An open, first-person authentic account of life, career and relationships and the trials and tribulations associated with mental health challenges including depression, mania and suicidality, and some of the challenges in seeking support.
Lots of wisdom in this for all. Bravo Chris.
This post was originally featured on WellnessUniverse.com.
I recently became a Diplomate in the Academy of Cognitive Therapy (ACT). The ACT is the only cognitive behavioral therapy (CBT) certifying agency in the world.
Joining this elite group of therapists is quite an honor. There are many therapists in the world that can say they are CBT trained but only 750 people in the world can say that they are CBT certified.
One of the greatest benefits of being an ACT Diplomate is joining their ListServ. Some of the most prestigious CBT therapists in the world are on this list and share their perspectives on a daily basis. Unfortunately, much of this information does not get outside this small network and the clients they work with.
In a recent ACT ListServ email from Reid Wilson, Ph.D., Dr. Wilson shared some helpful videos about anxiety relating to his new book Stopping the Noise in Your Head. I thought the videos were fun and demonstrate important concepts in CBT.
About Dr. Wilson: He has spent much of his 30+ year career providing free or inexpensive ways to help people combat anxiety and worry, and encouraging them to seek CBT services when appropriate.
In promoting his new book, Stopping the Noise in Your Head, he released a free video series called Noise in Your Head, which follows a young woman, Susan, in her struggles with anxiety.
Here are a few of the highlights from each video:
This post was originally featured on Vox.com
It was a Thursday night around 11, and I was making coffee in the office kitchen. I was just about to start my shift. But before I could finish stirring, my supervisor came in. She looked more worried than usual.
"Are you ready?" she asked me. "This guy's really going through it."
"I can take it," I said.
A month earlier, I'd decided to volunteer overnight at the Didi Hirsch Suicide Prevention Hotline. This was the time of night that drew the most hopeless of callers. Walking into my glass-walled cubicle, I set down my coffee, opened my notebook, took a deep breath, and picked up the phone.
"Hi, my name is Nick. I see your name is Johnny." I didn't wait for a response.
"What's going on tonight?"
A voice erupted on the line. Johnny was panicked, talking fast. There was so much intensity in his voice it was as if he were strapped to a detonating bomb. From his rolling R's and extended "o," I guessed he was Hispanic, young, but I never truly knew who was on the line. That was the point: strangers speaking with strangers.
When people call a suicide prevention hotline, they often don't know how to start the conversation. How do you tell someone you want to kill yourself? Johnny was no different. When I asked him what was wrong, he launched straight into a litany of terrible experiences, the worst of which was the end of a recent relationship. He was distraught. He felt helpless and unable to change his situation, and he was ready to end his life.
"Are you thinking of suicide?" I asked.
"Yeah," he replied timidly. I could sense he had never said the words aloud.
"And how are you thinking of killing yourself?"
"I'm going to jump in front of a train."
I took a deep breath. I was shocked. Usually the answer to that question isn't so specific.
"And where are you now?" I asked.
"I'm lying down on the train tracks."
My stomach churned. My throat tightened. My foot began shaking, and I closed my eyes. I felt a bead of sweat run down the side of my face. I needed to support Johnny quickly, and that meant meeting him on his terms. I imagined his each and every move. I focused on each sound I heard in the background. I tuned in to the tone of his voice, his cadence. I listened to his breathing, the sense of anxiety and dread building. The absence of sound or talking could be just as important. But I had to find something I could use to connect with this man, to join him in his suffering. That was the priority.
"What's that noise? It sounds like people." I asked.
"Just some drunk teens being assholes."
I could hear them in the background taunting Johnny: "Look at that idiot, what is he doing?"
"The world's against you tonight, eh, Johnny?"
"Yeah, nothing new."
"So it's not just tonight. You've been hurting for quite some time," I said.
"Yeah, no one cares. I've been doing this on my own for too long. I'm done."
"Have you shared how you've been feeling with anyone other than me?"
"Yeah, plenty of people. They just tell me to ‘suck it up,' ‘don't be such a downer,' or offer me a beer. I'm tired of feeling like a burden."
"You sound exhausted, hopeless even. You've been trying to connect with someone about what you're going through and encouraged to face it alone, until tonight."
Johnny was silent.
In the distance, I thought I heard the burgeoning sound of a train whistle. My heart rate quickened.
We all suffer. That's not just some Buddhist dogma — in my job as a mental health therapist in Los Angeles, I'm reminded that it's true every day. We may differ in the impetus of our suffering, the intensity of that suffering, and our response to it, but we share the universal burden. I've found accepting our own helplessness can be a transformational experience; so can joining another in their experience of pain. Unfortunately, many of us suffer alone.
After years in entertainment marketing, I decided to examine my life — I wasn't particularly happy, and I wasn't sure that my career was right for me. I sought out a therapist, and in treatment was asked a clarifying question: What times in my life did I feel most alive? I discovered it was when I felt connected to another person, not necessarily in space, but in conversation.
I reoriented my life around this revelation, allowing myself to explore a lifelong fascination with mental health. I joined the suicide prevention hotline, but quickly learned that a keen interest is not the same as aptitude or experience. I was surprised by the exhaustive volunteer training regimen for the hotline: It lasted months, each session opening with an in-depth lecture on a mental health topic followed by a series of group role-plays focusing on that day's topic. Until I began training, I hadn't realized how unprepared I was for my new career. I considered myself an empathetic person, a supportive friend, somebody who was caring to strangers — but I was severely mistaken.
It was during one of these training sessions — a Saturday afternoon role-play with a mentor — when I was confronted with the extent of my incompetence.
My mentor had a history of bipolar disorder. He struggled with suicidal ideation in his own life and had made serious attempts to end his own life. But his suffering made him especially adept at connecting with high-risk callers. He had an innate ability to join callers in their experience of suffering. In joining them, he created a shared experience, often the key to bringing a caller back from the brink. We began the role-play:
"All right, so in this scenario, I'm a 42-year-old man, I have no friends, I'm at high (suicidal) risk. I lost my job; my family has been dead for years. I have no attachments, a history of mental health issues, I'm not taking my medications, and I've pretty much given up," my mentor said. "You ready to start?"
"Sure, I said. I laughed nervously. I began the protocol for a call: "What's going on?"
My mentor started in as the caller. Using the details we'd agreed on for the scenario, he told a story so powerful and so rich that it seemed we were moving from a fictional story into his real life.
Suicide prevention training provides you with a basic format for each call: First, connect with the caller and assess the level of imminent suicide risk. Monitor level of suicide risk throughout the conversation. Second, determine underlying reasons for the call and explore those reasons with the caller. Third, brainstorm potential resources to assist the caller in improving his situation. Fourth, encourage the caller to call back as needed for further assistance or support. The hotline provided me with hundreds of pages of tips, perspectives, and stories of successful calls. But like becoming a new parent or climbing Mount Everest, no one can prepare you for the real thing. Only practice makes better.
"Are ... are you thinking of suicide?" I asked my mentor, stumbling over my words.
"Damn right! I've been thinking of suicide since I was 13. I've planned it out. I've attempted. I've felt the burn of the rope as it slid across my neck." There was no hesitation in his voice.
"And how might you take your life?"
"I dunno. There are so many ways, I haven't really thought about that."
My mentor's comfort in chatting about killing himself shook me. I didn't know how to enter this man's world. I couldn't join him in his aloneness. I didn't want to. I stopped the role-play.
"I have no clue what to say next." I said.
"Okay, then let's talk about what happened." My mentor said, breaking character. "You lost me. I didn't feel connected to you."
"Really?" I replied, still processing the role-play.
"Definitely. You felt distant. What was going on for you in that role-play?"
"It was hard to hear everything you were going through. I didn't really want to hear it."
"Absolutely. Makes sense why this guy is so alone, right? It's been hard for him to trust anyone to connect with his pain, his suffering. Most people don't want to be around that. They don't really want to hear it. They're scared or don't have the time. So he remains alone."
People join suicide prevention hotlines for myriad reasons. Some wish to give back, some have their own histories with suicide, some wish to experience a kind of pseudo-therapy environment prior to entering graduate school.
When I first joined the hotline, I did it for my ego. I believed my mere presence on the phone would be enough, that my knowledge would be enough, that I could change a caller's world in a word. But conceptual knowledge isn't enough. A voice on the other end of the line telling you it isn't worth it won't save anyone. My mentor during that session taught me the most important thing I've learned about suffering: People call suicide hotlines looking for a connection, for somebody who can join them in their anguish. Sharing our pain with others, just being seen in our experience of pain, can create tremendous momentum toward alleviating our suffering. Empathy is what saves people.
"We've been talking a lot tonight about the part of you that wants to kill yourself. But you called a suicide prevention line and are talking to me now. I wonder, is there a part of you that may want to live?" I asked Johnny.
"I guess. I mean, I'm pretty scared of this thing hitting me. I'm not sure I want to die."
"That's a powerful statement, and one to consider," I said. "In fact, I'm really glad you called tonight. It takes a lot of courage to pick up the phone, especially when a person gets to a place like where you are tonight. Placing your trust in a stranger, hoping they'll understand. That's hard."
I began to notice a shift in our conversation. Johnny's breathing had slowed. Some of his tension seemed diffused. But now I was sure I could hear a train whistle.
"That train sounds like it's getting closer." I stated, tempering my panic.
"Yep, it's coming right at me," he said definitively.
"Are you going to let it hit you?"
I couldn't believe I'd said something so directly. There was a chance my question would backfire, would cause Johnny to prove he was serious by letting the train hit him. I was terrified. This man wanted to die tonight, and I'd just reinforced his decision. I expected him to start yelling, to tell me his pain was real and if I didn't believe him, just wait.
But Johnny was silent. The pause gave me hope. It meant he was considering his options.
The train whistle grew louder.
Suddenly, Johnny took a deep breath and exhaled quickly.
"I think I want to live tonight," he said.
As soon as that last "t" came out, I heard the cacophony of a train passing by, the whoosh of air in the receiver of the phone. The train had passed by in what could only be inches.
My body shook with relief.
Nick Holt, LCSW, is a mental health therapist in Los Angeles serving the communities of Brentwood, Santa Monica, West LA, and Sawtelle. His expertise includes veterans, suicide prevention, and men's mental health.
This post was originally featured on HuffingtonPost.com
Being an eager, determined, and active male within my personal and professional roles, I understand the inherent challenges when it comes to living and maintaining a balanced lifestyle. It is also a frequent complaint encountered within my role as a therapist working with men. These conversations often start off like this:
"I'm functional. I have a good paying job, I'm dating, having sex, I'm happy. I'm close with my family and have quite a few close friends. I eat well, I exercise, take good care of my body, and I like myself. I maintain an active lifestyle and seek out new opportunities for growth and personal development. There's nothing wrong with me, so why should I consider seeing a therapist?"
There are many ways to answer this question. For the purposes of this article, I focus on two responses.
1) Few of us fall into this ideal on a consistent basis.
Yes, fundamentally and cognitively, we know exercise, diet and nutrition contribute to better mental states. That nature provides us the opportunity to connect with our spirituality, to rejuvenate, and relax. We know giving back to society, mentorship and volunteering reap deep intrinsic rewards. We understand management of stress is vital, and to do so, we need to carve out time to play, be creative and relax. We've heard the importance of healthy and intimate relationships; of the benefits afforded to processing and exploring recent events and stress. But really, who has time to do this?!?
Too often, we have competing interests in our day-to-day lives. With pressures coming from employment, peers, family, household chores and more, our daily tasks often become hasty, triaged decisions based in reaction rather than prevention.
This makes sense. The Organization for Economic Cooperation and Development (OECD) is a forum where member countries discuss issues and policies relating to economic growth, prosperity and sustainable development. The OECD reports people in the United States of America (USA) work more hours per year, and have more employees working "very long hours" than the average nation. Collectively, the USA ranks 33rd out of 36 nations when it comes to "time devoted to personal care and leisure," an outcome which contributes to poor physical and mental health.
Furthermore, our society reinforces a minimized view of such therapeutic activities and encourages other means of support instead. Roger Walsh states, "(these activities) require considerable and sustained effort, and many (individuals) feel unable or unwilling to tackle them. (Individuals) often have little social support, little understanding of causal lifestyle factors, and a passive expectation that healing comes from an outside authority or a pill." He identifies advertising as a main method of refocusing us onto more economic, and easier, ways of soothing these desires. These mechanisms include "self-medicating" via alcohol, nicotine, unhealthy food and other compulsions, which, at a certain point, become unhealthy and suffer from the psychological concept of habituation, the perceived benefits yielding less and less relief over time. These societal messages are further reinforced by many of our friends, family, employers, co-workers and many others.
What can we do?
Stress exists in all of our lives. It is not a question of if we will experience stress, but rather how we will deal with it. My colleague Ken Howard, LCSW recently listedsome warning signs when it comes to your lifestyle. Here's what I think:
2) Seeing a therapist can be helpful in moving from reaction-based decision-making to a more proactive approach. In doing so, we create an environment for preventative health care and move toward a more balanced lifestyle.
Like seeing a doctor for regular check ups and evaluations, seeing a trained mental health professional on a regular basis can be a great way to maintain consistency in perceiving, evaluating, interpreting and responding to the overwhelming complexity making up our daily lives. In fact, with many mental health symptoms seen in primary care physician settings, there is a push within the field to integrate mental health treatment earlier and more often in physical health treatment as well. Very few of us are allowed the conversational space required to explore the deep cognitive and emotional impact of our daily lives, not only on our minds but also on our bodies.
Given the challenges outlined by Walsh, being proactive over your lifestyle is imperative. In order to move toward a more proactive view of your lifestyle and healthcare, I believe integrating mental health treatment or coaching into one's schedule is vital. Prior to a mental health evaluation, it is important to have specific goals in mind. For example, if you are stuck, one goal could be to gain clarity. Other helpful hints in searching out a therapist include interviewing your therapist to ensure they are competent in approaching your unique situation (some great sample questions here), and to establish mutually agreed upon goals prior to beginning treatment. There are exceptional treatment protocols in the field of mental health including resolving uncertainty via Motivational Interviewing and Cognitive Behavioral Therapy, as discussed in my last post.
This post originally appeared on HuffingtonPost.com
As a mental health professional, I can't help but think about how my favorite TV shows, books and music apply to healthy mental living. For instance, I am a big fan of Cosmos: A Spacetime Odyssey. The images are striking. The writing, brilliant. It taps my imagination, and reinforces my thoughts and beliefs via scientific research and theory.
In a recent episode called "Unafraid of the Dark," I was struck by a discussion about how the factors that influenced the advancement of science and humanity parallel the tenets of a healthy philosophy for daily living.
Here is the excerpt:
It was the work of generations of searchers who took five simple rules to heart:
You can use deGrasse Tyson's five simple rules to encompass a broader view of personal growth, too. Taking them to heart can help us be more scientific in our thinking, which can lead to a more empathic understanding of ourselves and others in our daily lives.
For instance, I connected deGrasse Tyson's first three points to the biases we hold in our daily lives. As briefly discussed in my last blog, cognitive distortions (or biases, a slightly less judgmental word) are always in play. It is not a question of if we are biased in our thinking, but rather a question of if we are aware of such a bias influencing our thinking, e.g. personalization, emotional reasoning, etc.
A tool for all of us to better examine our thinking, and how our thinking influences our moods and behaviors, is Cognitive Behavioral Therapy (CBT). From its inception, CBT has become the most widely researched and evidence-based form of psychotherapy. In some cases, research has demonstrated its being as effective as psychotropic medication.
As Tyson talked about his fourth and fifth points, the frame of CBT was screaming through my mind. Some of the ways CBT provides a more structured and scientific approach to our thoughts, feelings and actions includes identification and evaluation of feelings, "automatic thoughts," intermediate beliefs and core beliefs, role playing, behavioral experimentation, examining the evidence, and many, many other mechanisms.
The most important portion of Tyson's commentary is the fifth point. Tyson talks about how "even the best scientists were wrong about some things," and it's similar to how we can and should move forward once we accept the inevitability of our own errors.
We do not achieve growth in our lives without missteps along the way. Ideally, acknowledging this will help soften our own tender approach and playful response to adversity in our lives when it comes. If we can't acknowledge our missteps, a real danger emerges in which we believe ourselves to be unequivocally right. In doing so, we often lose empathy towards ourselves or others.
Research demonstrates what happens when we lose empathy in our relationships, and communicate with vehicles such as criticism, contempt, defensiveness and stonewalling. The effects can be devastating on marriages, leading to a host of negative effects like lack of communication, emotional flooding, withdrawing from the relationship, even leading to affairs (1).
By better examining our thinking through a more scientific process and softening our internal and external response to failure, we are better able to continue our journeys in personal growth in order to advance ourselves, those around us and, hopefully and ideally, mankind.
(1) Gottman, John M., and Nan Silver. (1999). "How I predict divorce," in The Seven Principles for Making Marriages Work (Chapter Two, 25-46). New York: Three Rivers Press (Random House, Inc.)
This post originally appeared on PickTheBrain.com.
‘I feel the most fulfilled and perform best when I am helping others in a direct capacity, and am learning in a collaborative work environment.’
I recently told a friend this. Being able to put such thoughts into concise expression hasn’t always been easy for me. In fact, in my past, I’ve actually had different ideals, which I’ve gravitated toward. These ideals had little to do with my aforementioned paraphrase.
I’ve done considerable research on my interests and passions as well as possible career options, which take advantage of the intersection of these areas. I’ve read numerous books on these subjects, seen documentaries and lectures on the topics, and sought out a variety of mentors and a number of individuals in my own career search and selection. I’ve even done career assessment through surveys. I recently took one of these types of career assessments.
The Strong Interest Inventory is based on Holland Codes, and is a common career assessment tool. I’ve utilized this testing in the past but for some reason my latest assessment provided a new perspective for me, and what I learned was quite revealing. Not only was the view interesting and relevant to me, but I believe my insights were not unique. This explains my reasons for writing about this subject. I believe my thoughts are relevant to many of you as well.
[**] While on a trip to my hometown of Santa Cruz, California, I took time to meet up with David Thiermann to chat about my current career direction. (I am refocusing from entertainment marketing to mental health.) In the past, I have worked in a few environments where I perceived people caring more about the work getting done than the conditions under which it was completed. However, in addition to noticing this, I began to feel a deep disconnect between my own interests and my work. In bringing this up to David, we began to do some refinement when it came to my own personal ethos.
To give a bit more of a background on the Strong Interest Inventory, I believe it would be helpful to better explain the Holland Codes. According to Wikipedia, the Holland Codes are as follows:
[**] Of course these self-rating and selecting types of surveys can vary by moment. At the exact moment I took this test with David, he found me to be feeling most capable and motivated toward the Social, Enterprising and Artistic categories. The most interesting part about this experience was David’s comment about our society and how it tends to treat Social categories. David mentioned that in his experience, he’s noticed that society tends to encourage people within the Social category to move toward Enterprising paths.
BAM! His statement hit me like a ton of bricks. Not only did I feel this exact stigmatization toward my Social skills and Social career options growing up, but I perpetuated them by believing that I could excise them by working in “Social” settings, parameters and frameworks within the field of marketing. Upon further reflection, leadership and management were, and are, of incredible interest to me. As I see it now, my main issue within my experience in entertainment marketing was that in order to achieve leadership roles, I needed two specific things which I did not have at the time: patience and active mentors.
I believe my issues surrounding “patience” are based on the fact that I didn’t enjoy my work. It gave me little in return for a lot of hours of hard work, commuting and stress. It paid the bills and developed my skill set, but the work was incredibly dull for me. What I wasn’t thinking about at the time was that I valued helping others not the work itself; and, in order to make my way up the corporate ladder, I would need to prove myself in an career path which provided little return back to me. What a revelation! I only wish I could have made this distinction a bit sooner in my life.
This is not to suggest that by working in more Social environments I will not run into political situations, frustrations, people who are burned out and miserable, and need to exercise patience on a regular basis. However, when I was able to put my career into a Social framework, for me, the pieces began to better fit together and my current direction made much more sense. My purpose is helping others, not about persuading, selling and dominating. I enjoy collaborative environments. Though I appreciate competitive environments, when it comes at the expense of other individuals it becomes intolerable for me. Now that I have had this realization, what is left for me to do? Simple. Now I need to take the next step. I need to figure out a way to tap into more S.E.A. tasks and farm out as many of the C.I.R. tasks as possible. This may seem like a simple concept but in better understanding it, it is truly making a monumental difference.
[**] This post is meant to serve as a reminder to you that no matter much effort and energy you put into your life, you are only going to be able to achieve a level in life that you permit yourself to through such vessels as reflection, dedication, motivation, honesty, openness and risk. Even when you believe your current path to be absolute in its representation of your own life, life can still surprise you. I know it recently did for me. I encourage you to reflect on your own paths and see how you can better tune in to your life whether it is through a career coach, therapist, and friend or loved one. As in the wise words of my dear friend David: “When people stop going through transitions, they stop growing.”
Read more at http://www.pickthebrain.com/blog/being-stuck/#ywUkWAHmdOyXdb5z.99
Mental Health and Therapy Writer. As featured on Huffington Post, Vox Media and elsewhere.