100 ways to improve your mental health

We’ve reached a milestone today – this is my 100th post! To celebrate, I decided to make a list of 100 things. The most helpful idea that came to mind was ways to improve mental health, so here it is. I have broken the list down into categories so that you can find the ones that are the most relevant for what you are working on. (Another milestone: Happy birthday, A. You’re my favorite.)

  

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Emotionally

1. Honor your emotions for what they are and accept them fully.

2. Do something that makes you happy every day.

3. Remember that feelings are temporary; they will always change.

4. Express your emotions creatively.

5. Ask for help when you feel overwhelmed.

6. Know when to back out of a situation.

7. Stop your thinking and ask yourself what you are actually feeling and why.

8. Use a feelings chart to identify what you are experiencing.

9. Surround yourself with little things that make you happy – flowers, art, scented candles, etc.

10. Find positive and uplifting entertainment.

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Mentally

11. Stay in the present.

12. Deal with stress as it comes up.

13. Eliminate bad habits. 

14. Set realistic goals and work towards them.

15. Stop using negative words to describe yourself.

16. Reward yourself for doing difficult things.

17. Take a break when you need it.

18. Find new ways to do things.

19. Stop and consider other perspectives on what you’re experiencing.

20. Use good common sense.

                                                                                              Physically

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21. Exercise regularly.

22. Take time to relax.

23. Eat three meals a day.

24. Take your medication as prescribed.

25. Stay at a healthy weight. 

26. Get enough sleep.

27. See a doctor when you need to.

28. Choose healthy food.

29. Stay away from harmful substances.

30. Love your body as best you can.

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Socially

31. Rely on your support system.

32. Spend time with other people regularly.

33. Be a helpful friend.

34. Respect the needs of others and expect that they do the same.

35. Engage in volunteer work.

36. Eliminate negative influences in your life.

37. Set and keep healthy boundaries.

38. Make time for yourself.

39. Be clear in your communication.

40. Be considerate.

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Intellectually

41. Be educated about your disorder(s).

42. Learn something new every day.

43. Study things you genuinely find interesting.

44. Study something you know absolutely nothing about.

45. Do mind exercises like sudoku, crossword puzzles and word games.

46. Talk to other people about what they do.

47. Take an evening or community course.

48. Think up funny jokes and witty responses.

49. Take notes when you are learning about something. Refer to them later.

50. Do calculations in your head instead of using your phone.

Spiritually

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51. Practice mindfulness

52. Meditate and/or pray.

53. Eliminate unhealthy beliefs.

54. Rely on a higher power.

55. Learn about the beliefs of others.

56. Journal about your spiritual experiences.

57. Share your spiritual experiences with open-minded loved ones.

58. Forgive.

59. Find or decide on your life’s purpose and live it.

60. Stay true to what you believe.

                                                             Environmentally

                                                             61. Surround yourself with beautiful things.

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62. Hang up motivational posters.

63. Spend time in nature.

64. Keep your home clean.

65. Use sticky notes to post affirmations where you’ll see them frequently.

66. Support any environmental causes you believe in.

67. Use your resources well.

68. Take basic safety precautions.

69. Repair broken things so they don’t continue to frustrate you.

70. Stay organized.

Occupationally

71. Do things you love.

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72. Know your limits when it comes to work.

73. Develop schedules and routines.

74. Simplify your work.

75. Get support from colleagues when necessary.

76. Keep good boundaries between your personal and professional lives.

77. Compliment coworkers on a job well done.

78. If you are unhappy in your job, look for a new one.

79. Multitask less.

80. Take a day off when you need to.

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Self-care

81. Journal regularly. 

82. Go for a walk.

83. Make your favorite meal.

84. Use grounding techniques.

85. Have a list of coping skills.

86. Be patient.

87. Keep a gratitude journal.

88. Go easy on yourself.

89. Respect yourself.

Other

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91. Stand up for yourself.

92. Believe you can get better.

93. Keep a beginner’s mindset.

94. Learn from every experience.

95. Keep some money in savings.

96. Have alternatives for self-destructive behaviors.

97. Be prepared for change.

98. Have a safety plan.

99. Stay progress-oriented.

100. Make a list of personal reasons to recover.

Do you have any tips to add? Please do so in the comments!

5 dating tips for those with a mental illness

  

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Last week, we talked about dating someone with a mental illness. Today, we’re taking a look from the other side. Dating can be overwhelming and confusing, and having a mental illness just adds to that. But it is possible to have a successful, happy and healthy relationship even if you are struggling with your mental health. It took me quite a while, but finding that balance is possible. Here are my suggestions to speed up your process.

1. Don’t expect her to read your mind.

This is a good tip in general, but especially important when mental illness is involved. Other people don’t know what you’re thinking or feeling if you don’t tell them. For instance, you can’t expect someone to cheer you up if he doesn’t even know you’re feeling depressed. Assert your needs. Be as open about what you’re experiencing as you are comfortable with (and as is appropriate at your stage of the relationship). This will help your partner get a better picture of what you’re dealing with, which makes it easier for both of you.

2. Take responsibility.

Mental illness pushes us to do things we would not otherwise do. There are times when we legitimately can’t help it, but you can’t blame everything on your illness. It is not a crutch and it is not an excuse. You have choices, no matter how much you feel the odds are stacked against you. When you really, truly tried your best and your illness got in the way, say that and explain what happened. But you still need to own up to your faults because you are not possessed. You made a decision. You are still you and we all
                                                                             make mistakes sometimes.

3. Respect his needs.

It can be easy to get caught up in our own needs when we are struggling with our mental health. It feels like too much is going on and a lot of energy goes to managing our symptoms. But your partner has needs, too. Respect that she can’t always answer your call at three in the morning. Be okay with him taking the night off to see his buddies. See how you can be helpful as well. Even if you can’t do everything you’d like to, you can make an effort to show that you respect and value her.

4. Work on your recovery.

Your biggest gift to your partner is yourself. That is one motivation to work on improving. You want to be fully present and available, which can be hard when you are struggling with yourself. Dating someone with a mental illness can be stressful, so the improvements you make help it be more manageable for your partner. A healthy you is more able to meet his needs as well. Just be careful that your partner doesn’t become your only motivation.

5. Love yourself.

Have you ever heard someone complain about herself and thought, “I don’t see that at all”? No matter how unlovable you think you are, there are reasons others like and care about you. Pushing away this love to wallow in self-pity not only is unhealthy for you, but can be hurtful to your partner. Self-image is a huge part of mental health. Focus on what you do appreciate about yourself. You should be doing something to show that you care for yourself every single day. Besides, the more you healthily love yourself, the more you can healthily love others.

What has your experience been with dating while struggling with a mental illness? Talk about it in the comments.

5 tips for dating someone with a mental illness

  

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It’s February, so romance is on everyone’s minds. Love is such an important emotion. It can change lives in a way that nothing else can. We all need love, and that includes those of us with mental health issues. Here are some suggestions to help you if you are dating someone with a mental illness.

1. Ask appropriate questions.

You need to be reasonably respectful of your partner’s privacy, but don’t be afraid to ask questions. Preface them with, “You don’t have to answer this, but I’d like to know…” so that he doesn’t feel like he is being pressured. Focus on what pertains to you. “What do you want me to know about your condition and how it makes you feel?” “How can I be helpful?” “What are signs that your symptoms are worsening and what do you need when that happens?” It matters a lot when someone takes the time to find out how she can be supportive.

2. Give him space – or don’t.

At a time when your partner is doing reasonably well, talk about how much space she needs and when she needs it. Also talk about when he should not be alone. For instance, someone with PTSD might not want to be touched while experiencing flashbacks. Discuss those boundaries. Alternately, depressed people tend to shy away from others, but it isn’t always healthy. Asking in advance, is it okay to take initiative when these times come? If serious suicidal thoughts are an issue, make sure that your partner has someone to be around at all times. Support and space are equally important and it’s helpful to know when each is needed.

3. Focus on her strengths.

Mental illness can make you feel vulnerable, inferior – even useless. Some people feel like they aren’t contributing enough to the relationship or that they are being a burden. This is why it’s very important to make note of when he does something positive. Notice specific actions and comment on them. Things as simple as “Thank you for making me dinner,” “You look nice today,” and “I appreciate that you spent time with me today,” can boost self-confidence and foster positive emotions. A lot of people with mental illness need reassurance, so knowing they did something right can bring peace of mind.

4. Be accommodating and flexible.

Part of the challenge of mental illness is that it’s unpredictable. Sometimes there’s a reason that symptoms flare up, such as stress or failure, but other times random little things can set off an episode. Work with what you have at any given time. If you had a dinner and movie date planned, but your partner is too anxious to leave the house, order takeout and watch something on Netflix. If physical intimacy is difficult, go slowly and let him take the lead. If she has a hard time being around strangers, don’t drag her to big social events. 

5. Set your own boundaries.

Having a partner with a mental illness can be stressful. At times, you might find yourself in a caretaker role and it can be draining. This is why it’s important that you set boundaries. For instance, make sure you have enough time to take care of yourself. You might need to state that when he starts yelling at you, you will leave until he has calmed down. It might be helpful to make clear that there are some things she can’t blame on her illness (and what they are). It’s important to be understanding, but if you are struggling, you need to have the space to take a break and gather your strength. You can’t be as helpful if you aren’t doing well yourself.

Mental illness is hard on both partners, but it isn’t an impossible barrier to a happy relationship. While your partner might have some challenges, he also has gifts to offer. Living with a mental illness can make you empathetic, brave, considerate, grateful, persistent, thoughtful, strong and any other number of positive qualities. It encourages deep feelings and that includes love. In the end, both of you are just people. You have frustrating qualities as well. But love is beautiful in that it can make everything else disappear, if only for a moment at a time. Love is worth whatever it takes.

Check back on Tuesday to hear about dating from the other side.

What have you found helpful in dating someone with a mental illness? Tell us in the comments.

Some thoughts on recovery

Today I’m going to get a little more personal than I normally do. I’ve been thinking about where I’m at in my recovery, where I’m heading and what I’ve learned. From this, I have a few things I’d like to say.

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We all know life isn’t fair. Mental illness is one of those unfair things. Whether it’s caused by nature, nurture or something else, mental illness infringes on our lives in a way that is disruptive and even paralyzing. The things we want to experience and accomplish can seem so far out of reach. Hope can be elusive, but it’s important to believe it’s there.

There are times when I’ve spent months in bed. Other times, I only spent long mornings in bed. Now, I can get up just fine most days. What changed? A million little things. I have had a lot of therapy. I got on the right medications. I have done work on trauma I’ve experienced. I regulated my sleep cycle. I make sure to eat enough. I actively seek out things that keep my interest. I slowed down with school. I cut out negative influences in my life. I’ve worked to better my
relationships. I even got cats. 

So is recovery easy? By no means. All that had to happen simply for me to get out of bed before lunch. If that much and more was required to make that one change, how long is it going to take to do other things? 

The truth is, my whole life. Mental illness can and does go into remission, but you still have to work to stay as healthy as you can. I could say that things are “good enough,” but I think that would be selling myself short. To be honest, I’m not happy with myself unless I am working to heal and become a better person. 

And that is one thing I think mental illness can do: It can make you more motivated to grow and become strong. Recovery teaches you the skills to be healthier, which can be applied beyond reaching a baseline “okay.” As much as not having mental illness would have changed my life for the better in many ways, it would also rob me of some of my strengths. I wouldn’t be as resilient. I wouldn’t place such a high value on good relationships. I wouldn’t know how to handle a crisis. I wouldn’t be as grateful. I wouldn’t be able to run this blog and try to make treatment easier for someone else. 

I wish I knew a better way to express how much each and every good choice you make is significant progress. I don’t know that I’d listen to myself a few years ago. But it ended up adding up. It took a long time, but my life is on track to be what I want it to be. Not all my aspirations will come true, but I’ve made new ones that are realistic to me and my condition. 

I’ve been reflecting about why I run this blog at all. I really, really want my readers to believe that recovery is possible. Not only is it possible, but it’s something you can do. There will come a day when you’ll say, “It was worth it to keep trying.” It might even happen when you least expect it. You are meant to live a good and happy life. You have a right to achieve that. If you do ten things wrong today, the one thing you did right still matters. Those “one thing”s add up eventually.

Have you made progress? Do you have hope you will? Give us your thoughts in the comments.

7 alternatives to harmful behavior

Mental illness does not just affect our minds and our thoughts. It affects our behavior. There are things that people struggling with mental health will do that helps them feel better, but are actually more damaging in the long run. These include self-injury, substance abuse, eating disordered behaviors, acting out obsessions, lashing out at others and more.

 

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It can be difficult to stay away from harmful behaviors, especially during times of great distress. This is why it is important to have alternate ways of coping. It can take a long time to change harmful behaviors, as they do serve a purpose. As a starting point, though, here are some ideas of what you could do instead of engaging in harmful behavior.

1. Replacement behaviors
If you don't want to engage in a destructive behavior, replace it with something else. People use this strategy all the time to quit smoking by sucking on hard candy, chewing gum or playing with putty to give their hands something to do. In other cases, this could mean drawing on yourself with a red marker instead of cutting or drinking tasty non-alcoholic beverages when you feel the urge to drink. The point is to put something less harmful in the place of the old behavior.

2. Creative expression
You can engage the emotions you are feeling without engaging in the behavior that usually
accompanies it. Try to take that energy that is pushing you towards self-destruction and let it live out another way through using it as fuel for creativity. What does your drug use look like when painted as an animal? What would your eating disorder say if it were a character in a novel about your life? Looking at your behavior from a creative perspective can also help you see things differently, which is a good start for more permanent change.

3. Talk to someone
You don't have to go through tough times alone. If you are worried that you'll engage in harmful behavior, see if you can spend time with someone else. You can talk about what is triggering your desire to engage in the behavior or you can just try to focus on something else now that you're not alone. If you don't have someone to spend time with, see if you can call someone. If there's no one to call, try writing an email to someone you trust. Involving another person can make it easier to resist.

4. Write it out
Written expression can help calm down feelings that surround destructive behaviors. There are many ways you can do this. You can try to process what you are feeling through journaling. You can vent out everything that's causing you distress and tear the paper into as many pieces as you'd like. You can write a letter to bring to your therapist the next session. The point is to communicate instead of act.

5. Distraction
Sometimes, it is better to get your mind on something else. My mother would say that if you're feeling miserable, you might as well clean. If you're able to, you can use the stress you are under to accomplish another task. Not all of us can do that, though, and self-care is an excellent way of distracting. You can use this activity in advance to come up with things to do.

6. Take out your frustration on something inanimate
At times, people feel so much tension, pain, anger and frustration that they can't slow down and do something else. In this case, let the damage be something inanimate, not your body or another person. Sit in your parked car with loud music on and yell at whoever or whatever is causing you problems. Punch a pillow or even your whole mattress. Destry things that won't harm you in a disassembled state (yes on tearing up a pillow; no on breaking glass). Redirecting your emotions allows you to feel catharsis without causing any actual harm.

7. Reward yourself
For some people, having a reward system helps keep dangerous behaviors in check. This can have as much or as little structure as you'd like. It might be a system set up in advance where you have a list of rewards for making it X amount of days without engaging in harmful behavior. It could also be having a secret snack stash or video game that you gain access to only when you are actively controlling your impulses. Some people like having a visual reminder of how long they've made it without those behaviors. You know yourself best, so find what motivates you and use it to stop yourself from doing further harm.


What do you find helps when you feel like engaging in harmful behaviors? Trade tips in the comments.

Lapse, relapse and recovery

Part of recovery is relapse. It's almost expected. At some point, after things have gotten better, they'll probably get worse again. The truth is, though, that your attitude towards relapses will have a big impact on how you handle them and whether you can use them to grow.

   

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First of all, a relapse can be many things. It might be returning to substance abuse or self-injurious behaviors. It can also be falling into another depressive episode or having obsessive thoughts again. It is an increase in symptoms that you have previously managed to reduce.

Then there's the definition of relapse. Some people think that any step backwards is a "relapse." The thing is, there is a difference between a lapse and a relapse. A lapse is engaging in a behavior or experiencing an increase in symptoms. Lapses happen to the best of us. They are not the same as a relapse, which is a series of lapses that put you back into the state of illness you were in before.


Some mindsets, such as that of Alcoholics Anonymous and other groups in that tradition, say that a lapse means you're back at day one. This can be very discouraging. But it's not the only way to view it. A lapse can be a learning experience. It tells you about what triggers your symptoms and what your areas of weakness are. This allows you to become stronger in your recovery.

If you experience a lapse, don't give up and give in. Messing up once or having a bad day doesn't mean you have to start over. It doesn't mean you're having a relapse. It just means that you now know what you need to work on. Resist the urge to fall back into old patterns. Take the time to think and maybe journal about what happened and why. Share these thoughts with your therapist, who can help you come up with strategies to avoid similar pitfalls in the future.

Sometimes lapses do add up, though, and become a relapse. While not ideal, this is perfectly normal. But if you could become better once, you can do it again. Stay open and honest with your therapist and support system. If you are struggling, let someone know. It is easier to get back on track with someone cheering you on. Keeping secrets is a sign of trouble.

Every day you spend free of destructive behaviors or symptoms of illness should be celebrated. Whether or not all of those days are in a row is secondary. Each time you make the choice to be healthy, you are right to be proud of yourself. Whether you had a single lapse or are in a full relapse, recovery is still an option. Life has lots of ups and downs. It's what you do with them that matters.


What has your experience been with lapses and relapses? What keeps you on track towards recovery? Share your thoughts in the comments. 

10 commonly used psychological assessments

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Sometimes, meeting with a client in therapy isn’t enough for a therapist to know what is going on. You are seeing someone out of her regular context, moved into a intrusive (though supportive) environment. You aren’t the same self in therapy as you are the rest of the time, so it can be good to get a closer look at traits and symptoms. If your therapist needs more insight into your situation, he might request that you take one or a series of assessments. Following are some of the most widely used ones.

1. Clinical interviews

Clinical interviews are a series of set questions that focus on any symptoms you may have, helping the clinician better assess if you have a diagnosable disorder. During the interview, you will be asked open-ended questions. The interviews generally last between 30 minutes and two hours. Sometimes, the clinician that is administering the test will assess 

attitudes, appearances and behaviors in order to 

supplement the verbal answers given.

2. Screening inventories 

A screening inventory is an assessment that is looking at client symptoms and distress. They can be used both to diagnose mental illnesses and to look at therapy progress and outcomes, depending on the test and context you are taking it in. For instance, the Outcome Questionnaire-45 (OQ-45) can be used before each session to check in on where the client is at. The Beck Depression Inventory (BDI) might be used to get a better handle on a client’s depression symptoms. The Symptom Checklist-90-R (SCL-90-R) might be used to look at a number of symptom clusters while conducting a psychological study. There are a wide variety of tests to suit many purposes.

3. Rorschach test

The Rorschach test (also known as the inkblot test) is perhaps the most famous psychological test of all time. It is a projective assessment wherein the subject is shown a series of symmetrical images created by ink on paper. The subject says what she sees in the images and the test administrator will write down everything, no matter how trivial it may seem. These statements are later interpreted in regards to personality, emotional functioning and to detect thought disorders. 

4. Thematic Apperception Test (TAT)

The TAT is another projective assessment. In this one, the subject is shown ambiguous images of people. The client will tell the proctor stories about the individuals the pictures, which can be interpreted in a multitude of ways. This test is considered a glimpse into the subconscious and the way people see the world. It has been used to study a variety of items, such as motives, concerns, personality and emotional stability. 

5. Rotter Incomplete Sentence Blank (RISB)

A third commonly used projective test is the RISB. In this assessment, the subject is given a list of 40 sentence stems, or incomplete sentences. These are deliberately vague and encompass such phrases as, “I need…,” “Other people…” and “My greatest fear…”. The subject simply completes the sentences however he wants. There is not much in terms of standardized scoring, but themes will emerge, such as a preoccupation with ones appearance or social anxiety. These can help the therapist better tailor treatment to areas of concern. 

                                                                                                                   6. Wechsler Adult Intelligence Scale (WAIS)

   

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The WAIS, currently in its fourth edition, is an intelligence test. It measures raw intelligence and gives you an IQ score. The average IQ is 100. It focuses on a variety of areas, including working memory, processing speed, arithmetic and vocabulary. It has questions ranging from picture completion to finding similarities between words. This test measures your aptitude, not how well you are actually doing in the areas tested.

7. Woodcock-Johnson Tests of Cognitive Abilities

The Woodcock-Johnson, in contrast to the WAIS, is made to measure cognitive performance. It shows how well you actually do in the areas of math, reading and writing. You may score higher or lower than your actual IQ would indicate; for this reason, it can be useful in identifying learning disorders. 

8. Minnesota Multiphasic Personality Inventory (MMPI)

The MMPI is the most commonly used psychological test. It is used to assess personality and psychopathology. Depending on the version of the test you take, you answer either 338 or 567 true or false questions about yourself. This is used to gauge your level of pathology in areas such as depression, hysteria and paranoia. Based on the areas you have the highest scores in, a portrait of your personality and psychological issues can be made. There is also an adolescent version of this assessment, the MMPI-A, which is 478 items long.

9. Millon Clinical Multiaxial Inventory (MCMI)

Used strictly to assess psychopathology, the MCMI does not tell you about personality in the same way the MMPI does. It has a clear focus on psychological symptoms, as it identifies personality disorders and clinical syndromes. It is, however, much shorter than the MMPI, only having 175 true or false questions that can generally be answered in 25-30 minutes. The adolescent version of this assessment is called the Millon Adolescent Clinical Inventory (MACI) and is 160 items long.

10. Child Behavior Checklist (CBCL)

This test is designed to be used with minors, starting as young as 18 months of age. A parent or caregiver takes the test and reports social, behavioral and emotional observations of the subject. There are also versions of the test that can be filled out by teachers or the youth themselves. The assessment asks how true certain statements are, such as “talks or walks in sleep” or “acts too young for his/her age.” Because parents and teachers have higher access to the youth than the therapist does, it can be helpful to get input from someone used to seeing the child in other settings. 

Have you taken any psychological assessments? Did you learn anything interesting about yourself? Talk about it in the comments. 

10 signs of mental illness you should never ignore

   

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There are a lot of symptoms of mental illness, more than anyone can list off the top of their heads. But some are more severe than others. Here are a few of the ones where you should immediately seek advice from a mental health professional. 

1. Hallucinations

Hallucinations are experiencing the presence of something that is actually not there. Visual and auditory hallucinations are the most well-known, but they can also be smells, tastes, tactile stimulation and more. Hallucinations are a symptom of several serious mental illnesses, so they should always be taken seriously. It is possible that there is a more benign explanation – it could be a lack of sleep or the side effect of a medication. But it can be difficult to judge what the  cause of a hallucination is,
                                                                                                                   meaning that a professional evaluation is called for.

2. Antisocial behavior

Antisocial behavior is not a reference to being introverted and liking alone time; rather, it’s deviating from the norms and laws of society. This often is expressed through aggressiveness, dishonesty, disregard for safety and criminal behavior. Antisocial actions can have long-lasting consequences for both the person performing them and for others, so it’s important to get it under control. When there’s a pattern of these types of behaviors, it’s important to seek help in order to prevent more permanent damage.

3. Identity confusion

There are times when people start questioning who they really are and what they want their lives to look like. Adolescence and mid-life crises are a couple examples. But if taken too far, this uncertainty is potentially dangerous. If someone suddenly abandons what was previously loved and don’t know what to replace them with, it could be a sign that something more serious is going on. At the extreme, there might be complete blank on who one is, which can be indicative of amnesia. It’s important to talk to a mental health professional to identify the cause of losing one’s sense of self.

4. Mania

Everyone gets worked up and excited sometimes, leading to increased activity in one’s life. But sometimes, it becomes out of control. If someone has persistent and abnormal elevated or irritable moods for over a week, it might be a manic episode. These episodes, a hallmark of bipolar disorder, might present with an inflated sense of self-esteem, a decreased need for sleep, racing thoughts, distractibility, being unusually productive or engaging in behaviors that will have serious negative consequences. Because of the lasting impact these episodes can have on one’s life, professional help is warranted.

5. Learning difficulties

It’s normal to struggle with learning sometimes. We are all better at some things than others. But when someone is, in at least one area, several grade levels below where one should be, it could be a learning disability. This doesn’t mean that someone’s stupid, but rather indicates a lack of the ability to learn in certain areas. Learning difficulties could also be indicative of a high level of distress, which needs to come down before one can resume regular patterns of learning. A sharp change in one’s ability, like suddenly being unable to perform tasks one could do before, should also be looked into.

6. Self-injury

Self-injury is indicative of severe distress. It often means that someone is in a lot of pain and is unable to cope with it in a healthy way. Self-injurious behaviors include cutting, burning, bruising, interfering with wound healing and intentionally sustaining injuries. While most of the time there is no intent to cause lasting damage, it might happen anyway. This is one reason why, when someone engages in self-injury, it’s important to intervene. Talking with a therapist can help in terms of finding healthier alternatives and in understanding what caused the behavior in the first place.

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7. Delusions

Delusions are beliefs that are unique to oneself and that contradict the generally accepted reality. Some examples include believing that one is under surveillance by the government without sufficient reason; thinking a song was written about oneself despite never even having met the artist; and insistence that a partner is cheating despite a complete lack of evidence. Something like believing in alien visitations or prevalent conspiracy theories are not delusions, as they are beliefs shared by lots of people. Delusions can seriously impact quality of life and might even lead to people making dangerous decisions, so talking to a professional is important.

8. Substance abuse

As discussed in an earlier post, substance abuse is highly correlated with mental illness. The two can feed off of each other, with substances being used to mask symptoms which in turn become worse due to the substances. While not all substance abuse is indicative of mental illness, it is a serious problem that should be addressed either way. It can also cause physical health problems or lead to acting impulsively in a risky way. There are lots of professionals that specialize in treating substance abuse, so find someone with experience.

9. Major shifts in personality/goals

People are generally pretty consistent in how they act and what they want. While some variations are normal, like deciding to end a relationship or to take up a new hobby, there are times when changes can be a cause for alarm. These changes are more notable when they occur rapidly. A consistently cheery person might abruptly become frequently cynical or someone may suddenly drop out of school despite indications that things were going well. It is important to take a good look at what caused these types of change, as they can be a sign of distress or mental illness. 

10. Suicidal thoughts

Thoughts of suicide should always be addressed. The risks that come with brushing it off or not seeking help are not worth it. Suicides have permanent impacts on both those who commit them and their loved ones. It’s not a decision that happens and stays in a vacuum. Surviving a suicide attempt can also lead to lasting health problems. If you feel like ending your life or suspect someone else might, talk to a professional. The earlier one gets help, the easier treatment will likely be. To learn about what suicidal people talk about, read this. I have also put together a list of hotlines, which can be found here. 

What symptoms made you seek help? Have you seen these signs in a loved one and encouraged him or her to get help? Let us know in the comments.

Make a 5-step safety plan right now

In the midst of a crisis, it’s hard to think clearly and make good decisions. That’s why it’s important to know ahead of times what to do when the going gets tough. A safety plan gives you a template for action when you are feeling suicidal, tempted to self-harm, drawn into addictions, engaging in unhealthy behaviors or feeling self-destructive. 

Having a written safety plan can be a huge help when you’re symptomatic, so let’s make one. One way of doing this is by looking at all the questions surrounding the issue. By using those five Ws, you can pretty quickly explore the many facets of staying safe. Grab a piece of paper or copy the questions into your word processor and finish this post with a safety plan in hand. 

 

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Who can I talk to?

You don’t have to go through tough times alone. Write down the people in your support system who are good listeners and who know how to make you feel better. Include their addresses, phone numbers and/or email addresses just in case you don’t have access to that information. Put a suggestion by each name stating what this person can be helpful for, like “Call my boyfriend to hear why I am loved,” or “Visit my mom to get advice.” 

What can I do to feel better?

Think about difficult times in the past and try to identify what, exactly, you were feeling and maybe even what caused those feelings. By identifying what’s setting you off, you can better find ways to manage it. Write a list of your most common triggers and a healthy way to deal with each one. This might look like “When I feel scared to go outside, I can have someone come with me,” or “When I am disappointed, I can create a gratitude list.”

When do I need to seek help?

Know your limits. Create a guide showing what to do at the different stages you might escalate through. This takes away the decision making element that can be overwhelming when you are upset. It could look something like this: “Feeling sad: Go for a walk. Wanting to hurt myself: Spend time around friends. Engaged in self-injury: Care for my wounds, then do something nice for myself. Feeling suicidal: E-mail my therapist. Actively suicidal: Call a suicide hotline or 911.”

Where can I go?

Sometimes a change of scenery can make all the difference. Make a list of places that you enjoy or that are helpful to you. While still being safe, make sure you have options for both day and night, even if it’s just a different room in the house. Some places you might want to consider are the homes of loved ones, support groups, your favorite park, a local coffee shop, the library, a scenic route for driving or even your own backyard.

Why should I not do this?

Make a list of all the reasons acting on your impulses aren’t a good idea. Acknowledge the negative consequences, but make sure to also stay positive. Having something worth not giving in for is really helpful. This could range from “I want to keep my body healthy,” to “I want to reach three months without this behavior,” or simply, “I deserve to be happy.” If you need help getting started, a list of reasons to recover can be found here.

Keep copies of your safety plan in accessible places, like in your purse, wallet, backpack, car, nightstand, comfort box and on your phone. You can also give them to people you trust who will notice when you are having a tough time so that they’ll have a guide for how to best help you. If you haven’t already been following along, I really suggest you do this. Having a safety plan is invaluable when you are in the midst of being symptomatic. It’s a lot easier to think of things now than in the moment.

What did you include in your safety plans? Is something important missing? Make suggestions in the comments.

Mental health myths: Am I crazy enough?

Mental health concerns come with a lot of misunderstandings and there is plenty of misinformation out there. That’s why I like to tackle mental health myths from time to time. Today, let’s look at some thoughts about seeking treatment.

Myth: If I see a therapist, I’m crazy.

Fact: There are lots of “non-crazy” reasons to seek help.

   

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Somewhere in their heads, people set an imaginary standard for what the threshold should be for seeking mental health treatment. People come up with an idea of what they think is “bad enough.” One of the unfortunate consequences of this is that it makes people assume that someone who is in treatment meets their criteria for what they believe a mental health patient is. This is often not the case.

An acute crisis or severe symptoms definitely warrant treatment. But these are not the only reasons to seek it. It’s completely normal to go to a therapist if you are experiencing mild or moderate distress. This is, in fact, a good thing. By working on your problems before they get magnified with time saves you a lot of effort in the long run. 

It’s kind of like getting a headache. You notice that you’re hurting, but think that it’ll pass. As the day goes on, it gets worse and worse. Finally, you take some ibuprofen. But because the headache has set in more deeply at this point, it might be that no amount of pills makes it go away. You just may not feel better until after you sleep it off. Ultimately, you prolong your pain by not taking preventative action when your discomfort was tolerable. 

The same goes for staying in treatment after you start feeling better. There is no pressure to terminate until you are ready. You don’t have to stop just because you’re mostly doing better. Maintenance is important. My symptoms are not nearly as bad as they have been in the past, but I’m still in treatment because I don’t want to go back there. You might want to reduce the frequency of your sessions when you have made significant progress, but that is something to discuss with your therapist. Together you can make a decision on that.

Some people feel like they have to “earn” the right to be in therapy. They think that they don’t deserve treatment because they aren’t psychotic, don’t have a history of trauma or can cope reasonably well with their lives. The thing is, you don’t have to be a certain way to deserve help. The only prerequisite is a desire to improve your life. 

Honestly, you don’t even have to have problems to be in therapy. Plenty of people go for self-improvement. Some examples include learning to develop better relationships, finding greater fulfillment in your life, learning more about yourself and so on. You just can’t make assumptions about why people are in therapy.

In short, you don’t have to have hallucinations or be so depressed you can’t get out of bed for months before seeing a therapist. If you feel like therapy is or would be helpful for you, go for it. Likewise, don’t pass judgment on anyone else for seeking help. They don’t know your circumstances and you don’t know theirs. There is no template for what someone in treatment looks like. 

What beliefs have you had about yourself because you’re in treatment? How did you work through them? Talk about it in the comments.

The isolation of mental illness

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Mental illness can be a very lonely experience. It can feel like what applies to the rest of the world gets turned on its head when it comes to you. When others ask questions like, “Why didn’t you come to the party?” or “Why haven’t you finished your assignment?” it can be hard to come up with answers that are both understandable and that protect your dignity. It’s hard to find words to describe what permeates your life and makes you feel separate from everyone else.

I wish I could say that people are generally understanding and that if you just say it how it is, you’ll get an empathetic response and an offer of help. The truth is, people are generally uncomfortable talking about mental illness. This societal silence perpetuates the feelings of isolation that mental illness can create.

Still, mental illness affects everyone, whether through experience or indirectly through others in their lives. With one in four Americans struggling with mental illness in any given year, everyone knows someone. It is, however, for the most part an “invisible illness” and people learn to hide their symptoms so no one knows anything is wrong. But it’s still there. 

The next time you sit in a meeting, classroom or other group situation, start counting off one in four people. Now take that group and expand. Remember, the one in four figure is for any given year. Some people have recovered from a past mental illness and others will experience it in the future. Seeing how common it is in this way can be an eye-opener. It’s a lot more prevalent than it seems when you’re lying in bed at 3:00 p.m. and wondering what’s wrong with you since “everyone else” can move on with their days. 

   

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But knowing you are not alone and feeling isolated are not mutually exclusive. While you might theoretically know that others are struggling, too, it’s not like people show up to work saying, “I didn’t come in yesterday because I had a really bad panic attack,” like they say, “I didn’t show up because I had the flu.” Mental illness is surrounded by so much stigma and perceived shame that it’s hard to talk about.

If you want to change the conversation and help others understand how mental illness impacts everyone, that’s great. Just take care of yourself while you do so. As a starting point, here is an article on how to tell others you have a mental illness. If you’d rather avoid the topic, that’s okay, too. It’s your right to decide how much you want to talk about your condition, if you want to talk about it at all.

One thing that can help you feel less alone is through entertainment. Finding stories of others we can relate to can be cathartic and empowering. There are lots of mental health memoirs that focus on specific conditions, so you can surely find one for yours. For instance, there’s Prozac Nation for depression and Girl, Interrupted about borderline personality disorder. There are so many more if you just search for them. There are also fictional stories of mental illness, as well as more technical books. (I’ve compiled a list of books that help you learn more about your condition.) Movies that address mental health topics abound, too, like these Oscar-winning best picture films.

There are also online communities that can offer support. For instance, HealthyPlace has a variety of forums addressing different conditions. Another cool site is PatientsLikeMe, where in addition to having access to forums, you can track your symptoms. Everyone’s data is used to come up with helpful information. It covers a lot of medical conditions, but there’s a section for mental health concerns. Be aware, though, that these groups are for support only. They are not a replacement for a doctor or a therapist. Simple symptom management tips and sympathetic stories are great, but you should not use forums to resolve more serious issues.

Remember that mental health issues are just as much a part of the human experience as anything else. It can feel isolating, but you are by no means alone. You can choose to seek out others who share your experience, or you can just comfort yourself with the knowledge that what you are experiencing is, in its own way, normal. How you approach your condition is entirely up to you, but always know that you aren’t broken, you aren’t weird, you aren’t crazy and you aren’t alone.

What do you do when your mental illness makes you feel alone? Share feedback in the comments.

5 tips for discussing trauma

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Trauma is one of the hardest things to talk about, yet doing so is essential to healing. If you continue to repress the bad experiences of your past, they will continue to interfere with your life in ways you may not even realize. So it’s something that’s both incredibly important and incredibly difficult. Here are some strategies on how to make it more manageable.

1. Get stabilized first.

When doing trauma work, you need to be in a reasonably stable place. The week after a breakup or before a stressful holiday event are not ideal times. Work on getting yourself in the best situation you can. Make sure you have strong relationships you can rely on, as it is difficult to go it on your own. You also need to have a firm grasp on which coping tools work best for you. Your therapist should be able to help you identify if you are in a good place to start working on
the trauma.

2. Go in intervals.

You’re not always going to feel better after blurting out a narrative of everything all at once. It can even be retraumatizing. Trauma is very complex and all the different aspects need to have their own time to be addressed. That’s why going in intervals is important. You can set aside sessions to discuss specific components – the narrative of what happened, how it impacted your relationships, what fears it left you with, etc. You might also want to set time limits. Start with a low time, maybe even as low as 10 seconds. Then increase it each week until you feel you have reached a productive time.

3. Stop when you need to.

You have no obligation whatsoever to keep talking when you get uncomfortable or triggered. You can stop discussing your trauma at any time and for any reason. It takes time to learn to talk about such a difficult subject and even when you are able to, you’ll need breaks. No matter where you’re at in your story or thoughts – even if you are seconds away from a critical point – you can stop. That’s your prerogative and it’s not good to push yourself too far. Discuss in advance with your therapist how far you think you are able to go in each session.

4. Reestablish a sense of safety.

Always leave time to get yourself feeling somewhat normal again. It’s not ideal to leave the session a complete wreck. When you are done with talking about the trauma, take time to ground yourself firmly in the present. Remind yourself of where you are, when it is and who is with you. Your therapist can help you with that. Remind yourself that you are safe, that your circumstances have changed and that you have what it takes to ensure your own wellbeing. Trauma work has a way of sending us back to a different time, so make sure you have a return ticket. (In addition, here are some grounding techniques).

5. Prepare self-soothing activities.

Have planned activities for after session. Do things that help you feel better. These might include taking a bath, reading a book, going to lunch with a friend, meditating or going for a walk. Whatever works for you is what you should do. By knowing in advance what you are doing after session, it’s easier to navigate the difficult post-trauma talk space. Have backup options ready in case the coping strategy you selected is not proving effective. It’s okay if it takes you a while to recover from talking about the trauma. It is a very difficult thing to do and you should always be proud of yourself for doing it – even if it’s only a few seconds.

What have you found helpful when discussing trauma? Share tips in the comments. 

7 signs of abuse in children

Child abuse is one of the greater evils in society. It can be incredibly damaging to children and affect them for the rest of their lives. This is why it’s so important to catch abuse as often or early as possible. Here are some signs to look out for. (This list is by no means comprehensive.) 

1. Problems regulating emotions

It’s hard for abused children to safely express emotions, so they might have outbursts of strong feelings. This can manifest in their behavior as well. When the child does something somewhat explosive, try to find out what feelings were behind it. This trouble regulating emotions can continue into adulthood.

 

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2. Excessive fear of doing something wrong

When a child has a strong fear of doing something wrong, it might be because she is used to being punished for her mistakes and shortcomings. Even trivial decisions might be difficult due to fear of making the wrong choice. This fear might also manifest as being withdrawn or anxious. It might be a fear related to a certain type of choices or a generalized fear.

3. Unexplained physical injuries

Look for bruises, cuts and other injuries. If the child has no explanation – or provides an unconvincing one – monitor it. If there is abuse in the home, it may be continuous, leading the child to have frequent injuries. Accident proneness is one thing, but that will have more credible explanations (though it might still indicate neglect). 

4. Extremes in behavior

Another sign of abuse in children is that they are very extreme in their behaviors. This can go either way. They might be very rigid or they might be disorganized. They can be excessively obedient or completely rebellious. If a child is “too much” of anything and completely lacks the ability to navigate a middle ground, it’s a bad sign.

5. Age-inappropriate sexual knowledge

If a child seems to know a lot more about sex than he should, it might be a sign of sexual abuse. This can manifest both verbally and in behaviors. They might have a lack of appropriate physical boundaries with others or even be overtly seductive. This can, however, also swing to the other extreme, where the child is wary of touch in general.

6. Avoiding someone specific

A child may be trying to escape abuse by avoiding the abuser as much as she can. If there is no obvious reason for the child to avoid this person, it’s worth looking into. This is more than just going to his room because he doesn’t feel like being around someone. The child might hide when the person is nearby or even run away from home.

7. Regressing to earlier behaviors

An abused child might use coping skills from a younger age. This might include wetting the bed, fear of the dark, thumb-sucking, needing a comfort object and clinginess. It can even extend to the child being less skilled in language usage, talking like someone who is younger. It is especially worrying if the child has quit the behavior before, but is returning to it.

If you suspect that a child is being abused, you need to contact someone. A good starting point is a child abuse hotline. In the U.S., the national number is 1-800-4-A-CHILD (1-800-422-4453). If you live elsewhere, search online for a number or contact local authorities. It is better to be safe than sorry when it comes to children who might continue to be hurt if you don't seek help.

Do you feel like you could notice if a child is being abused? Talk about what helps identify these children in the comments.

15 grounding techniques

Grounding is a very useful tool when you are feeling symptomatic. It is finding a way to stay in the present moment instead of giving in to what your mental illness is causing you to experience. It can be used to decrease anxiety, help with reality testing, stop flashbacks, reduce dissociation, end panic attacks and more. 

There are lots of different grounding techniques. Having strategies in mind ahead of time can help reduce distress in the moment. Knowing which ones work are a matter of trial and error, so here is a list of 15 that you can try out.

     

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1. Name five things you can see, three things you can hear and one thing you can smell. 
2. Describe your environment (“The carpet is beige and soft. The chair I’m sitting in is made of wood. The walls are painted green,” etc.).
3. Focus on your breathing. Breathe in through your nose for four counts, hold your breath for seven and exhale through your mouth for eight.
4. Carry something small that you can play with (bracelet, stress ball, putty, etc.). Focus while you use it.
5. Go through the alphabet and think of something for each letter (names of bands, movies, cities, etc.).
6. Get a hot or icy drink and focus on the sensation of drinking it.
7. Smell something you find calming. You can put on lotion or carry a handkerchief with perfume or essential oils on it.
8. Take a shower or a bath. Notice how the water feels on your skin and imagine that all of your stress is being washed away.
9. Say reassuring things to yourself out loud. (“I am in my apartment and it’s safe here. I am loved. I can call a friend if I need to,” etc.)
10. Move. Go for a walk, wiggle your toes; do whatever works for the situation you’re in.
11. Mentally go through everything you did today. (“My alarm went off at 8:00. I got up and took a shower. I ate breakfast,” etc.)
12. Listen to music you find comforting. Pick out all the different instruments                                                                          and notice how each of them sounds.
13. Engage in a hobby you enjoy. Let everything else go while you focus on doing what you love.
14. Write down exactly what you’re thinking and feeling. Imagine it disappearing into the paper. You can tear it up when you’re done, if you’d like, and throw those thoughts and feelings away.
15. Put your feet on the floor. Keep your eyes open. Engage all five of your senses. Force yourself to stay in the present.

What grounding techniques work for you? Let’s make a list in the comments.

7 ways to support someone with an eating disorder

Eating disorders have the highest mortality rate of any mental illnesses. Because of this, it is extremely important to work towards recovery. It is easier to get better when friends and family are supportive. But eating disorders are complex both physically and psychologically, so it can be hard to know what to do and say – or what to not do and say. Here are some suggestions on how to be supportive of someone with an eating disorder.

1. Remember that eating disorders don’t discriminate. A person of any age, gender, race or size can have an eating disorder. They’re not all bone-thin, white teenage girls. There are several different kinds of eating disorders and it’s impossible to tell by a glance whether or not someone is struggling with one.

  

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2. Understand that it’s not just about being skinny. Eating disorders are complex. While societal pressure to be thin can be a factor, it’s not the only one. There are usually intricate emotional reasons behind the disorder. Risk factors that can influence the development of an eating disorder include having another mental illness, substance abuse, perfectionism, sexual abuse and being involved in activities focused on weight (sports, dance, modeling, etc.).

3. Focus on positive non-physical traits. Eating disorders are often accompanied by a lot of insecurity. It’s therefore important to help build self-esteem in areas not related to the body. Compliment your loved one for his kindness, intelligence, skills, etc. Encourage participation in hobbies and activities that she excels in.

4. Be a good listener. If you are consistently paying attention and responding appropriately to your loved one, he will find it easier to talk to you about difficult subjects. Don’t push the topic of eating disorders, but if it comes up, be supportive and gently encourage recovery. If she has brought up the topic, you can carefully try to follow up, but follow her lead.

5. Do things together that don’t involve food. Eating disorders can be very isolating. It’s important to still have a social life, but a lot of social activities are centered around food. This can be very difficult. Invite him to do things where food is not the focus. Instead of going out for ice cream, go to the arcade or a concert. She’ll feel a lot more comfortable.

6. Don’t make demands about recovery. You can’t force someone to change. Recovery can only happen at the pace that someone is able to work at, so you need to respect that. Not doing so can damage your relationship and make your loved one feel uncomfortable around you. Trust his treatment team to keep tabs on how he’s doing.

7. Get emergency help if needed. Forcing treatment on someone can be ineffective and potentially counterproductive, but sometimes intervention is necessary. If symptoms get severe enough, call 911 or take her to the emergency room. Fainting, seizures, an irregular pulse and other severe symptoms call for medical intervention.

How do you maintain relationships with someone who has an eating disorder? If you have one, what do you find helpful? Share your thoughts in the comments.