physiological conditions — such as issues ranging from a public health emergency to social media — can affect our health.

The Power of Girlfriends

In an evening class at Stanford University the last lecture was on the mind-body connection - the relationship between stress and disease. The speaker (head of psychiatry at Stanford) said, among other things, that one of the best things that a man could do for his health is to be married to a woman; whereas for a woman, one of the best things she could do for her health was to nurture her relationships with her girlfriends. At first, everyone laughed, but he was serious. Women connect with each other differently and provide support systems that help each other to deal with stress and difficult life experiences. Physically this quality "girlfriend time" helps us to create more serotonin - a neurotransmitter that helps combat depression and can create a general feeling of well being. Women share feelings whereas men often form relationships around activities. We share from our souls with our sisters, friends, and evidently that is VERY GOOD for our health. He said that spending time with a friend is just as important to our general health as jogging or working out at a gym. There's a tendency to think that when we are "exercising" we are doing something good for our bodies; but when we are hanging out with friends, we are wasting our time and should be more productively engaged. Not true. In fact, he said that failure to create and maintain quality personal relationships with other humans is as dangerous to our physical health as smoking! So every time you hang out to schmooze with a gal pal, just pat yourself on the back and congratulate yourself for doing something good for your health! We are indeed very, very blessed! So let's toast to our friendship with our girlfriends (inc. grandmas, sisters, mothers, nieces, cousins, aunties...). Evidently it's very good for our health. Forward this to your girlfriends to stay in touch, just like I just did! Thanks to all the women in my life who have helped me stay healthy, and feeling very loved.

Couples Covid Resilience

These are trying times. Our lives have been upended. We’ve been mandated to stay at home and work from home; our social outings have been drastically reduced, as have our social interactions with others. We’re faced with 24/7 interaction with our partners. The result is a unique form of cabin fever, which when combined with the stressors of an invisible enemy), (covid 19) creates profound uncertainty (When will this end? How? Will it return? Will I or my loved ones get sick?), major changes to our routines, and economic concerns, and becomes a stressful burden on even the happiest couples. These are times that call for our best—but how can we be our best when the natural human response is an uptick in anxiety and/or depression levels? Most of us have “COVID-brain”: It’s hard to think clearly when we are so worried and scared or feeling like molasses from our blueness. There’s just too much going on! We’re living in unprecedented times, locked out from the outside world and somewhat locked out of ourselves; we are unable to digest and reflect. This lessening of our cognitive function can impact our ability to ride the choppy waves in our couple relationship. Cindy Baum Baicker PhD,a clinical psychologist, interviewed senior psychoanalysts and described 5 factors which can be guide posts for couples during this stressful period. Pragmatism: Now is not the time for minor irritations. Let things go.  If you have had some alcohol and are annoyed or angry at your partner, let it go and if you’re still angry the next day, bring it up for discussion. We’re myopic when we drink, and nothing good can come from conflict resolution when we’re in an altered state. Think existentially: Who do we want to be when all of this is over? What will it have meant for us? Balanced Paradox: We’re separate, and we’re attached. Allow for each of these realities in your relationship. Make space to spend time together and apart, even though you’re living in the same space. Cognitive-Affective Differentiation: Allow for difference! A couple’s resilience during this time will depend on the state of the two people who are in the relationship. Stress affects each one of us differently and we each cope differently. Affect Optimization: The act of naming your emotions has been found to benefit wellbeing. Let yourself experience the range of all that you’re feeling and share it with your partner. That said, wise relators allow for “emotional blend,” but have also learned to lean towards or focus on their positive emotions. These are difficult times and also times to deeply feel one’s gratitude for what one has, and perhaps even for who one is. Emotional Generosity: Kindness, patience, humility, and deep regard for the other are all aspects of emotional generosity that you can bring to your relationship. Find that olive branch if there’s a disagreement, and extend it. When asked what they thought was required for a good long-term relationship, these wise elder clinicians said one word more than any other: tolerance. During the COVID-19 crisis, when we can all get underneath each other’s skins a bit too often, remember that word. Tolerance. And while you’re at it, remember why you fell in love with that person in the next room or in the room with you, and reconnect with those feelings.

Advice During Coronavirus

As the coronavirus robs us of the life we cherish, a renowned therapist, Esther Perel has some advice. Anxiety, dread, depression — these are just some of the emotions that hit us as we shelter in place and as death tolls rise. The irony of the moment, is that in a time of unimaginable death we can be reminded how to live. Social distance doesn’t preclude our coming together. Ms. Perel counsels us to create moments of connection - whether by volunteering, picking up the phone or sharing a story that made you laugh. It is important, she says, to keep living - particularly in moments of grief.

Anxiety, Depression and COVID-19: Now's the Time to Feel Our Feelings - Here's 8 Ways How To

We are in an anxious time. We are worried. Fearful. And ill at ease. Things are changing. Our schedules and routines. The ways we engage with others. And things are staying the same. The exact same. Day after day. Without going to work and having social calendars to adhere to, we’ve all found ourselves with more time in the day. More time to relax. To think. To stand still. And stillness is exactly what we need. Stillness in our communities. In our households. In ourselves. For being still is when we learn the most. When we connect the most. To others and to ourselves. It’s when we’re still that we feel our feelings. When our feelings surface the most. Perhaps why some of us stay so busy. For it’s easy to avoid your feelings when you don’t have a free moment. When you don’t take the time to do nothing. And now that is exactly what we must do. We are being called upon to stop what we are doing and to listen. Listen to what our bosses tell us. To what our community tells us. To what our doctors tell us. To what the government tells us. So why not use this time to listen to what we tell ourselves. The truths and the lies. The things that we’ve refused to see. Now is the time to address our mental health. To address our feelings. To admit them to ourselves. To acknowledge them. Sometimes all a feeling needs is to be acknowledged in order to be released. For those who don’t like to address their feelings, I realize it can be uncomfortable. Sometimes it feels easier to hide our feelings. Even to ourselves. Tricking ourselves into thinking we’re okay. When we’re not. I know what it’s like to keep your feelings hidden. I used to be a master at hiding mine. But I’ve learned that it did much more harm than good. And that identifying my feelings and talking about them is part of what helped me understand them. To acknowledge them and to let them go. Be sure to take this time to talk to yourself. Yes, I said talk to yourself. Through journaling. Or heck, out loud. Why not. I do it all the time. Notice how you feel with each thing that you do. Take time to reflect on the day. On the week. On each interaction you have and how it makes you feel. What a TV show or a book brings to the surface for you. A conversation with a loved one. A correspondence with a coworker. And why. Why certain things make you angry, anxious or sad. What makes you feel good and brings you joy. We don’t always have the time to address our feelings. But we’ve been given time. Possibly for the first time. It’s a gift. So it’s only wise to use this time to connect back to ourselves. To what’s happening within us. To our feelings. Here are some steps to take to helping you feel your feelings:
  1. Spend time in silence. Even if you only take 10 minutes a day, spend time alone in silence. Silence yourself and the things around you. And let your mind relax. Daydream. Unwind. Observe your body. Your feelings. And pay attention to what messages you are receiving.
  2. Observe your experiences. Since everything has slowed down, we can take the time to be more present in what we do. To observe the world around us. To notice others. And to notice what feelings come up in ourselves when we interact with others.
  3. Pay close attention to the things you say to yourself. Are you telling yourself you’re anxious? Depressed? Angry? For whatever feelings come up, instead of feeding into them, stop and listen to them. Observe them. Identify why you are feeling the way you are and what you can do to make it better.
  4. Do non-screen activities. Read an actual book or magazine. Color (yes adults, you too). Put together a puzzle. There are so many things that bring us joy that we too often neglect to do because so much of our time is spent staring at screens. Start by committing to one non-screen activity a week. If you don’t enjoy it, stop. If you love it, do it again soon. Tangibly connecting to things helps us feel our feelings too.
  5. Be playful and move your body. When we’re playful, we allow ourselves to be free, which allows our feelings to surface. Movement unlocks feelings stored deep within our body’s tissues. Doing both every day helps us explore our feelings.
  6. Journal your feelings every day. It can be as simple as adding a note to your phone with inconsistent thoughts and incomplete sentences. But be sure to record what comes up for you each day. In order to help you explore all the things you feel. Read here for tips on journaling to improve mental health.
  7. Talk to a loved one or to a therapist. Hopefully you have someone you can trust to share your feelings with, but if not, find someone you can. While starting with a new therapist may not be possible right now, talking to one still is. For example, Psych Central has an Ask the Therapist page where you can ask therapists questions and see previously asked and answered questions. You could also join an online support group.
  8. Find a teacher. I realize we can’t literally go out and find teachers right now, but that doesn’t mean we don’t have access to them. After you determine the feelings you’re having, and maybe even why you’re having them, conduct research. Find doctors, therapists and experts who have written and spoken about what is ailing you. Also keep in mind, anything can teach you what you need to learn. All you need to do is to observe, to listen and to acknowledge how you feel.
Remember to find the stillness in yourself: to connect to and to acknowledge your feelings and to heal the parts of yourself that need to be healed. I hope you are all safe and well. For those who are sick or who know someone who is suffering, may you feel better very soon.

10 Ways to Take Better Care of Yourself This Winter

Winter can be a difficult time.  Here are some ways that you can care for yourself:

Self-care is always important

Self-care includes all the things we do to maintain or improve our wellbeing. We all know how important basic self-care activities such as adequate sleep, exercise, healthy eating, hobbies, and spending time with friends are. And we know that when we don’t prioritize self-care, we feel lousy. Our health suffers. We get sick. We’re irritable, lonely, sluggish, and unfulfilled.

Self-care for the winter

As the seasons change, we often need to change our self-care routines to accommodate the weather, amount of daylight, our schedule, and so forth. The winter months can be particularly tough on us both physically and mentally. We’re more prone to colds and flu. some of us suffer from seasonal depression (the winter blues or Seasonal Affective Disorder (SAD) because of the lack of sunlight. And it’s hard to get out and be active. So, we need some self-care activities to meet the specific needs we have in the darker, colder months. Below, you’ll find 10 of my favorite self-care activities that are well-suited to winter.

1. Write in a Journal

It’s the beginning of a new year and a perfect time to start writing in a journal. Journaling is great for your mental health. It provides a place to dump your feelings, process and reflect, and clear your head. Even if you’ve already got a journal, you may want to consider starting a new one. I hear from many avid journalers that there’s something uplifting about the fresh, clean-start feeling of a new journal.

2. Enjoy Nature’s Beauty

Yes, winter can be cold and dreary. But it can also be beautiful – fresh snow on the trees, icicles hanging from the roof, red cardinals at your birdfeeder, a full moon. When we’re mindful and take the time to look, there’s a lot to take pleasure in.

3. Go to Therapy

Have you been thinking about starting therapy? It can be daunting to find a therapist you feel comfortable with, get yourself there consistently, and pay for it – but most people find the results are well worth the effort. And since we’re already inside so much during the winter, it seems like a good time to start or resume therapy. And if the weather or transportation are significant barriers, there are more and more options for online therapy, as well.

4. Get More (Sun)Light

Exposure to light (sunlight or artificial light) improves your mood and energy. So, if you’re living in the Northern Hemisphere during the winter, you’ll probably feel better if you spend an extra 20-30 minutes outside when it’s sunny. Even opening the curtains and turning on the lights in your office or home can help.

5. Relax and Get Cozy

On a cold winter’s day, there’s nothing better than staying home in your pajamas, cuddling up with a good book (or your significant other or your cat!), sitting in front of a fire, or binge-watching your favorite show. Occasionally, give yourself permission to stay home and just relax.

6. Connect with Friends

We all need to socialize, connect with others, and feel like we belong. And yet, spending quality time with friends or your spouse may end up at the bottom of your to-do list. How about meeting this self-care need by planning a game night, potluck dinner, or hosting a party to watch the Oscars with your friends? Not only is spending time with friends good for our mood, doing so may encourage us to relax, laugh, do something active, or try something new. And again, if it’s hard to get out and do things in person, have a virtual coffee date on FaceTime or Skype, or schedule a time for an old-fashioned phone call.

7. Enjoy a Hot Drink

A hot drink on a cold day is so comforting – a true simple pleasure. I’m a big coffee drinker, but I can easily overdo it. So, I try to mix things up with a collection of herbal teas and homemade sugar-free hot cocoa (just warm milk and a little cocoa powder and your favorite sweetener).  Maximize this self-care practice by slowing down. Instead of gulping it down in the car, take a few minutes to sit and relax and savor your drink. This is a quick, easy, and inexpensive way to pamper yourself.

8. Get a Flu Shot

Getting a flu shot isn’t necessarily enjoyable, but that’s true of a lot of self-care. It’s something you do for your health. And it’s not too late in the season to get one. So, speak to your doctor or pharmacist about whether a flu shot is a good choice for you.

9. Exercise

Many of us need to change our exercise routine or physical activities to accommodate winter weather. If you don’t have a regular exercise plan for the winter months, consider adding some winter sports (skiing, ice skating, snowshoeing, winter hiking) to your routine. Alternatively, there are lots of indoor exercise options such as yoga or dance classes, exercise equipment at a gym or home, or using exercise videos on YouTube or television. Don’t let winter weather be an excuse – you know you’ll feel better if you get a little movement into every day.

10. Encourage Your Creative Side

If you’re stuck inside, tap into your creativity. Did you know that arts and crafts are good for your mental health? Benefits such as reduced stress, depression, and anxiety, a sense of accomplishment, increased confidence and self-esteem have been reported. Crafts are nice because they can be done alone or in a group. And there’s something for everyone – everything from painting, scrapbooking, knitting, quilting, woodworking, jewelry making, and more. Pull out an old favorite or try something new this winter!

Put self-care on your calendar

Now that you’ve got a few ideas for your winter self-care, it’s time to put it on your calendar. Self-care (like most things) is much more likely to happen if you create a plan for when and what you will do to take care of yourself. Where will you begin? Perhaps, just add one new self-care activity to your schedule this week.

Statement of APA President in Response to Mass Shootings in Texas, Ohio

WASHINGTON - Following is the statement of APA President Rosie Phillips Davis, PhD, on the shootings in El Paso, Texas, and in Dayton, Ohio: "Our condolences are with the families and friends of those killed or injured in these horrific shootings and with all Americans affected every day by the twin horrors of hate and gun violence. “As our nation tries to process the unthinkable yet again, it is clearer than ever that we are facing a public health crisis of gun violence fueled by racism, bigotry and hatred. The combination of easy access to assault weapons and hateful rhetoric is toxic. Psychological science has demonstrated that social contagion — the spread of thoughts, emotions and behaviors from person to person and among larger groups — is real, and may well be a factor, at least in the El Paso shooting. “That shooting is being investigated as a hate crime, as it should be. Psychological science has demonstrated the damage that racism can inflict on its targets. Racism has been shown to have negative cognitive and behavioral effects on both children and adults and to increase anxiety, depression, self-defeating thoughts and avoidance behaviors. “Routinely blaming mass shootings on mental illness is unfounded and stigmatizing. Research has shown that only a very small percentage of violent acts are committed by people who are diagnosed with, or in treatment for, mental illness. The rates of mental illness are roughly the same around the world, yet other countries are not experiencing these traumatic events as often as we face them. One critical factor is access to, and the lethality of, the weapons that are being used in these crimes. Adding racism, intolerance and bigotry to the mix is a recipe for disaster. “If we want to address the gun violence that is tearing our country apart, we must keep our focus on finding evidence-based solutions. This includes restricting access to guns for people who are at risk for violence and working with psychologists and other experts to find solutions to the intolerance that is infecting our nation and the public dialogue.” For people who are suffering distress in the aftermath of the shootings in Dayton and El Paso, APA offers a variety of resources, including:
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