Depression

Wrapping our head around a mass shooting: Post-traumatic Stress Disorder in victims and those that care for them

As a therapist, I am certainly not immune to emotional distress and trauma. The biggest mass shooting ever to occur in the United States just took place in my hometown of Orlando at a nightclub that I have been to before. My friends/colleagues in mental health work at the very hospital where over 53 injured victims were taken and they are frantically trying to comfort distraught shooting victims and the family members who are looking for their loved ones who may be injured or dead. All the first responders who attended the scene may have trouble getting the picture of what they saw in the nightclub out of their heads. My own brain is struggling with the enormity of it all as this huge loss to our community sinks in even though I was safely home in bed when the whole event occurred.

A big part of my practice these days involves using a type of therapy called Eye Movement Desensitization and Reprocessing (EMDR) in my work with clients who have survived a trauma of some kind like rape, plane crashes, car crashes, physical abuse or witnessing a violent death. These clients have developed post-traumatic stress disorder (PTSD) and their symptoms include:

-Experiencing intrusive flashbacks or re-experiencing the traumatic event

-Avoiding the place where the trauma occurred or anything that reminds them of the event

-Feeling hyper-aroused which means they have trouble sleeping and feel jumpy and/or irritable

-Dreaming about the traumatic event

-Having panic attacks

When I think about all the recent victims of this mass shooting, I know that many of the survivors will develop PTSD in the coming weeks and months. Family members and loved ones of those who perished may also develop PTSD as a result of having to identify their bodies of their loved ones and grieving their unexpected and tragic loss. Not everyone develops PTSD as a result of experiencing or witnessing a traumatic event and we don’t really know why that is. But, what I do know is that many people with PTSD suffer in silence for a long time before they go to their physician or a mental health professional for diagnosis and help.

If you or a loved one begins experiencing symptoms of PTSD after a traumatic event or loss, please don’t ignore the symptoms or tell yourself that you just need to “suck it up and be strong.” PTSD is a very treatable condition and the impact that untreated PTSD has on one’s quality of life is profound.

My thoughts and prayers go out to all the victims of this senseless tragedy. I work with a lot of LGBT clients in my practice and I take comfort in knowing that our local LGBT community is very strong and that they will support each other as they heal.

 

Dana Nolan MS LMHC NCC

Licensed Mental Health Counselor

Altamonte Springs — Orlando

 

Surviving Childhood Trauma

April is Child Abuse Prevention Month. Sadly, child abuse occurs far too often. Some families seem to pass on the legacy of physical, sexual and psychological abuse because many times victims of childhood abuse grow up to abuse their own children. This pattern can be halted if victims of abuse seek and receive professional help to deal with their trauma.

Commonly, a survivor of abuse will “stuff” their emotions and the memories of the traumatic events when they arise. They may turn to drugs or alcohol to numb the pain or to make the memories of their abuse disappear. These strategies work in the moment, but the thoughts, feelings and memories will keep coming up unless they are processed therapeutically. Quite often, my clients have told me that they have tried on their own for many years to get rid of their traumatic memories, anxiety and negative thoughts before they seek counseling.

There are a variety of therapeutic models to deal with the trauma of childhood abuse.

Trauma-Focused Cognitive Behavioral Therapy– helps victims of abuse to reframe the irrational and negative thoughts/beliefs that are often formulated after surviving childhood abuse.

Eye Movement Desensitization and Reprocessing (EMDR)-a very specialized form of trauma treatment developed to address the flashbacks, memories and negative thoughts common in those with post traumatic stress disorder (PTSD).

Dialectical Behavior Therapy-a collection of therapeutic interventions that focus on helping victims of abuse learn to manage their emotions, cope with stress in interpersonal relationships and tolerate emotional distress.

Play Therapy-a therapy for children that helps them express and process their emotions and memories of abuse in a safe environment. Play therapy uses dolls and toys to teach about healthy relationships and boundaries.

Pharmacologic Therapy-many times survivors of childhood abuse develop sleep problems, anxiety disorders (generalized anxiety disorder, post-traumatic stress disorder or phobias) or a mood disorder. Psychiatrists can prescribe medications to help manage symptoms which allow the survivor of abuse to work through trauma in counseling.

In my practice, I work with adult survivors of childhood abuse and utilize trauma-focused cognitive behavioral therapy, EMDR and dialectical behavioral therapy and have found these modalities very successful. It takes a great deal of courage and trust to reach out and seek help. If you are a survivor of childhood abuse and are ready to start feeling better, ask you primary care physician for a referral to a mental health care professional in your area that specializes in post-traumatic stress disorder and interview a few therapists to make sure you feel comfortable talking with them

Reflections for a New Year

As we say goodbye to the year 2015 and welcome 2016, it is normal to reflect upon the past year and to plan for the future. We hope to leave behind the sad or hard times and wish for happier and healthier times in the coming year. The New Year is a time to pause and take stock of our life, our goals and our relationships with a view to make the future better.

The New Year is not the only time that we review our lives and try to make improvements. When we turn another year older, it is common to think about where we have come from and where we are going. Birthdays that end in a zero (like 40) or a five (like 65) may have more of an impact emotionally. When we are young, we imagine what our life will be like and what we will have achieved when we are 40 years old or if we will be able to retire when we are 65 years old.

Experiencing a loss like the death of a loved one or a divorce also leads to re-evaluating our life and re-adjusting our plans for the future as we adapt to our loss. It is important (both emotionally and psychologically) to pay attention to these times in life that lead us to pause and reflect .

Many times we simply begin down the road of life that starts when we finish high school and our life road may include college, military, career, marriage, kids, travel, etc. We can become so focused on staying on our “road” and getting to our destination that we forget to stop periodically and make sure that we are on the right road for us. When the New Year, our birthday or a loss makes us stop for a moment, it is a good opportunity to remind ourselves (or rediscover)  what is truly important to us (our values) and our goals in life. Some people may find that they are not living their lives according to their values or that they find their goals have changed somewhat. We can use these pauses to re-adjust our path and maybe change our direction a little bit so that we are living our lives authentically and reach our goals.

As a therapist, I truly love working with clients who have discovered that they need to re-adjust their path in life. These adjustments could be a career change or shift; it could be deciding that a committed relationship has become unhealthy or unhappy; it could be that we are not being the parents that we wish to be to our children.  In counseling we get to explore what is truly meaningful to us and forge a path to get there. When we set out in life as young adults, we may fail to take into account that what we truly want in life may change as we age. This is normal process and is only a bad thing when we fail to pay attention to how we have evolved as a person and fail to recognize that we need to change paths a little bit.

I hope that this holiday season and the New Year find my friends, family and clients happy and safe.

 

Happy New Year!

Dana Nolan MS LMHC NCC

Licensed Mental Health Counselor

Altamonte Springs — Orlando

Preparing for the Holidays –Relieving Anxiety & Stress

Even though it is not even Thanksgiving yet, all you have to do is look around and you’ll see that the Christmas season is upon us! Last evening I went with my family to see a holiday light display at Disney’s Hollywood Studios in Orlando. We have gone each year for the last 7 years and have always enjoyed the amazing Christmas lights that dance with the music. Every year we take pictures as a family at the light show and either I am getting shorter or my children are getting taller!As we strolled slowly down the street looking at the lights, my husband and I danced and sang aloud to the Christmas carols which embarrassed my teenage sons!

We all tried very hard to pretend that the foamy bubbles floating from the sky were really snowflakes even though it was a balmy 65 degrees. It was fun to see the facial expressions of the young children in the crowd as the dancing lights came on for the first time! We told some families who had never seen the lights before about finding the Disney characters hidden within the lights. As a family we don’t have too many holiday traditions, but the few that we have mean a lot to us and we have always tried to find the time to make them happen and to be mindful as we celebrate.

During my work as a psychotherapist (mental health therapist), I find that this time of year brings a burst of clients wanting to get it in to see me. It is usually due to depression, anxiety or family/relationship stressors which seem to increase during this busy time of year. Why would so many of us feel emotionally distressed during a time that is supposed to be a joyous? Most of us already have busy schedules and too much on our plate without adding on gift shopping, annual holiday parties and decorating our homes for the season. It is easy to get wrapped up in our “to-do” list and feel stressed so that we aren’t really present during this time of year.

You may have heard of “mindfulness.” It refers to being as aware as possible in your current situation and place. Sometimes we float through life spending too much time ruminating on the past or worrying about the future which means that we aren’t enjoying today. There are many books and research articles about mindfulness and the emotional and physical benefits of practicing it. Rather than try and summarize all that information, I’d like to offer a few tips to help you be mindful during the holidays and all year round, as well.

1. Let go of trying to keep up with the “Jones” this season. Some people feel overwhelmed by trying to have the biggest or best holiday yard decorations or to make the perfect-looking Christmas cookies to give away to friends. Others feel pressured to get their children the latest must-have toys or gadgets (which are always on back order with Amazon!) Comparing our lives and possessions to others usually leads to a lower self esteem and feeling inferior which feeds pressure to “out-do” each other and can sometimes exacerbate underlying issues such as depression and anxiety. It is less stressful and more healthy to simply focus on those few activities that have the most meaning to your family and forget about trying to win the “best holiday decoration” award in your community.

2. Put reminders on your calendar to “Stop what you are doing and be aware of life around you.” Re-read my description above about my family’s visit to see the dancing lights. We stopped and watched the lights and listened to the music. We felt the temperature outside. My husband and I danced and sang in the middle of the crowd and didn’t care what anyone thought about us. We made the effort to interact with people around us that we didn’t even know and will never see again. THAT was how we were mindful…we stopped and simply paid attention and connected with what was around us.

3. Accept that you will probably feel some stress and anxiety in the next coming weeks. If we try to be more self-aware of our thoughts and feelings, then we can better cope with them. Unhelpful thoughts (I like to call them “shoulds”) can lead us to feel pressured to do too much or try and make too many people happy. It is a good idea to question where these “shoulds” come from because they lead us to feel stressed out and also keep us from enjoying the moments of the season.

I hope that all of you have a happy, healthy and MINDFUL holiday season this year!

Mindfully,
Dana Nolan
Licensed Mental Health Counselor

Making and Keeping Your New Year’s Resolutions

Every January my local gym has an influx of new members and becomes crowded to the point that I have to wait in line to use the exercise machines. However, I’ve noticed that the crowds thin out considerably after a few weeks. Why does this happen? I believe that people have the best intentions when they decide to get in shape for their New Year’s resolution. But, it seems that keeping many of our New Year’s resolutions is a challenge. Statistically, thirty percent of those who make a New Year’s resolution break them by February. Only 7% of us reach our goal by the year’s end.

Why do many people fail to reach their resolution goals?

Goals are too general

“I want to get healthier.” “I want to get out of debt.” “I need to get a better job.” We are more likely to reach our goals when they are specific and measurable. A better goal is “I want to pay off $2,000 of credit card debt by June.” or “I’d like to lose 10 lbs in 10 weeks.”

Resolutions are unrealistic or inflexible

“I am going to go the gym every day.” “I am going to give up all fried foods and never eat dessert.” Goals need to be realistic AND flexible. It may not be possible to go to the gym EVERY day due to our work schedule or if we get sick. If our goals are not somewhat flexible, then we may get frustrated and feel like a failure if we do slip up and have a slice of birthday cake or can’t make it to the gym one day.

Lack of planning

It is great to set a goal to pay off our bills and get out of debt. But, that will not happen without a plan. It is necessary to make a budget that includes our income and expenses. From there, we need to decide exactly what will need to change in our budget each month to find the money to pay down our debt.

Why is this goal important to me?

It really helps to define why a particular goal is important to us. How will OUR life be better if we reach this goal? Research in human behavior indicates that changes are more likely to be permanent if we are able to identify how we will benefit from making a change. It can be very motivating to recognize that we will be able to retire a few years sooner if we save “X” amount each year.

If feelings of guilt or shame are the primary motivation for our resolution, then we are less likely to be successful. Guilt about being overweight, in debt or a smoker does not promote healthy, long-term behavior changes.

How can we be SUCCESSFUL with our New Year’s Resolutions?

We need to select ONE specific and realistic goal that is truly meaningful to us. From there, we need to write down a plan on how we will accomplish that goal and how we will measure our progress towards that goal. As we take a small step each day towards that goal, we also need to be flexible enough to accommodate those unexpected events in our life that may derail us a little bit from our goal. Most of all, we need to be KIND to ourselves as we adjust to a new routine and allow ourselves to grow into a new way of living.

Best wishes of happiness and success in the 2015!

Dana Nolan
Licensed Mental Health Counselor
Healthy Living Counseling

Dealing with Sexual Issues For Cancer Patients

There are a wide range of thoughts and emotions that accompany a cancer
diagnosis that are completely normal. However, these thoughts and
feelings may not feel normal because you may not have felt them before.
Symptoms of depression, anxiety, sleep problems, and relationship
challenges very typically occur along with all the effects of cancer or
its treatment. However, discussions about sex are often neglected by
health professionals and patients.

Many people are not comfortable discussing sex, especially cancer
patients who are dealing with life-changing issues and have more stressful
and life-threatening concerns on their minds.

But should the topic of sex be equally important to those with cancer?
Of course.

I have often found in my work as a mental health counselor, that couples
are very interested in learning about how to have sex comfortably and
safely during and after cancer treatment.

A cancer patient and their partner often have questions about sexual
intimacy due to a loss in the cancer sufferer’s libido (sex drive) or
negative sexual functions that can result from the cancer treatment. As
a result, they look for advice from their doctor and/or other health
care professionals to gain a better understanding of the affects of
treatment and how it affects their sex drive so they can continue to
enjoy having sex as they did before diagnosis with cancer.

The difficulty with talking about sex, falls not only upon the patient,
but upon doctors too. Many doctors will often avoid the subject or wait
for the patient to raise it. Yet, a cancer patients and their
caregivers often wants information to understand how treatment will
affect their sexual desire and function.

One study suggests, that: “Health professionals may also believe their
discussions [about sex] may be construed as disrespectful and
inappropriate by the patient, with research suggesting that gender, age,
culture, socioeconomic factors, and religion all contribute to health
professionals’ avoidance of the topic…” (Asia-Pacific Journal of
Clinical Oncology, 2009).

In my experience as a counselor, whom has provided therapy for cancer
patients, it’s easy to understand how concerns about sex may go
unattended to because both patients and physicians are unwilling to
engage in dialogue about the topic.

Raising this issue with your doctor is important because many newly
diagnosed patients and their partners may not be aware of the safety
issues involving sex, cancer, and treatment.

Whether or not your doctor raises the issue, you should be brave and
raise the issues and questions you have about cancer treatment and sex.

As a guide, here are some helpful questions in which you can ask your
doctor about sex and mesothelioma:

Do I need to take precautions during intercourse while I am on
chemotherapy?

How will treatment affect my energy levels and libido?

How soon after surgery or a procedure can I have sex?

Is it safe for me to physically exert myself during sex while I am on
treatment?

Have other patients receiving the same treatment reported side effects
that impact sex?

Is oral sex safe during treatment?

How will treatment affect my hormone levels?

Will I be able to have children after I finish treatment?

How will treatment affect my fertility?

When you or a loved one are battling cancer, so many things do not feel
normal. Sometimes, sex can return some sense of normalcy. It can also
improve a couple’s quality of life during this difficult time. It may
take some courage to raise concerns and questions about sex to your
doctor, which may not be easy, but most patients find the payoff in
having discussions about sex while battling cancer is well worth the
effort.

Parenting To Prevent Suicide

As a licensed mental health professional, I’ve worked in a variety of hospital settings where I have worked with adults and teens who have tried unsuccessfully to commit suicide. The vast majority of those who survived their suicide attempt were so grateful to have survived their attempt. Almost all of them want to learn how to better cope with life so that they never reach a point that they feel so hopeless, desperate and impulsive again. In working with family members after a loved one’s suicide attempt, it has been challenging to explain how their loved one could reach such a hopeless state of mind that suicide was the only or best option.

 

As a mother to two teenage boys, one of my goals is to teach them how to manage life’s emotional challenges like not getting that job they really want, not making the varsity team, or the breakup of their first true love. Recently, I was assessing a teenage patient in the ICU who barely survived a very serious suicide attempt after the breakup of his first serious relationship. As I talked to him and his family, I couldn’t help but to ask myself “What if that were my son?” This particular young man had a very bright future academically, yet he felt so emotionally distraught that the only solution in his mind was to take a bottle of pills.

 

Throughout my years of practice, I’ve learned that when people are unable to acknowledge, understand or cope with emotional pain, anger, sadness, or grief in a healthy way that they typically turn to unhealthy ways of coping like misusing drugs or alcohol to numb their pain. Alternatively, they may engage in impulsive and dangerous behaviors including cutting and suicide. As a therapist, my work with these clients is to help them recognize, understand, and better cope with their emotional pain in a healthier way.

 

Emotional intelligence is a term that relates to one’s ability to recognize their own emotions, other people’s emotions, AND to manage unpleasant emotions in a healthy way. Studies show that people who have high emotional intelligence and emotional resiliency are much less likely to self harm either by cutting or attempting suicide or to misuse drugs and alcohol. When children demonstrate high emotional intelligence, they are more likely to use healthy coping skills and have healthier relationships with others. However, it is rare that our children’s school curriculum includes teaching about emotional intelligence, so it’s one of those things that we have to learn on our own.

 

How can parents influence their children’s emotional intelligence?

There are many things that parents can do to teach and model emotional intelligence and emotional resiliency to our children. In addition to teaching our children how to read, tie their shoes, and how to drive a stick shift, we need to also teach them about emotions. We need to show them that it’s okay to ask for help when we are struggling. We can normalize their emotions when they are sad, lonely, or down on themselves. We can be brave enough to share our own pain as children and teenagers like not getting asked to the prom. We can talk to our children as we watch news stories about people who deal with their anger or fear in an unhealthy or illegal way. We can support and encourage our children when they talk to us about something that is bothering them. We can avoid labeling or degrading those who seek counseling or psychiatric care for anxiety, depression or to simply improve their mental health. We need “walk the walk” and not just “talk the talk.” We need to model to our children healthy ways of coping with life’s stressors, challenges and heartbreaks. We need to have conversations about ways to manage stress with our children and encourage them to find their own healthy stress management skills. We need to talk with them about how to forgive ourselves if we make a mistake. We need to teach them to problem solve so that they don’t repeat mistakes. We need to talk to them about healthy relationships and what makes a relationship abusive. These types of conversations may not come as easily to some parents as conversations about their homework and chores. But, the payoff to your child is well-worth your effort.

 

It is normal to want to protect our children from both physical and emotional pain in life. Of course, most parents acknowledge that we cannot protect them from everything, but we can prepare them for life. We need to do more than tell our children not to cry, to just suck it up, to get over it, to forget about it, or to be strong. As parents, we need to acknowledge and talk about ALL the emotions we experience in life. We need to be human and share with our children how we learned to cope with our disappointments, break-ups/divorces, job losses, financial crises, and deaths of loved ones. When children, teens, and adults feel supported and capable of handling life’s emotional ups and downs, they are much less likely to reach a place of hopelessness, helplessness, and desperation where self-harm or suicide feels like the best option.

 

April is Child Abuse Prevention Month–Child Abuse Awareness

 

From the desk of Dana Nolan, Licensed Mental Health Counselor…

April is Child Abuse Prevention month.  In my practice, I have way too many clients who suffered childhood abuse and/or neglect and now have ongoing emotional or psychological issues related to trust, self-esteem, depression, anxiety/PTSD and unhealthy relationships. My job as a therapist is to help survivors of childhood abuse work through the abuse to become happy, well-adjusted adults. Ideally, it is always better to prevent a problem than to try and fix it later on.

Florida Governor Scott recently approved laws aimed at reducing childhood abuse. Today, anyone who fails to report incidents of child abuse, neglect or exploitation can be charged with a felony. Previously, only “mandated” reporters (doctors, nurses, mental health professionals and teachers) were obligated to report known or suspected abuse of a child or vulnerable adult. The purpose of this law was to make EVERYONE responsible for reporting abuse. Historically, child abuse was considered a private, family matter and many adults failed to report abuse they observed or suspected because they believed it was “none of my business.” This new Florida law means that it is EVERYONE’S business to look out for our youth and vulnerable adults.

It is really quite easy to make a report to the Department of Children and Families services here in Florida. You simply call 1-800-96-ABUSE (1-800-962-2873) or log onto https://reportabuse.dcf.state.fl.us. It is important to have specific information ready to provide in making the report: Name, date of birth (or approximate,) race, gender, address or location of child and what exactly you observed that leads you to believe that a child is being abused, neglected or exploited. All reports to DCF are confidential and you cannot be held liable for making a report provided it is made in good faith.

Most of my clients who suffered childhood abuse or neglect have said they always wondered why no one ever stuck up for them or reported the abuse when it was observed. Please know that you CAN make a difference in the life of a abused or neglected child by being that ONE person who does stick up for them and makes that phone call to make a report.

Finding Success with Your New Year’s Resolutions

Many people use this time of year to get a “fresh start” and make some changes in their lives. Most of the time these changes involve self-improvement like losing weight, exercising more, quitting smoking or addressing an emotional or relationship problem that has been worrisome. It is natural to use the ending of one year and the beginning of another to reflect on our lives, where we are headed and where we have been.This self-reflection can be a very insightful and positive exercise.

Regardless of what kind of change you may want to make, it is important to have realistic expectations of ourselves and to have a plan of action. When we are motivated to make a change, we are pumped up and want our excitement to translate into quick results! Unfortunately, this just does not happen as our habits are formed slowly, weight is put on over months and years, emotional and relationship problems evolve over time. But, DO NOT GET DISCOURAGED and stop your efforts to feel better and live better if you don’t see or feel results within a few days!

Here are some tips to help you be more successful with your New Year’s Resolutions:

1.Get rid of the words “always” and “never.” Don’t say that I am “always” going to go to the gym after work as there will be days that you simply can’t go every day at the same time. It is then too easy to say that “I blew it! I give up!” and just quit going to the gym altogether. Sometimes when people are going to lose weight they say “I am never going to eat chocolate again!” These statements are too rigid and absolute and don’t allow for the flexibility we all need in our lives.

2.Take your time. Lasting behavior change takes time to sink in and become routine. Additionally, our bodies need time to adjust to changes in physical activity, diet and quitting smoking, alcohol and caffeine.

3.Question why you are making a change. Are you quitting smoking because your spouse is nagging you incessantly? Are you trying to manage anxiety because your family said that you are driving them nuts? Successful life changes happen when we are able to identify what we personally plan to get out of that change. How will you FEEL if you quit smoking? Will you have more energy? Will you hopefully live longer to see your grandchildren grow up? How will your life be better if you finally get that claustrophobia under control? When we are able to connect with what WE will get out of making a change, we are far more likely to stick with it.

Best wishes for a happy, healthy New Year!

Dana Nolan, Mental Health Counselor

And

Tejal Parekh, RegisteredDietitian

Healthy Living Counseling, LLC

Depression

With an estimated 19 million Americans living with major depression, it is quite likely that you or someone you know is struggling with this very treatable condition. Some of the common symptoms of depression include: change in appetite; sleep problems; fatigue; feeling worthless, guilty or hopeless; lack of interest in things you used to enjoy; avoiding family and friends; poor concentration/memory; decreased motivation and suicidal thoughts.

As a therapist, I have found that the most challenging symptoms of depression are the ones that lead a person to believe that nothing will ever get better (hopelessness) and that no one cares about them or would miss them if they were gone (worthlessness.) It is these beliefs that keep a depressed person from reaching out for help.

A combination of anti-depressants and cognitive behavioral therapy is the BEST treatment available and improves symptoms of depression most of the time. If someone you care about appears depressed, tell them that you are concerned about them, offer to go the doctor with them and encourage them that things will get better if they reach out to professionals for help.

Dana Nolan
Mental Health Counselor
Healthy Living Counseling, LLC