Tag Archives: anxiety

The Mind/Body Connection in Chronic Symptoms

neck pain

Pain and other chronic symptoms—like IBS, vertigo, tinnitus or bladder issues—can take over our lives. Physical symptoms naturally create fear, and symptoms and fear together can become the center of our attention, pushing everything else into the background.

When pain or symptom keep us from doing the things we enjoy, it’s common to feel anxious or depressed. In fact, most people who struggle with chronic pain also experience anxiety or depression. It’s not always clear which came first, because they are closely connected. Many people with chronic symptoms have experienced childhood adversity, and are likely to be perfectionists or people-pleasers—traits that can increase stress and make us more vulnerable to both physical and emotional symptoms.

While chronic pain and other physical symptoms appear to be based in the body, research shows that trauma, emotions and stress play a powerful role—even sometimes when pain seems to have a clear physical cause.

I experienced this firsthand. Years ago, I developed chronic wrist tendinitis that was attributed to  typing too much. My pain was real and constant, and I tried everything—chiropractic, physical therapy, massage, acupuncture, Alexander Technique, and Feldenkrais classes. Nothing helped for long. I had to stop doing many things I loved. I wore wrist splints, used voice-recognition software, and avoided cooking, gardening, and knitting. Despite all these precautions, I was in pain for more than two years.

Then I found Dr. John Sarno’s book Healing Back Pain. He discovered that many people who had  physical findings that might cause pain—like herniated discs or arthritis—had completely different pain experiences. Some had severe pain, while others with the same imaging results felt none at all. One large study of over 3,000 people found that spine changes seen on MRIs are usually a normal part of aging and don’t necessarily cause pain. His work with his patients demonstrated that emotional stress and repressed anger can create very real physical pain. He helped many thousands of people recover from chronic pain with his medical practice and his books. I was one of them. 

It’s important to note that pain or other symptoms are not “all in your head.” Chronic symptoms are  absolutely real. But all our experiences are mediated by the brain, and our brains interpret pain based on not only sensations sent from the body, but also based on expectation, and the perception of danger. If we’re afraid that something is wrong with our bodies, or of conflict, negative emotions, or anything else we experience, pain and other symptoms can begin or intensify. On the other hand, if we feel safe and confident in our body’s strength, and in our ability to handle our emotions and our relationships, they can fade—even when nothing physical has changed. This is why treatments that reduce fear and increase a sense of safety can be so effective. The fact that changes in in how we interpret the world impact our symptoms is why we call these symptoms “neuroplastic.”

Over the past several years, there has been increasing evidence supporting Dr. Sarno’s theory, and new treatments have begun to be proven to help patients overcome neuroplastic symptoms. In 2020, I completed training with the Pain Psychology Center to work with clients using Pain Reprocessing Therapy (PRT). A study at the University of Colorado found that people with long-term back pain experienced major or complete recovery after just four weeks of PRT.

PRT helps retrain the brain to interpret pain signals differently. It uses mindfulness, cognitive, and behavioral techniques to reduce fear, calm the nervous system, and build a sense of safety in the body. As fear decreases, pain often does too—sometimes permanently.

Chronic symptoms, as miserable as they can be, often serve hidden purposes. They may give us permission to slow down, rest, or seek care from others. They may distract us from emotions we’d rather not face. Understanding these patterns can help us reclaim our energy and our lives.

When we start to truly trust that our bodies are strong and resilient, and that we can handle our emotions and the stresses in our lives, we can stop letting pain dictate our choices. With the right tools and mindset, recovery is possible—and life can feel full and joyful again.

 

Take a test to see if your chronic pain or symptoms are likely treatable using a mind-body approach

References:

  1. Sarno, M.D., John E. Healing Back Pain: The Mind-Body Connection. New York, NY: Warner Books, 1991.
  2. Sarno, M.D., John E. The Mindbody Prescription: Healing the Body, Healing the Pain. New York, NY: Warner Books, 1998.
  3. AJNR Am J Neuroradiol. 2015 Apr; 36(4): 811–816.

    Published online 2014 Nov 27. doi: 10.3174/ajnr.A4173

 

Share this on:

Antidepressant Medication in Pregnancy

Pregnant Belly

The debate over the safety of psychotropic medications during pregnancy continues to spark strong opinions. Critics of antidepressants often cite numerous articles and isolated studies highlighting potential risks or questioning their effectiveness. What we’re seeing, in many cases, is a form of “splitting”—the tendency to categorize something as entirely good or entirely bad. When it comes to psychiatric medication, people often fall into one camp or the other and accept only the evidence that supports their viewpoint.

The reality is more nuanced. Yes, some psychiatrists make mistakes, and psychiatric medications can be overprescribed or misprescribed. Some people do not respond well to them. But many others experience profound relief, and for some, these medications are lifesaving. This is why clear, balanced, and evidence-based information about the use of psychotropic medications during pregnancy and breastfeeding is so critically important.

Many who oppose antidepressants advocate for natural or holistic approaches to treating depression and anxiety. These approaches can absolutely be helpful for some people. I’ve personally tried acupuncture, chiropractic care, homeopathy, craniosacral therapy, and herbal treatments, and at times found them beneficial. But, just as we rely on modern medicine for conditions like Type 1 diabetes, there are situations in which holistic measures simply aren’t enough.

In my own experience many years ago, no amount of holistic treatment or psychotherapy touched my severe postpartum anxiety and depression. I was eventually hospitalized when I no longer wanted to live. Six weeks after starting an antidepressant, I was able to function again and finally benefit from therapy. I know that medication saved my life, and I’ve heard countless similar stories from other birthing people.

Perinatal mental health disorders have both biological and psychological components. Hormonal shifts, physical recovery from childbirth or cesarean, and chronic sleep deprivation can all play significant roles. In my work with birthing people, I’ve seen again and again that those with severe perinatal depression, anxiety, or OCD often do best with a combination of approaches—psychotherapy, self-care, social support, nutrition, sunlight, and moderate exercise, and medication when needed.

Some parents choose not to take medication, and many do recover with therapy, support, and lifestyle changes. But some later wish they had considered medication sooner, regretting the weeks or months lost with their baby while they struggled to bond or function due to overwhelming symptoms.

Untreated depression and anxiety during pregnancy and the postpartum period carry real risks. They can affect birth outcomes and have lasting effects on the parent, the baby, and the entire family system.

The truth is that some new parents simply do not have the energy, motivation, or clarity to benefit fully from therapy or self-care until their symptoms are stabilized. In my experience, most of these individuals improve significantly once they receive the right medication. That practical reality matters far more than abstract debates about whether medication is “good” or “bad.”

New parents deserve balanced, compassionate information—not scare tactics, shame, or political agendas. Their health, their babies’ well-being, and their family’s future depend on access to accurate guidance and the full spectrum of effective treatment options.

Share this on:

Coping with Anxiety Using Mindfulness

anxiety

You know the feeling when it starts: an unpleasant burning in your chest or abdomen, a feeling of cold on the back of your neck, tingling in your arms, or tightness in the back of your throat. Anxiety is a physical phenomenon.

Many of us are unaware of the specific physical sensations associated with our anxiety, but it sends a signal to our brain that we are in danger. On its own, anxiety tends to pass quickly and without much ado. It is the way we attribute meaning to the sensations in our body that causes anxiety to feel unbearable and to stick around. We interpret our anxiety as being “out of control.” We look to our environment or our thoughts for signals that we really are in danger, either physically or emotionally. And we beat ourselves up for feeling anxious, telling ourselves “What is wrong with me?” “Why can’t I feel calm?” And even worse, “I can’t tolerate feeling this way.”

But in reality, we can tolerate anxiety. By tolerating it and observing, without fear, and without judgment, its physical manifestations, we rob it of its power over us. And over time, anxiety will diminish if we refuse to escalate it by letting it take over our thoughts and our decisions. The quickest path to diminishing anxiety is to accept it and not to catastrophize about it or let it make our lives smaller.

Mindfulness is one of the most powerful tools for coping with and transforming anxiety. While it may feel like WE ARE anxious, bringing awareness to our body and choosing to focus on the specific physical sensations we are experiencing allows us to see that we are the observer of anxiety, not its victim. We can choose to halt self-defeating thoughts by returning awareness to our body and reminding ourselves “Anxiety cannot hurt me. It is only a feeling, and it is temporary. I am in control of myself. I can choose to be aware of the anxiety without letting it take over my thoughts.”

Practice doing mindfulness exercises such as this one when you are not feeling particularly anxious, as a way of being ready for anxiety when it comes. Learning to focus your full attention on your body rather than your thoughts takes some practice, but only five minutes a day can make a huge difference in reducing anxiety and helping you cope with it when it comes.

Anxiety is often associated with depression, even if the depression is not severe. Taking steps to address negative patterns of thinking, grieving losses, and learning to take better care of ourselves physically and emotionally is another important step in dealing with anxiety. If you need help to learn to identify and challenge negative thoughts, work through with past trauma or loss, or learn to improve your self-care and relationships, finding a therapist you trust is a great place to start.

Share this on:

Why Parents Should Nurture the Child Within, Too

Young woman on swing
Young woman on swing

Becoming a parent brings out so many new qualities in each of us. We learn to nurture selflessly. We learn patience and empathy. We learn to read the cues of our new baby, and how to meet their needs as best we can. It is an opportunity for growth like no other in our lifetime.

However, as we learn to give love and care to our child, many of us also begin to face the reality that we were not nurtured in certain ways in our own childhood. As we provide a loving mirror to our child, reflecting back a positive and validating image, we may become aware that we were not mirrored in a loving way ourselves. Perhaps we were shamed for certain qualities, or silenced when we voiced our truth, or in other ways shown that we were “not OK” the way we were.

Many of us have internalized shaming and dismissive attitudes directed at us as young children. We may not even realize that we continue the pattern by shaming or silencing ourselves. The child part within each of us, which is our source of joy, passion and creativity, is often stifled by our own inner shame. Our need for validation, love and nurturing are easily dismissed as “selfish” or “needy,” as we tell ourselves that we “shouldn’t” need the things the child inside us craves. The things we most enjoy and that give us pleasure are easily lost as we focus our attention on practical realities and the needs of others, especially our children and our partner.

This pattern of self-neglect fosters depression and chronic pain or physical symptoms. The child inside us loses hope that he or she will ever experience joy and fulfillment, contributing to depression. Or the child gets angry at being neglected and acts out, causing us to be resentful, irritable, or develop chronic symptoms (anxiety or somatic complaints) that tell us that all is not well in our inner world.  

This is how I understand my own struggle with anxiety and chronic symptoms as a mother raising my children. When I lost touch with the child inside me, as it is so easy to do while raising children, my anxiety mounted. If I continued to be what I believed a “good mother” was (e.g. selfless, endlessly patient and focused on the needs of others), the result was depression, painful physical symptoms, overeating, and other self-destructive patterns. What I came to discover was that by focusing my attention inward, and creating a loving dialog between my inner parent self and my inner child, I was able to heal those childhood wounds and feel a sense of balance and wholeness. 

Some clients of mine find that they can identify a clear inner parent and inner child voice. But for those who find it more difficult, the following exercise can be useful. You can communicate in the voice of your inner parent by writing with your dominant hand, and can reply as your inner child by writing with the non-dominant hand. It is amazing how easy it is for many people to access the child part of themselves when struggling to write with their non-dominant hand! If you have difficulty “hearing” your inner child voice, put your hand on your belly — that can help you access this vulnerable part.

You can start a dialog by asking “how are you doing?” or “how can I take care of you today?” or “what are you needing from me?” Some will find that the child inside them is quite angry and distrustful of the inner parent at first, for having neglected them for so long. But you can overcome this distrust by responding consistently in a loving parental voice, and reassuring the child inside you that you are there for them, that you will not leave them alone again, and that you love them just the way they are. You may not always be able to give your inner child what it wants in that moment, but just as we do with our children, we can learn to validate their needs and make sure that we create a life in which our inner child’s needs have some level of priority as well.

Here’s an example of an inner child dialog, that was initiated when the client found herself feeling very heavy and having back pain:

Parent: What are you needing from me today, Sweetie?

Child: I’m sad and I want to play with my friends, but I always have to work and take care of people.

Parent: I’m so sorry you’re sad. Working so much is really hard. We don’t have time to go play today, but I will make sure we have a couple of hours this weekend to go do something fun. You’re feelings matter to me, and I’m really glad you told me how you feel. Would asking [partner] for a hug help make this day easier?

Child: Yes, I like hugs. But I’m still sad.

Parent: I know, and it’s OK to be sad. Your feelings matter to me. Do you think a nice bath before bed would feel good?

Child: Yes, that’s good. Can I have bubbles and music?

Parent: Absolutely! I’m so proud of you for asking for what you need and I love you very much.

This exercise will allow you to begin a conversation that can allow you to experience a corrective emotional experience of being cared for and attended to, which can heal your heart in a very deep way. You can also learn how to create a balance between the needs of others and the needs of this tender part of yourself, which will allow you to live a more authentic, joyful life.

Share this on:

Perinatal Mental Health and Perfectionism

canstockphoto10868712

You’ve read the books. You’ve prepared the nursery. You’ve heard about Postpartum Depression—even if you may not see yourself as someone who’s likely to experience it. The commonly known risk factors for Perinatal Depression and other perinatal mental health disorders include:

  • A previous episode of depression or anxiety (especially during pregnancy)

  • A recent loss or major stressor, such as financial or health challenges

  • Lack of social support or relationship difficulties

  • A complicated pregnancy or birth, or breastfeeding challenges

Many of the clients I work with can check several of these boxes, and having one or two doesn’t guarantee you’ll struggle emotionally after birth. But there’s another risk factor that’s harder to measure—one that isn’t about what has happened to you, but about how you relate to yourself and the world.

Research shows that perfectionism and related personality traits can significantly increase the risk of postpartum depression. In particular, new parents who struggle the most with making mistakes are about four times more likely to experience postpartum emotional challenges. Also at higher risk are those who naturally prefer order, clarity, and control. This makes intuitive sense. Becoming a parent is the ultimate beginner’s role—messy, unpredictable, and often undertaken on very little sleep. If uncertainty or imperfection has always been hard for you, new parenthood can feel especially overwhelming.

In my practice, many of the new parents who struggle most aren’t just perfectionistic—they’re also used to taking responsibility for everyone else’s feelings and needs. That may work—barely—before a baby arrives. But a newborn instantly multiplies the emotional load. Babies cry. They will cry no matter how devoted, attentive, or skillful you are. And the more pressure you put on yourself to be a flawless parent, the more strained your energy and relationships can become. It’s a setup for stress, anxiety, and depression.

This is why learning to let go of perfection—in small, practical ways—can be powerful preparation for parenthood. Let the dishes wait a few hours. Run out of clean socks once in a while. Burn the rice because you got lost in a great article. Notice what’s going well instead of what could be better. Enjoy the sunshine in your half-landscaped yard. Allow people to be disappointed on occasion—after all, they disappoint you sometimes too. Practicing being good enough is not just healthy; it’s the foundation of sustainable, compassionate parenting.

If the idea of leaving a dish in the sink feels impossible, consider trying mindfulness practices or guided exercises. Mindfulness can help you accept what’s happening in the moment instead of feeling responsible for fixing everything. And you might benefit from support with a warm, understanding therapist (bonus points if their desk is a little messy). Learning to release some of the pressure you’ve carried for years is an investment in your well-being—and in the emotional health of your growing family.

Share this on:

People-Pleasing Moms: At Risk

Sad new mom holding baby - people-pleasing momsOne of the common themes I come across when working with mothers experiencing depression and anxiety is perfectionism and people-pleasing. Moms get worn out when they are trying to make everyone happy all the time.

There are often good reasons for a tendency to be over-responsible for the feelings of others. Many of us come from families where there was an unspoken expectation that a child must be “good,” because one or both parents were unable to tolerate the challenge of even normal childhood misbehavior. Or sometimes, children develop an unconscious habit of caretaking for others as a way to get their own needs met.

Read the Article

Take a test to see if you have Prenatal or Postpartum Depression

Share this on:

Does Your Personality Style Put You at Risk for Postpartum Depression?

mother baby

By Meri Levy, MA, MFT

What are the risk factors for Postpartum Depression and anxiety? Can your personality contribute to your risk? Check out this article of mine, published on www.GoodTherapy.org.

Take a test to see if you have Prenatal or Postpartum Depression

Share this on:

My Journey Through Postpartum Depression and Panic Disorder

Whenever I talk about the symptoms of perinatal mood and anxiety disorders, I always include “unusual physical symptoms.” What does that mean? It means that any new physical symptoms that begin during pregnancy and postpartum can be related to mental health.

My own experience with postpartum depression and anxiety was quite atypical, and that was partly why I suffered for months before receiving the proper diagnosis and treatment.

I had lots of risk factors for postpartum depression: a previous bout of depression, the sudden loss of my mother only a few years before, a previous birth trauma, an unsupportive marriage, and breastfeeding difficulties. But even though I had suffered from depression before, after the death of my mother, my postpartum symptoms were not recognizable to me.

I did OK after my first child was born, although it was a difficult time for me. But after my second child, my stress level was off the charts. My older son was kicked out of two day care programs because he wouldn’t use the potty (he regressed after his brother was born). I never made enough milk for the new baby because of my stress level and because he was so big (born almost 10lbs) , and he refused to nurse completely as soon as he started solid foods. I felt guilty about “failing” at breastfeeding, and I was also afraid that I would not be able to go back to work after maternity leave because I couldn’t find daycare that would take my challenging and potty-resistant older son.

In the meantime, I had difficulties in my marriage. My husband worked long hours, and when he was there he criticized my parenting style, my cooking, and my housekeeping. Even our challenging preschooler was my fault! I was trying my best to make everyone happy, but I was clearly failing.

During this time, I started to have odd physical symptoms. I started feeling that the room was tilting and that I was off-balance. I had to lie down and felt the room was spinning around me. My doctor thought it was either an inner-ear infection or possibly Multiple Sclerosis, and I was sent for neurological testing. The tests came back normal, although MS couldn’t be ruled out (a bonus for my anxiety, of course!).

My symptoms came and went, and then began to include nausea and vomiting along with the dizziness, a complete lack of appetite, and an inability to sleep. I had a low-grade fever on and off for a couple of months and my white blood-cell count was high. I lost 16 pounds beyond the baby weight, slept about three to four hours a night, and threw up regularly — out the door of the car, in the sink at the pediatrician’s office, etc. I felt that my body was swaying even when I was perfectly still, and my bed felt like it was shaking as I lay in it trying to sleep. My skin felt prickly, my chest burned and my hands tingled. The dizziness made watching TV or reading impossible, and walking or driving became difficult. I felt sure that I was dying.

My doctor considered an inner ear problem, hormones, diabetes, thyroid issues, and even encephalitis, but every test came back normal. I was living on Ensure and Gatorade, because I couldn’t keep any solid food down. The stress of caring for my children became unbearable, so we hired a babysitter and I spent most of every day lying in bed, praying to fall asleep for a couple of hours to get some rest. I was prescribed Ativan, but it just knocked me out for an hour or two and I would wake up feeling even worse than before.

After about four months, I fell apart completely and told my doctor that he had to hospitalize me because I was dying, and at that point I wanted to die if they couldn’t stop the misery I was living in. I was admitted to a psychiatric inpatient unit, but my doctor was still sending me around to specialists, trying to figure out what was physically wrong with me.

I stopped vomiting as soon as I was admitted to the hospital. That was when I realized that whatever was going on with me had to do with stress. I spent 12 days in the hospital, during which time I started taking antidepressants and was prescribed an anti-anxiety medication that allowed me to sleep. For a few days, all I did was sleep. When I was awake I was no longer nauseous, but I was filled with unbearable emotional pain. I was terrified that I would never be able to care for my children without getting sick. I felt like the worst mother in the world.

After I was released from the hospital I did a full-day partial hospitalization program for a month, which gave me time for the antidepressant to start working and allowed me to take care of myself for a change. I learned in group therapy about the ways in which I had prioritized my responsibility for others way above self-care, in unhealthy and unhelpful ways, and I began to heal. With the help of medication, therapy, and later couples counseling, I recovered. I still had anxiety at times, but I also had joy and passion for life. I became a lactation educator, started a small business helping other new moms, and led new parent support groups for several years. Eight years later I went back to school to become a Marriage and Family Therapist.

I still have to be vigilant about managing stress and maintaining good self-care. I tell myself that this is the “gift” of being prone to depression and anxiety: I don’t have the luxury of tolerating a great deal of stress like some people seem to do, or living life in a way that generally makes me unhappy. I am obligated to do work that I love, to have a healthy relationship with my husband, and to prioritize joy, peace and comfort as well as caring for my family. I know that I always have to be mindful to avoid a recurrence of depression, but I also know that I am strong and resilient and will do whatever I have to do to be healthy and take good care of myself and my children.

My mental health issues began when my second child was seven months old, and yet no one ever considered a postpartum condition. My symptoms were fully consistent with panic disorder and depression, and yet my doctor and my therapist (yes, a trained therapist!) never considered these diagnoses. My hope is that in the future, mothers and their caregivers become better educated to recognize perinatal mood and anxiety disorders so that they can be treated early and mothers can return to enjoying their lives again.

  • If you need immediate help, please call the National Suicide Hotline at 1-800-273-TALK (8255)
  • If you are looking for pregnancy or postpartum support and local resources, please call or email Postpartum Support International:

Call PSI Warmline (English & Spanish) 1-800-944-4PPD (4773)
Email support@postpartum.net

Take a test to see if you have Prenatal or Postpartum Depression

Share this on:

How Doulas Can Help With Postpartum Depression

family with babyOn Wednesday, I was invited to speak to a group of local doulas, the Mt. Diablo Doula Community, about prevention of Perinatal Mood and Anxiety Disorders (PMADs), as well as how to recognize the disorders and how to help their clients. I hope the presentation might be helpful for doulas who are wanting more information about these disorders and what role they can play in keeping moms healthy and happy. You can access the Presentation Here. Attachments to the presentation are the Edinburgh Postnatal Depression Scale and an associated Suicide Screening Interview.

Share this on:

Antidepressants: Yay or Nay?

canstockphoto19841317For individuals who have struggled with depression, the decision of whether to try, or later to stay on antidepressant medication is often a difficult one. Some people swear they will never try an antidepressant, until or unless their depression becomes so debilitating that there seems to be no other option. For others, the promise of relief is so attractive that they jump into the decision to take antidepressants, but then they struggle with the question of whether the medication is a lifelong sentence.

To Take Antidepressants or Not to Take Antidepressants

There are no easy answers to this question (as is true for most important ones!). Studies show that individuals suffering from moderate to severe depression have better odds of recovery with a combination of therapy and antidepressants. However, for some people, changes in diet, additional exercise, and better strategies for coping with stress can work just as well. For debilitating depression, medication can often help to lift a person up enough to be able to meaningfully participate in therapy. But depression generally happens for a reason, and often changes in thinking patterns, relationships or career are necessary for a person to have more happiness and fulfillment in their life. Medication alone may not make these changes happen. Does relying on antidepressants to make life more bearable reduce the motivation to make needed life changes that will improve the quality of one’s life? The answer to that question may be different for every individual, and is something that can be explored in therapy.

Side Effects

Some individuals find great relief on antidepressants, and don’t have any bothersome side effects. But others experience weight gain, sexual side effects or other unwanted secondary effects from these drugs. Sometimes, switching medication can resolve these issues, but in some cases the antidepressants that work for the individual are the same ones that cause other problems. That is a common reason why some people consider going off medication and try to manage their depression in other ways.

Never Go Off Antidepressants Without Consulting Your Doctor

A reminder here is important; never go off antidepressant medication suddenly, or without the supervision of the prescribing doctor. Some of these drugs require an extended period of weaning to avoid serious withdrawal symptoms. And an important factor to consider is the possibility that if you wean off your antidepressant medication, the same medication may not work for you as well in the future. That is one factor that you need to weigh with your health provider when making this decision.

Issues Raised by Weaning Off Antidepressants

Individuals that decide in consultation with their doctor to wean off antidepressants face a whole other set of challenges. The fear of a relapse of depression can be the most difficult part. Coping with the symptoms of withdrawal can be challenging, and often brings up these fears. Also, people who go off antidepressant medication may find themselves more vulnerable to feelings of sadness, irritation, anger and stress than they are used to. Learning coping strategies for these emotions is very important. A really bad day can create a lot of anxiety that the depression may be returning, even if the emotions involved are normal and healthy. Therapy can be an helpful place for reality-testing in terms of what is healthy and what is a signal that depression may be returning.

The thoughts and feelings around the decision to go on or off of antidepressant medication can be confusing. Therapy and consultation with your medical provider to sort through the questions and concerns raised by antidepressants is a good place to start.

Share this on: