Escaping the Fear Trap

In a world deeply enveloped in fear, we can choose to avoid the traps that leave us feeling helpless.

The first time I remember really feeling fear was when I was in the second grade. The cold, dry winter air did not couple well with my asthma, and one night I found myself struggling for air in the middle of a terrifying asthma attack. Usually my mom or dad would grab my albuterol to calm my panicked breaths, but this time, my medicine was nowhere to be found. I couldn’t catch my breath despite all effort, and I began to worry that I never would. My mom found my medicine after some relentless searching and my breathing settled before the situation became desperate, but I still vividly remember the feeling of fear that petrified me as I searched hopelessly for air to fill my empty lungs. 

Fear is the central nervous system’s physiological and emotional response to a serious threat to one’s well being. While fear can prepare us for fight or flight responses in dangerous situations, it can also become a roadblock to progress and peace if prolonged. 

After the events of 9/11, unprecedented fear and terror filled the lives of millions of Americans. Curious how such an intense fear could spread so rapidly, researchers began to study the roots of fear. Their findings completely changed my perspective of fear and how it is cultivated. 

The study found that the roots of human fear stem from what researchers call risk perceptions. Risk perception suggests that we attribute fear to things that pose any risk toward us– the more the risk, the more the fear. This explains why humans appear to fear similar things (like heights or spiders), why we subconsciously decide what we are afraid of (like skydiving, even if we’ve never done it), and why our responses to risk are not always internal or rational, but rather emotional (screaming in a scary movie), reflecting our values and perceptions of a risk itself.

What are the Fear Factors?

What I found most interesting from my research about fear was that there were common underlying factors which seemed to alter how risks are perceived, ultimately increasing the fear experienced by populations at large toward a particular risk. I’ll share a few of these factors and invite you to consider how they may affect your risk perceptions and consequent fear. 

Factor 1: Awareness

As our awareness of a risk increases, so does our fear. Awareness can be generated by the media, word of mouth, and even personal experience.

Factor 2: Uncertainty

The more uncertain we feel of a risk, the more afraid we are. Where did the risk come from? When? Who? Is it likely to affect me? 

Factor 3: Newness 

We are more afraid of risks that are new rather than those that have been around for a while. After we’ve lived with a risk for a while, we gain a better perspective and understand the real dangers posed by the risk. 

Factor 4: Control

The more control we feel we have over a certain risk, the less fear we feel. Less control over a risk brings about greater fear. This is why people ride bicycles without helmets and rarely hesitate to drive their car; they are in control. Does this lessen the risk of injury or harm? Perhaps not, but it establishes a sense of control. 

How can we Escape the Fear Trap? 

I present these factors in hopes that you may realize, like me, that sometimes our fears do not match the facts. Whether your fears are work, school, home, family, or world-related, they can be pressing, consuming, and heavy. Yet, as we look at these factors, it’s clear that we can choose to escape the fear trap by making small, simple decisions that align our fears more with reality:

Monitor Awareness

While the media presents incredible information and benefits, it can also be a fire hydrant of facts. Monitor the sources you trust, limit your time on social media, and seek information from reliable sources. 

Discover What You Know 

There are so many uncertain things in life, but there is so much that is certain! Although there may be aspects of risk that we cannot find the answers to, there are truths and facts that can help us to feel more certain about our future. Focus on the things you know and the things that don’t change as a result of risk. 

Practice Patience

When risks are new, they feel more threatening. We can avoid the tendency to overreact by reminding ourselves to be patient. Even when others respond fearfully to news risks, we can recognize new ways to learn, live, and grow as we become familiar with risks, instead of being afraid of them. 

Control the Controllable

While some things will always lay outside of our control, we can focus on the things we can control. Study for your upcoming test; make an emergency preparedness kit; wear a seatbelt in the car. We will never be able to eliminate all risk, but we can decrease our fear as we focus on the things we can control. 

In a world deeply enveloped in fear, we can choose to avoid the traps that leave us feeling helpless. Although it takes great effort, we can handle the fear we face by heightening our awareness, focusing on what we know, learning to live with risk, and recognizing our control. Risks may always abound, but we decide how we will react to them. Let us choose courage and conscience as we encounter the risks that raid our lives. 

Melissa Cluff is a licensed marriage and family therapist based in North Texas, providing face-to-face and telehealth therapy options to clients in Texas. 

References: 

Comer, R. J., & Comer, J. S. (2018). Abnormal psychology. New York, NY: Worth Publishers/Macmillan Learning.

Gray, G. M., & Ropeik, D. P. (2002). Dealing with the dangers of fear: the role of risk communication. Health Affairs, 21(6), 106-116.

Debunking the Myth: Men CAN Have Anxiety

“No matter what our circumstances, we’re all carrying around things that hurt — and they can hurt us if we keep them buried inside,” he wrote. “Not talking about our inner lives robs us of really getting to know ourselves and robs us of the chance to reach out to others in need.” 

~Kevin Love of the Cleveland Cavaliers 

There is much conversation about women experiencing anxiety in the workplace, in forming and maintaining relationships, all throughout motherhood… It is well understood that women of all ages across the globe undeniably face anxiety in nearly every stage of their lives. But why are men so quickly excluded from the dialogue on anxiety? In today’s post, I would like to do my part in creating an open conversation on men and anxiety!

Do men experience anxiety, too? The short answer is a resounding yes! Anxiety is no respecter of person; men and women alike are vulnerable to its effects. Everyone feels anxious from time to time. Not only is it common, but it is actually important that humans have the capacity to feel anxious because anxiety is the body’s way of telling you that there is a threat that needs attention. (Note: With an anxiety disorder, a person may repeatedly respond to situations as if there is a perceived threat, although there is not one.) While both men and women can feel anxious during their lives, they tend to respond to their anxiousness differently. 

The facts about men and anxiety:

  1. Studies have found that about 1 in 5 men (and about 1 in 3 women) will have an anxiety disorder during their lifetime. On top of that, only half of the men experiencing anxiety will be diagnosed and untreated! (In a recent Wall Street Journal article, it was reported that mental health professionals fear these figures grossly under-report male cases.)
  2. It is more common for men to experience anxiety than depression
  3. Men and women are prone to different types of anxieties. For instance, women are more commonly affected by generalized anxiety disorder, specific phobias, and panic disorders than men. When it comes to social anxiety disorder specifically, men and women are equally affected. 
  4. Suicide rate among men is four times higher than the suicide rate among women. This is important to note because suicide is often set in motion by indicators of anxiety–narrowing of vision, a hopelessness, the sense that things are not going to get better, etc. 
  5. Anxiety manifests itself differently in men than in women. Women tend to manifest anxiety through nervousness, excessive worry and avoidance of frightening situations. Men manifest their anxiety in ways that often seem unrelated to anxiety which can lead to many instances going undiagnosed. Researchers and psychologists are finding that men report headaches, difficulty sleeping and muscle aches and pains. Or their anxiety is masked by anger, irritability, and aggression. Men are also more likely to use alcohol and drugs to cope with anxiety, so what looks like a drinking problem may actually be an underlying anxiety disorder. 
  6. It is more socially acceptable for men to employ strategies such as substance use and alcohol to suppress their emotions than to admit to anxiety. There needs to be more talk about productive resources like men needing a good friend with whom to talk, the benefits of self-care in combating anxiety, the power of communication instead of bottling up (or ignoring altogether) feelings of anxiousness. 
  7. Men are socialized to not ask for help or be vulnerable. An informative study found that when male (but not female) leaders ask for help, they are viewed as less competent, capable, and confident. And when men make themselves vulnerable by disclosing a weakness at work, they are perceived to have lower status. This is problematic as it becomes a vicious cycle where men needing help are not able to admit to it, let alone treat it. 

In my research on men and anxiety, I came across an example that perfectly illustrated the stigma around men and anxiety: A construction worker, who worked on scaffolding 30 feet high, described daily panic attacks that would come on quickly and would make him feel dizzy, nauseous, and disconnected from reality. This went on for ten years before he sought treatment. When he finally got help, he was asked why he had waited so long; he said he felt his ‘episodes’ were a manifestation of a weakness on his part. He believed he could control them (“mind over matter) but he tried for ten years without success. This construction worker did not free himself from his debilitating anxiety until he admitted to needing and sought for help. This is the case for any man or woman struggling with anxiety: Healing and balance is possible but often requires getting professional help. 

If you struggle with anxiety, reach out. Talk about it. Get help from a trained professional. Anxiety is not a weakness. Anxiety disorders are real–often a chemical imbalance of the brain. It exists in men and women. Men, you are not alone and it is okay to get help! Everyone deserves to live their life with tools to face anxiety and be in control of their life. Healing is possible! Please do not hesitate to contact me and schedule a session.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

References:

Breaking Up With Your Relationship Anxiety

“Our anxiety does not come from thinking about the future, but from wanting to control it.” ~ Kahil Gibran

You are dating someone wonderful. You are happy. You are strongly attracted to your partner. There is a deep level of trust, commitment, and enjoyment in your relationship. Yet, despite it all, you find yourself ruminating… what if she is not the right one for you? What if she is hiding some deep, dark secret? What if she is perfect but you worry about her sticking around? You fear that you are incapable of maintaining a healthy relationship and that your partner will soon find out and leave you. 

This downward spiral of thought is known as relationship anxiety. If you can relate, raise your hand. You are not alone! Relationship anxiety is actually quite normal. You might feel anxious at the beginning of a relationship–before your partner shows mutual interest in you. Or maybe you feel anxious even in the most established of relationships. You may wonder if you matter to your partner, if he/she will always be there for you, if he/she is still attracted to you, etc. The doubts can creep up in all aspects of your relationship at any given moment, really.

Oftentimes, the relationship anxiety is not necessarily caused by anything in the relationship itself (though it certainly can lead to behaviors that negatively affect your relationship). Relationship anxiety may be caused by negative experiences in previous relationships, low self-esteem, and the attachment style you developed during childhood. 

The good news is, if you are experiencing relationship anxiety, there are some simple things you can do to choose your relationship over your anxiety: 

  1. Do not pull away. An overarching theme I have seen in research and in my clients is that when you are feeling relationship anxiety, you will be inclined to pull away from your partner. You distance yourself for fear of appearing weak, overly sensitive, or a myriad of other untrue perceptions. Though it is in self-preservation, this step often damages your relationship. Do not pull away!
  2. Connect with your partner. Instead of physically and emotionally closing yourself off to your partner, work to draw closer to him/her. Connect with your partner in ways meaningful to your specific relationship; spend time one-on-one together, go on a date, do a fun activity, be intimate…whatever it is, connect with your partner. Also, be up front about the relationship anxieties you are experiencing. Express your feelings and emotions, and describe what you are going through. Being honest and open about your anxieties can quiet your fears/worries about your relationship, and will bring you closer together. This type of vulnerability inevitably leads to meaningful connection, which breeds relationship security and satisfaction. 
  3. Express your feelings. use your words…express yourself! Relationship anxiety comes from within and often has nothing to do with your partner; if, however, something specific is fueling your anxiety (ie: your partner playing on their phone when you talk or not wanting to visit your family for the holidays) try bringing it up in a respective and non-accusatory way. Use “I” statements. Through their research, Kashdan et al. found that relationship closeness is enhanced when negative emotions are openly expressed. Though you might initially think the contrary, expressing your feelings can actually lessen your anxiety and help you connect with your partner!
  4. Keep your self-esteem tank full. As I said earlier, oftentimes relationship anxiety sprouts from a lack of self-esteem. Remember that your partner likes YOU for who you are. Work to maintain your identity instead of being who you think your partner wants you to be. Be true to yourself! Practicing self-care and mindfulness help immensely with the constant effort of keeping your self-esteem tank full. See the plethora of self-care posts on my blog for more ideas on how to do this! 

In addition to the above ideas, counsel with a therapist. In therapy, you learn tools that will help you express your feelings, stay true to yourself, and connect in meaningful ways with those you love. As a trained, experienced therapist, I see individuals and couples battling relationship anxiety fairly often. I am here to help. Please contact me today to get started!  

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Sources:

Cluff, Melissa:  “Choosing the Right Therapist for You”; “The Key to Slowing Down in a Fast-Paced World”; “Love Languages: Showing Love Through the Gift of Quality Time”; “The Power Behind Vulnerability”; “Self-care: Is it Selfish?”; “Self-Esteem & Self-Worth: Two essential Components of the Self”

Kashdan, Todd B.; Volkmann, Jeffrey R.; Breen, William B.; Han, Susan (2007). Social anxiety and romantic relationships: The costs and benefits of negative emotion expression are context-dependent. Journal of Anxiety Disorders: 21(4), 475-492. https://doi.org/10.1016/j.janxdis.2006.08.007.

Murray, S. L., Holmes, J. G., MacDonald, G., & Ellsworth, P. C. (1998). Through the looking glass darkly? When self-doubts turn into relationship insecurities. Journal of Personality and Social Psychology, 75(6), 1459–1480. https://doi.org/10.1037/0022-3514.75.6.1459

Porter, Eliora & Chambless, Dianne L (2013). Shying Away From a Good Thing: Social Anxiety in Romantic Relationships. Journal of Clinical Psychology 70(6), 546-561). https://doi.org/10.1002/jclp.22048

Practical Principles for the Practically Perfect

OCD

Anxiety manifests itself in many forms. Phobias, social anxiety, panic disorder, and even obsessive compulsive disorder (OCD) are commonly categorized under the umbrella of anxiety. There is, however, another emerging diagnostic disorder with which I have personally become familiar with in recent years: perfectionism. 

Perfectionism plays a major role in a variety of psychological disorders. Despite an abundance of research, there is still no concrete definition of what it is. Perfectionism can be characterized by excessive concern over making mistakes, high personal standards, the perception of high parental/employer expectations, doubting quality of one’s actions, and a preference for order and organization. From afar, it may not seem so harmful, but it can interfere with routines, everyday interactions, and emotional regulation. 

I didn’t recognize the severity of perfectionism that I experienced until my junior year of college. I sat in a lecture focused on the difference between being outcome-oriented and task-oriented. The professor explained that outcome-oriented people feel the need to seek approval from others. They are in constant need of validation and often set extreme goals that are not achievable. Task oriented people were those who live in the present, set realistic goals, and do not rely on the approval of others for their success. As I considered these opposing mindsets, it was apparent that I resembled the first; I panicked at the thought of future failure, set practically impossible goals for myself, and sought success from the approval of others. 

What then, is the relationship between an outcome-oriented mindset and perfectionism? Outcome-oriented individuals spend little time living in the present. Instead, they are focused on future outcomes or past failures. Performance psychologist Craig Manning teaches that anxiety comes from living in the future. When our thoughts are constantly centered on future events where we are expected to perform, our anxiety spikes. It turns out that agonizing over the past doesn’t help much either. As we set our focus on past failures or mistakes, our confidence in our ability to perform in the future decreases, again leading to high anxiety levels pointed toward future performance. 

Although perfectionism isn’t notably linked with the outcome-oriented mindset in psychological literature, the connection that I drew between the two was the spark that ignited my path towards empowerment. While my tendencies toward perfectionist symptoms are deeply rooted in past experiences, there is so much that I, and others who experience perfectionism, can do right now to lower the anxious feelings and constant stress. 

First, we can work on setting realistic expectations. Growing up, I relied on the expectations of others to guide the expectations I held for myself. This is normal as we are learning and growing, but eventually, we should begin to set our own expectations and determinants for success. Setting realistic expectations requires that we consider our strengths and limitations. In recognizing what we can do, we also acknowledge room for error, improvement, and learning. People who experience high volumes of perfectionism often perceive that others have extreme goals and expectations for their behavior. Setting our own expectations draws attention away from others’ expectations for us and towards the expectations we set for ourselves. Although difficult, learning to set realistic expectations allows us to worry less about others and spend more time living in the present. 

Another tool we can use to calm anxious perfectionism is proactive self talk. Proactive self talk is a popular practice in performance psychology. It includes using proactive language, recognizing skills, and being aware of our thought patterns. Many athletes and teams use proactive self talk to improve sports performance, but its effects extend past the arena or stadium. Proactive self talk has actually been proven to lower levels of anxiety when performing under pressure. For perfectionists, proactive self talk becomes a tool that instills confidence in concrete skills and actions that enhance their performance. The fear of inability shifts to a confidence in individual ability. 

These practices are just a couple of methods that can lower the anxieties that accompany perfectionism. Personally, I have been empowered through a balance of professional therapy, diet and exercise, and research-informed practices. Don’t be afraid to reach out to a professional for assistance; they have resources and training that can link you with the help you need! 

Although my struggle with perfectionism hasn’t been easy, I have learned more compassion– both for myself, and for others. I have learned that it is empowering to speak out about my experiences and encourage others to share theirs. Most importantly, I have learned that there is help and there is hope for everyone experiencing mental illness. 

Lydia Judd is a senior at Brigham Young University studying psychology. She lives in Dallas, TX with her husband where she works as an RBT at Blue Sprig Pediatrics.  

Frost, R.O., Marten, P., Lahart, C. et al. Cogn Ther Res (1990) 14: 449. https://doi.org/10.1007/BF01172967

Hatzigeorgiadis, A., Zourbanos, N., Mpoumpaki, S., & Theodorakis, Y. (2009). Mechanisms underlying the self-talk–performance relationship: The effects of motivational self-talk on self-confidence and anxiety. Psychology of Sport and exercise, 10(1), 186-192

Hewitt, P. L., & Flett, G. L. (1996). The multidimensional perfectionism scale. Toronto: Multi-Health Systems Inc.

Manning, C. (2017). The fearless mind: 5 essential steps to higher performance. Springville, UT: CFI.

Q&A: Is My Anxiety Curable?

“Keep your face to the sunshine and you cannot see the shadow.” ~ Helen Keller

Everyone feels worried from time to time. You may worry about a presentation you have to do in school or work; or perhaps you worry about your spouse on a work trip, or your child away from home for the first time. Feeling worried is a normal emotion. Feeling anxious, however, is different. Maybe you have experienced both sentiments, but presumed them to be synonymous? Join the club. These two terms are often used interchangeably in casual conversation, but, in reality, they are quite different. Read on to learn the fundamental differences between worry and anxiety, if anxiety is a curable or not, and four everyday tools anyone can use to manage anxiety.

How are worry and anxiety different?

In a study where 189 university students were asked about the differences between anxiety and worry, worry and anxiety were defined very similarly. However, certain negative outcomes–like depression and confusion–were more related to anxiety than to worry, and problem solving was more related to worry than to anxiety. Other key differences include the following:

Worry…

Is experienced in the head. 

Is specific

Does not provoke mental imagery elicit a cardiovascular response.

Is accompanied by problem solving. 

Creates mild emotional distress. 

Is caused by a specific concern.

Is often controllable. 

Is temporary. 

Does not impact one’s overall functioning. 

Is considered to be a normal/common emotional state. 

Anxiety…

Is manifest in the body.
Is vague or general.

Provokes mental imagery and elicits a cardiovascular response.

Is not accompanied with problem solving.

Creates severe emotional distress. 

Is a non-specific, broad fear.

Is difficult to control. 

Lingers. 

Does impact one’s overall functioning. 

Is not a normal/common emotional state.

Are you beginning to see the difference between being worried and experiencing anxiety? Though there is some overlap, the two emotions are actually quite different. If I could add one more, it would be that being worried occasionally usually does not lead one to see a therapist, whereas therapy can be very helpful with prolonged anxiety.

Is anxiety a life sentence? NO!

I always tell my clients, who are battling anxiety, that what they are facing is not a life sentence! While you may feel seriously burdened by your anxiety at present, you do not need to be controlled by it. The goal of therapy is not to get rid of everything that may be causing you anxiety, but rather to give you the tools to face your anxiety and to learn from it. 

Four things you can do TODAY to get relief from your anxiety:

  1. A deep relaxation technique. There are several options for this tool. I would recommend muscle relaxation, visualization, or meditation to start. Force yourself to slow down, take deep breaths, relax, and release some of the tension you are feeling. Here are some helpful apps: Calm; Stop, Breathe & Think; UCLA Mindful.
  2. 30 minutes of vigorous exercise. This suggestion may seem obvious as regular exercise is recommended to achieve optimal health. Exercising is an amazing tool in combating worry and anxiety. Exercising releases a feel-good hormone in the brain and nervous system that positively affects you physiologically–naturally combating worry and anxiety. Additionally, vigorous exercise during the day will lead to better sleep at night which has many benefits. There is great power found in exercising!
  3. Good nutritional habits. Similar to exercise, having a balanced diet will benefit you in many aspects of your life. When you fuel your body with a well-rounded diet to sustain yourself throughout the day, your overall health with be positively influenced. You will have more energy to deal with life’s stressors, you will be less likely to fall sick, and you will be able to think more clearly. All of these outcomes will aid you in the process of rising above worry and anxiety.
  4. Replacing negative self-talk with positive affirmations to counter mistaken beliefs. Self-care is a major focus with my clients, and one form of that is positive self-talk or affirmations. You are your own worst critic. When you change your self-talk from negative and degrading to supportive and loving, you will break negative patterns to see life (and yourself!) through a different lens. This is a major step in working through anxiety.

Your anxiety does not have to be a life sentence. Seek out an experienced, qualified therapist. Develop a daily practice of deep breathing/mindfulness, get up and move your body for 30 minutes a day, eat a colorful and balanced diet, and speak kindly to yourself. Implementing these four tools in tandem will yield astronomical results in combating anxiety. Let’s get started today!

References:


What to Expect When You Are Expecting…To Start Therapy

Starting Therapy

“Psychotherapy can be one of the greatest and most rewarding adventures, it can bring with it the deepest feelings of personal worth, of purpose and richness in living.” ~ Eda Leshan

In 2018, 56.7% of U.S. adults with a mental illness did not receive treatment. Maybe you are thinking about seeing a therapist…but you have no idea what to expect, or where to start. You may wonder what happens during sessions, how long will you be in therapy, how you will know that you are done in therapy, or a million other questions. These are common and completely valid concerns, and my goal in this post is to cover that basic information so you will know what to expect when you are expecting…to see a therapist.

What to expect before you start. 

Before going to therapy, it is important to identify the areas in your life that need help and healing. Consider whether it is an individual or relational issue. This step is huge because it requires humility and courage to admit that you need help and to be vulnerable. The next step is finding the right therapist for you. Brainstorm what qualities (such as experience or personal characteristics) are important to you in a therapist; not everyone is looking for the same thing when starting therapy. For example, researchers Susan Hardin and Barbara Yanico asked men and women what they looked for in a potential therapist and found differences in genders: Men tended to want an efficient counseling process, for the therapist to be directive and self-disclosing; while women have higher expectations for the therapist to be open, accepting, genuine, attractive, and trustworthy. Regardless of gender, these researchers found that prospective clients expect empathy, expertness, and concreteness from an experienced therapist, and a positive outcome. What are you looking for?

What to expect when choosing a therapist.

Once you have found a potential therapist, you may experience trepidation about meeting and disclosing your private struggles to this stranger. To help the matter, I urge you to familiarize yourself with the therapist(s) you are considering. Here are three helpful suggestions:

  1. Look at their google listing and familiarize yourself with their website. For example, on Cluff Counseling’s page, I have a section entitled “About Me” where you will find information about me like my hobbies, interests, educational experience and training. I also have a “Frequently Asked Questions” section that will give you insight to my structure and style as a therapist. 
  2. Do not be afraid to ask for a phone consultation before setting your first appointment.
  3. Ask your questions! Create 3-4 questions you would like to ask each of the potential therapists that you are considering. Common questions I hear are: Do I take insurance? How much is each session? Does it cost more for couple sessions? Do I have experience treating ______? Do I have a sliding fee scale? What is my cancellation policy? Do I do couple therapy if that is needed down the road? How long is each session? What do you need to bring to the first session? 

Remember, you are the client and so it is important that the therapist is a good fit for you. If the first one you talk to, or meet with, does not feel right, reach out to the next one on your list. 

What to expect when you start.

Many people are curious about the frequency of sessions, as well as what typically happens during a session. I schedule one 50-minute session a week–unless a client requests to meet more or less frequently, or needs longer sessions.  In the initial session, I always ask why the person decided to start therapy now, rather than a few weeks ago, or months down the road. The response to this question helps shed some light on the process the process went through to get to my office.  

Next, I begin to gather some history on the problem. If I am seeing a couple, I may ask how they met, what attracted them to each other, the highlights and lowlights of their relationship history. If I am meeting with an individual, I may ask how long the problem has been present, what they have tried, what has given them some relief, and who is in their support system. I spend the first several sessions gathering more information and helping the person feel comfortable with me. 

Lastly, I ask how they would know that therapy can help them. Their response helps me understand what they specifically want to address during our sessions together, and orients me to establish measurable goals for the client. I do not want a client to feel they are committing the rest of their life to therapy; setting goals ascertains that there will be an end to therapy!

What to expect during regular sessions.

Once the initial phase of information gathering is complete, we will get to work on meeting the goals. Often, I will give homework assignments to be completed between sessions that will support the work we are doing in session. We will work on coping skills and tools that can be practiced and applied to any unhealthy patterns in the client’s life. Areas where trauma work is needed are identified and a plan is created to do that work. Goals are continually assessed to  make sure they still fit the needs of the client. I remind my clients that the time spent with me is theirs and I invite their feedback; I do not want my clients to ever feel they have wasted their time in a session. Please do not hesitate to speak up to your therapist if your needs are not getting met!

What to expect when therapy is nearing an end.

One of the ways I know a client is close to graduating therapy is when a client or I suggest less frequent sessions. This speaks volumes about the progress and signifies they are feeling more grounded, are reaching their therapy goals, have established a support system outside of therapy, and are ready to put what they have learned into practice on their own. I find great joy when my clients no longer need my help…my goal is to work myself out of the job! My door is and will forever be open to my clients should they need a tune-up. My final question for clients, during their last session, is how they will know if/when they need to come back to see me. The message I want them to hear is that I believe in them and that coming back to me is always an option. 

If you have been considering getting into therapy, I highly recommend you to do so now.  If you are ready to schedule a session but feel nervous, remember that it is completely normal to feel a little anxious about starting something new! It is the therapist’s job to create a safe, comfortable counseling environment where you can begin to address your individual or relational worries. If you think you may need medication, a therapist can refer you to a psychiatrist, and together the therapist and psychiatrist can address your concerns. 

I love my job. You will find the best version of yourself as you shed the weight of trauma or addiction and work through any relational issues you are facing. I am here for you! Please contact me today to get started!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

References:

Keeping the Holiday Cheer All Year Long

“Christmas is not a time nor a season, but a state of mind. To cherish peace and goodwill, to be plenteous in mercy, is to have the real spirit of Christmas.” -Calvin Coolidge

I have a friend who gets truly depressed when Christmas is over. On December 26th he is like a deflated little boy confronted with the fact that Santa will be at the North Pole for the next 364 days. I understand that the end of the holidays can leave us in a slump; we all experience it to some degree! The anticipation of the jolly occasions can leave us feeling a little blue when it has all passed. 

There are certain things we can do, however, to keep the Christmas cheer throughout each year. Might I make four suggestions for how we can do so:

  1. Create a photo book. Looking at photographs can remind us of happy times from the past, and can be a great way to make ourselves happy in the present. There are so many online hosts that make uploading photos to create a photobook relatively easy, affordable and painless. Such a photo book can be a priceless treasure that will bring you great joy and happiness all of 2020!
  2. Keep celebrating. Part of the magic of Christmas is traditions. Family traditions bind families together. You spend time together, create memories, enjoy each other’s company, and strengthen your bonds. In a recent interview with CBS, Gretchen Rubin (author of The Happiness Project) recommends starting new traditions throughout the year–like the first day of spring, Groundhog Day, or this year we even have Leap Day! Find little milestones throughout the year and celebrate those with unifying traditions. You do not need the holidays in order to participate in traditions!
  3. Serve others.  One reason the Christmas season is so remarkable is because there is a natural tug to look outwards and serve others. There are food drives, clothing donations, fundraisers, Sub-for-Santas, treat deliveries, white elephant parties, gift exchanges, opportunities to volunteer and so much more. This service fill us with joy and peace; we would benefit greatly if this spirit of service carried over into the other eleven months of the year!
  4. Be a peacemaker. The holidays come with gatherings, which can lead to disagreement and discord. You may have had opportunities to be a mediator or a peacemaker this holiday season, and I urge you to continue in that pattern. If there is gossiping going on with your friends, do not take part. If there is complaining at work, point out the good. If the driver next to you has road rage, do not match it. Be a peacemaker. It will make your life and the lives of those around you infinitely better. 

I urge you to make the most out of this holiday season. Be present for your family gatherings. Pay more attention to people rather than things (or tasks). Savor the good food and the good times. And when it is all said and done, carry that happy Christmas spirit over into January-November of 2020 by revisiting photos, creating new traditions, serving others, and being a peacemaker. Doing this will be the best present you can give yourself. 

Happy holidays to you and yours! 

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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The Link Between Mood Disorders and Addiction

About 20% of Americans with an anxiety or other mood disorder (like depression) also have an alcohol or other substance use disorder.

Do you get anxious when you have to speak in front of an audience, take a test, or talk with a superior? Or maybe when you are facing debt, in an argument with someone you care about or at the precipice of a potentially life-altering decision? Every human being faces experiences that cause anxiety, but some feel it more than others. Research indicates that there is a genetic predisposition to anxiety; some of our nervous systems are more prone to anxiety than others. According to the National Institute of Mental Health, nearly 40 million people in the United States have suffered from some kind of anxiety disorder, including panic attacks and phobias. When you face anxiety, how will you handle it?

(Note: While this blog post focuses primarily on the link between anxiety and addiction, I have witnessed, with my clients, that this information can be generalized to other mood disorders as well.)

Individuals who come from unstable families and lack secure attachment often experience generalized anxiety; they may turn to drugs to calm themselves down. Many teens begin to abuse alcohol in their adolescence; it is their way of managing social anxiety.  A friend of mine abused prescription medications after her brother’s suicide; it was her way of muting her overwhelming feelings of loss. Many addicts relapse; it is their way to escape reality. Several of my clients suffering from post-traumatic stress disorder (PTSD) experience major anxiety; they have a difficult time regulating their nervous system responses and often turn to addictive substances for comfort.  Some people, however, face anxiety head on with exercise, self-care, hobbies, a balanced diet, etc. While everyone experiences some form of anxiety or a mood disorder (like depression) during their lives, only some individuals combat their anxiety with addictive substances.

The question begging to be asked is–does a mood disorder like  anxiety or depression cause addiction? No. So is there a link between anxiety and addiction? That answer is a resounding yes. Can it lead to it? Absolutely.

Anxiety consists of the excessive need for control; ignoring psychological and physical signs of stress; the unending need for approval; perfectionism; and strong reactions within the body and mind. The physical and psychological symptoms of anxiety are similar to withdrawal symptoms from drugs and alcohol. An addict will turn to substances, or other addictive behaviors to calm an anxious state. The avoidance of uncomfortable physical agitation and painful emotions are some of the key components that maintain the connection between addiction and anxiety. Both anxiety and addiction strengthen as the addictive behavior continues. Substance abuse can mask anxious feelings preventing the addict from receiving proper treatment for anxiety.

People who experience anxious moments, but who do not have anxiety disorders, will be able to go about their day when the crisis passes; people with anxiety disorders cannot stop the effects of their anxiety disrupting their everyday life. Professional, social, familial, and academic obligations will be interrupted and damaged by the sense of panic, stress, and foreboding that comes as a part of the condition. Social anxiety disorder frequently “travels in the company” of alcohol or drug abuse, as people with social anxiety disorder might try to make use of alcohol or cocaine to help make them feel more comfortable and less inhibited in social settings.

For individuals struggling with anxiety, substances offer an escape. For others, substances bring a feeling of relative normalcy (self-medication). For some, anxiety is a factor of their personality that also includes aspects like impulsivity that make the anxious person more likely to use substances.  Although not entirely understood, there is a connection between anxiety disorders and substance abuse. About 20% of those with an alcohol or substance use disorder also have an anxiety or mood disorder. In fact, many of my clients with an addiction (mostly sex addiction) are self-medicating their anxiety and depression with their addiction! It is also important to note that addiction can happen without any substances; you can be addicted to an eating disorder, gaming, sex, exercise, etc. The point is that mood disorders can either reinforce or be reinforced by addictive substances.

Treating substance abuse without treating the anxiety that causes it is a fruitless endeavor. 

Treating substance abuse without treating the co-occurring disorder can lead to higher rates of relapse. Due to the similarity of drug and alcohol withdrawal symptoms and anxiety symptoms, both need to be treated at the same time. The treatment for anxiety and addiction is referred to as dual diagnosis and it is important to find an addiction treatment facility, or a therapist, that can address both the addiction and the anxiety.

It is only through therapy that clients can make tangible strides towards restoring a sense of balance and stable mental health to their lives. Simply walking away from treatment after detox is ineffective…and might even prove more harmful. Now is the time to address the symptoms of anxiety and addiction that feed off of each other and keep you in the self-defeating cycle. Allow me to help you break the dependence on the substance or behavior, you have used to manage your anxiety and distress, as well as provide sustainable ways to cope with your mood disorder. Happiness is possible. Healing is possible. Contact me today to get started.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.


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Bulimia Nervosa at a Glance

“For me, the bulimia was about stuffing my emotions. So I stopped suppressing my feelings.” ~Cheryl James

My friend’s dad is a dentist; within the first minute of looking into someone’s mouth, he can tell if the person struggles with bulimia nervosa. This is because bulimia–the binging and purging of food–wreaks havoc on a person’s teeth. The acid from the stomach visibly destroys the enamel of the teeth and causes noticeable discoloration. But this particular side-effect of bulimia is only the tip of the iceberg among much more serious consequences that come from this eating disorder and mental illness. Continue reading to learn what it is, what causes it, as well as the symptoms, consequences, and recovery options for bulimia nervosa. 

Even though Derek Zoolander downplays the significance of bulimia nervosa, it is a very serious, potentially life-threatening eating disorder. People with bulimia secretly binge and then purge to get rid of extra calories in an unhealthy and unnatural way. Binging includes discretely eating a large amount of food, within a small amount of time, accompanied by a lack of control during this episode. Purging methods vary from regularly self-induced vomiting, misusing laxatives, weight-loss supplements, diuretics or even enemas after bingeing. Other ways include denying calories to prevent weight gain through fasting, strict dieting or excessive exercise.  The severity of bulimia is determined by the number of times a week that a person purges, usually at least once a week for at least three months. 

The exact cause of bulimia is unknown. Many factors could play a role in the development of eating disorders, including genetics, biology, emotional health, societal expectations and other issues.  Women are more likely to struggle with bulimia than men, but the latter are still susceptible. Bulimia typically begins in the late teens or early adulthood.

Bulimia shares several symptoms with other mental illnesses: Negative self-esteem, problems with relationships and social functioning, difficulty concentrating, poor sleep patterns, withdrawal from friends, etc. Symptoms specific to bulimia nervosa include extreme preoccupation with self-image, body shape and weight; fear of gaining weight; feeling uncomfortable eating around others; trying to “fill up” by ingesting unsubstantial food (ie. condiments), drinking excessive amounts of water or non-caloric beverages, or trying to chew food for an unnecessarily long amount of time; hoarding food in strange places; disappearing after eating (often to purge in a private place); frequently using mints, mouthwash and gum to cover unnaturally bad breath; and maintaining a rigid exercise regimen to “burn off” calories ingested. 

Bulimia nervosa affects far more than how an individual perceives him- or herself or what he/she eats. This eating disorder truly harms a person’s body in the following ways:

  • Unusual swelling of the cheeks or jaw area  
  • Calluses on the back of the hands and knuckles from self-induced vomiting 
  • Bloating from fluid retention  
  • Stomach cramps and other gastrointestinal issues (constipation, acid reflux, etc.) 
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 
  • Dizziness 
  • Fainting/syncope 
  • Feeling cold all the time 
  • Dental problems like enamel erosion, cavities, and tooth sensitivity 
  • Dry skin 
  • Dry and brittle nails 
  • Swelling around salivary glands 
  • Thinning of hair on head, dry and brittle hair (lanugo) 
  • Muscle weakness 
  • Yellow skin (in context of eating large amounts of carrots) 
  • Cold, mottled hands and feet or swelling of feet 
  • Menstrual irregularities
  • Poor wound healing 
  • Impaired immune functioning
  • Dehydration (leading to kidney failure)
  • Heart problems, such as an irregular heartbeat or heart failure
  • Severe tooth decay and gum disease
  • Absent or irregular periods in females
  • Digestive problems
  • Anxiety, depression, personality disorders or bipolar disorder
  • Fertility issues (in women)

Many people with bulimia nervosa also struggle with co-occurring conditions, such as self-injury (cutting and other forms of self-harm without suicidal intention), substance abuse, impulsivity (risky sexual behaviors, shoplifting, etc.), and even diabulimia (intentional misuse of insulin for type 1 diabetes). 

While bulimia nervosa is a very serious mental illness, the good news is that it is not a life sentence. There are many options available for treatment, including medication, support groups and group therapy, and individual therapy. By identifying your triggers, I can help you manage stress and avoid the cycle of binging and purging. Getting support and help often gives you extra strength to fight your eating disorder.  Because bulimia is related to self-image–and not just about food–bulimia can be hard to overcome on your own. Effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications. Contact me today to get started.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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When Self-Regulation Seems Near-Impossible: Borderline Personality Disorder

Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, but are commonly misdiagnosed with PTSD or depression. 

We all have mood swings, and some are more intense than others. As a therapist, I teach my clients how to self-regulate, or soothe, when a strong emotion washes over them; I have to practice those same techniques when I feel an especially heavy emotion. Although many of us are able to regulate our thoughts and emotions with practice, others struggle with it. The diagnosis of Borderline Personality Disorder may shed light for those struggling in this area. My wish is that by introducing this disorder, I may bring hope to those who want to understand and correct the cycles they find themselves stuck in.

Borderline Personality Disorder (BPD) is a condition characterized by difficulty regulating emotions. People who experience BPD feel intense emotions for extended periods of time, which makes it difficult to return to a stable baseline. Ordinarily, people can tolerate the ambivalence of experiencing two contradictory states at one time. People with BPD, however, feel emotions so strongly that they cannot see past whatever they are currently feeling. If they are in a bad state, for example, they have no awareness of the good state. They view things in extremes–all good or all bad. This includes their opinions of other people; an individual who is seen as a good friend one day may be considered an enemy the next. This unpredictable pendulum of emotions affects how they see everything, including themselves and their role in the world, resulting in impulsivity, insecurity, changing interests and values, and self-image issues. Difficulties with self-regulation can also result in dangerous behaviors such as self-harm and suicidal thoughts and behaviors.  

Listed below are the symptoms of borderline personality disorder. While this list is fairly comprehensive, it is important to remember that not everyone with BPD experiences every symptom. Some individuals experience only a few symptoms, while others have many. And these symptoms can be triggered by seemingly ordinary events and then be otherwise dormant.

  • An intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
  • Unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate her”).
  • Distorted and unstable self-image.
  • Risky and impulsive behaviors (excessive spending, unsafe sex, substance abuse or reckless driving).
  • Self-harming behavior (including suicidal threats or attempts, often in response to fear of separation or rejection).
  • Long periods of intense depressed mood, irritability or anxiety.
  • Chronic feelings of boredom or emptiness.
  • Dissociative feelings—disconnecting from your thoughts or sense of identity or “out of body” type of feelings (severe cases of stress can also lead to brief psychotic episodes).
  • Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety
  • Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights

The causes of BPD are not entirely understood, though scientists believe that this disorder is caused by a combination of factors. First, genetics: although no specific gene has yet been directly linked to this disorder, research has found that people who have a close family member with BPD are at higher risk of developing the disorder themselves.  Secondly, environmental factors like abuse or parental separation from a parent during childhood. Third, the neurological makeup is different in individuals with BPD than those without–particularly the parts of the brain which control emotions and decision making. This disorder commonly makes itself manifest by early adulthood.

Borderline personality disorder does not have to dictate your quality of life. Only 20% of the most serious cases necessitate psychiatric hospitalization and the vast majority of those stabilize and lead productive lives after their hospitalization. Please do not get discouraged if you have been diagnosed with BPD; you can learn to live a satisfying life with rewarding relationships. Help is available. Recovery options include therapy, medications, and group, peer and family support. The ultimate goal is for a person with BPD to self-direct their own treatment plan and to learn to regulate their emotions. Contact me to today to get started on the road to healing and recovery.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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