For most of us, depression is something that comes and goes. For a few of us, it’s something that comes and stays – for reasons that we don’t always know or understand. When we lose someone lose to us or have a situation that hurts, we might feel down. This type of depression can be situational more than anything else. This happens often after women give birth. For months following, they might feel down or blue. If they are able to pull themselves out of it through sleep, eating well, taking a shower, reading a book or some any other way that they use to cope, then its usually not post-partum depression. If it doesn’t go away after these attempts, it can be something more serious and may need medical or professional help. Depression is the same way. We can’t expect to pull ourselves out of depression on our own when it is the more serious type. Counselors are trained professionals who can help. Many of them will utilize the power of your relationships and invite your family to attend sessions. This helps because you are then able to connect to those who matter most and work it out together.

Every now and then, most of us feel down or blue – this is different than depression. Situational sadness comes and goes with whatever is getting us down. For example, if you don’t get recognized for something you worked hard at, you will probably feel sad. After time, your sadness will start to disappear. It isn’t as sad over time. This is situational. Depression, on the other hand, seems to last beyond these events. Even when something potentially sad has come and gone and if there is seemingly no reason to feel sad, you still might feel sad. This can especially be true in the winter. The days are shorter and colder. This causes most of us to stop moving as much, and to stay inside. We then lack exercise and sun light. On top of that, with the Halloween, Thanksgiving, Christmas and New Year’s, we tend to eat food that isn’t as healthy. We eat more sugar. This all contributes to feeling sad when we don’t seem to have anything to be sad about. Seasonal Affective Disorder (SAD) is what happens to many people during the winter months. Most people don’t realize they have this type of problem, they just think that they are down or blue. It is more than just having the ‘winter blues’. It impedes you in your daily life and interferes with your functioning. Recognizing that you have SAD will help you know what to do to overcome and let go of it. Some of the symptoms include: feeling sad, losing interest once enjoyed, change in appetite, change in sleep (usually sleeping more), loss of energy, restless activity, feeling worthless or guilty, trouble making decisions, and thoughts of suicide or death. If you think you might have this type of depression talk with a therapist today.

Sometimes the holidays hurt. When we have lost loved ones or when we are reminded of what we used to have, the holidays can turn from joyous to painful. During these times, it’s important to remember a few things. First, let the pain come in – embrace it. There is no need to try and hide from it or run. If we try to hide from it or ignore it, we often develop addictions to cover what we are feeling – ways to numb ourselves from uncomfortable emotions. In this numbed state, we don’t ever get to embrace and subsequently let go of painful emotions. It’s important to remember that in order to let go of something, we first have to have it (embrace it). Remember that these emotions come and go, they won’t stay with us forever. Second, find a way to honor your loved ones who have gone on or circumstances lost. I spoke with a friend once who had dealt with the loss of a job and a more abundant life. During times when this was more apparent, he was able to be grateful for the relationship he had and focus on enjoying them above all else. After having material possessions and different opportunities pass him by he realized what is most important as he put his life back together. As he did this, he was able to be grateful for past opportunities and current blessings. Third, some find comfort in having what I call ‘Present Mindedness’ – the ability to be in the moment. We let ourselves enjoy the here and now without stopping ourselves because we need to maintain anger or sadness from the past or from other current situations. We don’t have to punish ourselves – we deserve to be happy now.

Effective pornography treatment often includes family members. As I have worked with hundreds of individuals struggling with pornography use over the years, I have found that those who have loving, supportive family members often have better outcomes. For example, couples therapy is often a good place for you to learn how to connect with others instead of checking out or numbing through pornography use. This is a difficult thing to do because your spouse is someone who has the power to reject you in a way that can really hurt. It is hard to be vulnerable in these circumstances because of this fear of being hurt or rejected. It is also difficult because you are also working to heal the pain your spouse feels because of your pornography use.

One thing that you need is someone to be a ‘real’ person to you. Pornography is a fantasy world where there are no consequences and where other people’s emotions don’t matter. This is why couples therapy is so important – your spouse becomes more real to you as you let her describe and share her pain with you. She becomes more real to you as she is someone who your actions impact. She becomes more real to you as her experience is just as important as yours. A husband can turn their wife into pornography by not letting her be real – discounting her experience and not asking to hear it. A wife, inadvertently, can turn herself into pornography for her husband by thinking that she doesn’t want to stress her husband out by telling him about her feelings and therefore doesn’t say anything even though she is hurting.

Consider the impact that working with your spouse can have on your recovery from pornography use. As difficult as it is to face these issues, it’s a crucial part of your progress.

I am often asked the question, “Do I need medication?” As a counselor in Utah County, I work with couples, families, individuals suffering from depression, anxiety, pornography use, drug and alcohol use and other issues – all of which might need medication at some point. As a counselor, I am not trained to prescribe medication or do medication management, however, I often collaborate with practioners (i.e., MD’s, nurse practioners) who are. Together we are able to help many individuals overcome anxiety or depression. Talk therapy (couples counseling or individual therapy) and medication are often a good combination to combat the issues that bring most people into therapy.

My colleagues who prescribe medications often tell me how medications act like crutches. They aren’t meant for long term use or to be a ‘fix-all’, but rather, they are meant to give support so that an individual can gain strength. Once strong enough, the crutches are discarded and the individual moves on under their own power.

So, when clients ask if medication is warranted, I refer them to someone trained in this type of treatment. Medication is not always the answer, but there are times when it is best practice, however, to use medication and traditional talk therapy together (i.e., Bipolar disorder treatment). I refer them to see an MD, psychiatrist or nurse practioner. I encourage them to meet with someone who does Genetic testing for medications. This is a method where an individual submits a DNA sample which is sent to a lab for testing. The results show the individual and prescribing professional which meds are most likely to work with the individuals genetic structure (usually for anxiety or depression medications). My nurse practitioner colleague tells me that this ‘takes the guess work out of medication management’. Given that the typical experience for individuals trying medications is months of trial and error, this is a relief to many.

Pornography use often leaves the user feeling empty and shameful. To deal with this shame of using in the first place, they might actually use pornography again to numb themselves. This vicious cycle is played out within minutes of each other or within days, even weeks of each other.

 

I am often asked by spouses of pornography users one simple and somewhat complex question, “Why can’t they just stop using?” They tell me that they know that their spouse see’s how it hurts them and how it is ruining their lives and relationships. After a husband talks about his remorse about using pornography, a wife will often follow up with, “Then just stop it”. It isn’t this simple, however. Studies have shown the impact that pornography use has on an individual’s brain chemistry. Some would say that the brain and the person become hijacked – causing them to act in ways that they wouldn’t normally act. This is the same phenomenon that would cause a grandson to steal his grandmothers wedding ring to sell for drugs. You are not yourself, seemingly. The cycle of pornography use doesn’t make sense to those who are in it and doesn’t make sense to their loved ones.

 

Fight the New Drug is an organization who educates the public on the harmful effects of pornography. You will find a lot of good resources to understand this addiction. Strangely enough, it is somewhat a controversial addition. It is not included in the DSM-V (the big book of mental health disorders decided on by experts throughout the country). Educate yourself so that you can make a little more sense of it. A good counselor will also be able to help you understand the nature of this addiction as they work with you and your loved one. As a therapist in Provo Utah, I often see clients in these situations. I have several colleagues at the Center for Couples and Families that are experts in this area of treatment as well.

As a therapist in Provo Utah, I often work with clients in a faith crisis. They come to me wanting to leave their religion or try to understand what they have been taught through a different lens. One thing I work with them on, inevitably, is letting go of some of the culture (real or perceived) that can accompany religion – the culture of pressure to be perfect or to at least appear so. Working with them to understand how to hold on to what they believe while letting go of certain surface level cultural aspects of living in an area which is highly religiously homogeneous. This can be a difficult task given the pressure to conform and follow.

My suggestions to individuals in these circumstances is to do the following: Differentiate between your religions doctrine and the culture. Most people see these as different. Understanding the difference will help you embrace what you believe and let go of what can be damaging.

 

At one point or another anxiety will impact you. Most of us have an experience with anxiety that makes us feel scared and stressed. Anxiety is the body’s emotional and physical response to a stressful situation or anticipation of a real or perceived difficult circumstance.

 

It’s important to understand that anxiety is largely a physical reaction to a real or perceived stressor. Calming your body down when anxious allows you to engage the coping skills you have at your disposal. When working with clients presenting with anxiety one of the first things we do is focus on techniques to cope through physical exercises such as diaphragmatic breathing or progressive muscle relaxation. After clients possess the skills to calm their bodies down when anxious, we are able to work on the emotional, relational and intellectual aspects of this difficult emotion.

 

Anxiety can often take the role of a secondary emotion – an emotion that presents itself as an attachment to your primary emotion. For example, if you are feeling sad, lonely, stressed overwhelmed you might get a general sense of anxiety. Knowing that anxiety is sometimes a secondary emotion helps you to know dig deeper to see what is really going on. Addressing the previous emotions in a specific and deliberate manner helps anxiety lessen.

I recently wrote this for the Utah Valley Health and Wellness Magazine.

Enjoy –

Whether in my role as a therapist, friend, business associate, or family member, I’ve been lucky to meet and associate with a wide assortment of personalities in Utah County and around the world. Though we may have different backgrounds and stories, I’ve noticed a troubling commonality that impacts most of us. We unknowingly send ourselves a subtle and potentially dangerous message – that of should and supposed to.

We tell ourselves, I should be nicer to my kids or I’m supposed to serve and help others. Many of us experience shame as we struggle with feeling that we should be doing more. It’s easy to feel like we are bad if we don’t measure up to the shoulds and supposed tos in our lives.

As a therapist, I often teach my clients to let go of this attitude by replacing should with want to. This helps us live a life we choose rather than one which is chosen for us. Helping another person because we want to feels different than helping them because we are supposed to. I counsel many to consider this idea: If you don’t want to do it then don’t do it.

What if, however, we don’t want to do something, but we still feel that it is healthy to do? Does this mean we don’t drive our kids to and from activities because we don’t want to? No! Our children can’t drive themselves. When facing tasks we don’t want to do that must be done, let’s embrace an attitude of wanting to want to.

The next time we hear ourselves say I should or I’m supposed to, let’s pause, take a step back and refocus on doing things because we want to do them, not because we feel obligated and forced.

I love that we can turn shoulds into want tos – let’s choose the life we live.

 

Dr. Triston Morgan

Licensed Marriage and Family Therapist

Executive Editor – Utah Valley Health and Wellness 

It might seize you in the middle of the night, or perhaps at the beginning of a work meeting, or maybe while driving your kids to soccer practice. Wherever it happens, it can overwhelm you. Your mind won’t stop running. Your body is tense. Your heart is racing. You can’t breathe! You can’t relax and enjoy yourself. If you have ever felt a combination of these sensations, you have probably felt anxiety—a common experience among adults and adolescents. Whether you accept it or not, anxiety is part of a normal, healthy life. Diagnosable anxiety disorders, however, are different than normal, everyday anxieties. A hallmark characteristic of an anxiety disorder is excessive fear or anxiety about a real or perceived threat (DSM-V).

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 40 million people in the United States suffer from an anxiety disorder in a given year. That’s 18 percent of the population! Specific anxiety disorders include generalized anxiety disorder, selective mutism (failure to speak in social situations even when able to speak in other situations), specific phobias (fear of animals, objects, etc.), social anxiety disorder, panic disorder, or agoraphobia (fear of having a panic attack or other embarrassing symptoms in locations such as public transportation, standing in a line, etc.). Some anxiety disorders, such as phobias and generalized anxiety disorder, most often begin in childhood around 11 years old and can continue into adulthood if left untreated. These two disorders are the most common anxiety disorders in adulthood according to SAMHSA.

Because of their belief that things will not change, or that they just need to get over it, many suffering with an anxiety disorder do not seek treatment. The good news is that anxiety is treatable! Your biology has a lot to do with an anxiety disorder; therefore, a first step in reducing anxiety includes dealing with the body’s physical response to stress.

Diaphragmatic Breathing

Your body’s internal organ regulator, your autonomic nervous system (ANS), has two applicable parts of the solution. First is the sympathetic nervous system (SNS), which is in charge of your fight-or-flight responses. This part, for example, pumps up the mailman’s body so she can outrun that dog hiding in the bushes. Second is the parasympathetic nervous system (PNS), which aids in calming your body. This part helps her body deescalate after she has escaped that dog so she can return to delivering the mail as usual.

When you feel anxious, your SNS is engaged. To help calm your body in these moments, the key is to activate your PNS. The exercise outlined below (partially adopted from The Anxious Brain: The Neurobiological Basis of Anxiety Disorders and How to Effectively Treat Them) triggers this part of your ANS.

How to do it:

1. Lie down, stand, or sit in a comfortable position. Make sure you are “grounded” by creating an open posture with both feet on the floor and your back against a chair or bed. If you are crying, in the fetal position, or hunched over, this technique is difficult to do.
2. Breathe in deeply. Picture a water balloon being filled with water as you first fill up your abdomen with air and then your chest. Feel the warmth and the weight of the air as you breathe in.
3. Breathe out with an elongated breath—longer than it took you to breathe in. Purse your lips as you breathe out. This will slow your breathing. Breathing out slowly will help activate the PNS, which helps calm your body—the whole purpose of this breathing technique.
4. As you breathe in and out, focus on the physical sensations you experience. Focus on your feet touching the ground, your abdomen and lungs expanding and contracting, the feel of air rushing over your tongue and through your pursed lips. Notice how your head, arms and hands feel. Doing this will help you be present and in-the-moment.
5. Practice! This is a skill that must be developed. Try doing it while you are at work, stopped at a traffic light, or at home. Do each cycle (breathing in and breathing out) ten times or more, as you learn to engage your PNS.
6. If you feel dizzy, light headed or out of breath, do not continue this technique. If your breathing is restricted or obstructed there may be other issues to consider. Speak with a therapist or doctor about the appropriateness of this exercise for you. This technique is a good start to help reduce anxiety in the moment, but is most successful when done in conjunction with therapy.

Anxiety disorders affect millions. Those who suffer with anxiety often feel there is no solution. But basic biology tells us differently. Activating our PNS through breathing techniques really does work—give it a try next time you feel anxiety creeping in. You might be surprised at how effective these simple breathing techniques can be!

Originally published on Utah Valley Health and Wellness Magazine

Written by Dr. Triston Morgan