My name is Ryan, but I go by Dr_Mick in online spaces. I'm a marriage and family therapist in the state of Illinois in the United States. I have a PhD in human development and a MS in marriage and family therapy. I am also an approved supervisor and a clinical lecturer of psychology at a local university.

My clinical specialty includes working with all types of anxiety, with couples, and with clients who play video games. I also write academically about video gaming's impact on individuals and relationships.

I'm passionate about de-stigmatizing therapy, and about challenging assumptions about therapists. Therapists should be approachable and relatable - after all, we are people too!

Feel free to ask me anything about therapy, finding resources, mental health, video gaming, or whatever else is on your mind! The views expressed in this AmA are my own and do not represent anything other than my own experience.

Proof: https://imgur.com/zMG9364

Relatedly - I recently combined my love of video games with my desire to help people find a starting point for accessing mental health resources and support by hosting a Twitch channel titled [Game] Sessions with a Therapist. Though I cannot ethically provide therapy services on my stream channel, I can (and do) answer general questions, provide general guidance, help find resources, as well as talk about all sorts of things from anxiety to depression to relationship health and more. My goal is to build a community where people can feel supported by me and other viewers, and where they can chat in a space that's more accessible and relatable.

I stream nightly at 11:30pm CDT but also at other random times during the week if I get the time. If you've ever wanted the opportunity to talk to a therapist in a more casual environment, stop by - I'd love to chat with you!

Twitch channel: twitch.tv/dr_mick

Twitter: @drmick7

edit: WOW. This blew up and I am SO grateful that so many are open to talking about this. I'm doing my best to answer questions as fast as I can! Stop by the stream - I'm live right now answering questions verbally as well!

edit 2: this has been absolutely incredible. Seriously. I want to get to every single one of you but you would not believe how swamped my inbox is! be patient with me please! And if you'd like to ask me directly, stop by the stream this evening and every evening at 11:30pm central time! This thread proves that mental health is worth talking about, that it matters, and that having a community and open forum for it is desired and needed!!!

A final edit: as you can imagine, my inbox is still swamped. It'll take forever for me to respond to each message, so I am going to make this edit to answer a few common-thread questions I've received:

  1. How do I find a therapist?: Referrals from friends and family or people you trust are a great start. If those are not available I suggest a resource such as psychologytoday.com, which can help you narrow your search. If you are looking for affordable counseling, check if there are any nearby universities with sliding scale clinics where you could see a student (btw, there's some preliminary research that suggests there is little variance in outcomes from working with students versus seasoned clinicians). Sliding scale, for those who do not know, is when a therapist adjust their fee based on your gross or net income. Some therapists keep a "pro bono" or sliding scale case on their caseload, so it never hurts to ask. Also, many therapists are willing to set up brief, free consultations prior to treatment to see if it will be a good fit on both ends.
  2. How do I get over [x] or handle my [x]? This is obviously a case-by-case basis. If you do not currently see a therapist, I would encourage you to seek one out who can properly assess and work with you/tailor therapy to fit your needs. There is no one-size-fits-all treatment for anxiety, depression, etc. It takes work, and can be a difficult, yet worthwhile journey that is made easier through the support of a mental health professional. There is NO shame in seeking out a therapist - it is a sign of strength, courage, and vulnerability.
  3. How do I convince [x] to go to therapy?: At the end of the day, unless you're a parent responsible for a minor, you cannot "force" a person into therapy. However, I encourage everyone experiencing this issue to take time to listen to the potential shame and vulnerability around the suggestion. Suggesting therapy to a person often brings these feelings up, and they are worthy of listening to. Be supportive, warm, and compassionate, and hear their concerns. That might invite a more effective conversation :)
  4. How do I know if my video gaming is a real problem? If you believe that it is, I encourage you to find a therapist who indicates that they have familiarity or interest in video gaming/ working with clients who play them. They can do a full assessment for something like Gaming Disorder. Quantity is not part of the criteria for a diagnosis such as that. If you're interested in reading more about my perspective, check out this Op-Ed I wrote for the Chicago Tribune: http://www.chicagotribune.com/news/opinion/commentary/ct-perspec-videogames-disorder-gamers-mental-health-world-health-organization-0629-story.html
  5. Am I doing this to promote my stream more than talk about mental health? No. My Twitch channel is the platform that I can share this information through, though. The response has showed me that it's a group of people who have been wanting the space. I'm truly thankful for all of my followers and subscribers, but it's something I would be doing anyway. I truly am passionate about helping people break down their barriers to seeking the help of a therapist. It's something every one of us could use, whether healthy, struggling, or having an experience anywhere in-between.
  6. How do I know which therapist is right for me? If you are seeking family or couple therapy (or poly therapy for the poly folks out there), a marriage/couple & family therapist is my recommendation. If you're interested in medication, seek out a reputable psychiatrist. You can also seek out social workers, clinical psychologists, or mental health counselors - they all exist to help!
  7. Where can I get a list of Dr. Mick's and others' writings about video gaming? I don't have my writings aggregated - however, if you join my Twitch channel's Discord channel, I have a thread with my writings as well as other mental health resources. It's also a wonderful community ripe with incredible discussions. Google Scholar is also an excellent resource - make sure you look at the impact factors of journals you find video game/mental health info in - the higher the number, the more reputable.
  8. How do I become a therapist? In the United States, graduate school is the way to go. Before determining which path, sit down and be honest with yourself about what modality (individual,couple,families) you are interested in working with, what kinds of issues (severe mental illness, psychosis, depression, anxiety, etc.) and in what contexts (agencies, private practice, schools, etc.) because that will dictate which mental health profession is right for you. If you go the MFT route, make sure you attend a COAMFTE-accredited school! There are also online options you can look into if you'd like to learn from home. And there is no age requirement, min or max - plenty of people change careers to become therapists!

Unfortunately, I cannot respond to inquiries for specific therapeutic advice or guidance, as I am bound by an ethical code and state licensure protocols. I will say, that based on the questions I've received, the need for more mental health care, de-stigmatization, and accessibility is totally necessary and will hopefully be welcomed in the coming months and years. De-stigmatizing therapy starts with all of us - if a person is struggling, be compassionate. Avoid playing into the notion that therapy is for the weak. It's for the strong. Many amazing therapists are out there ready and willing to help. And, if you don't feel a connection with your therapist, shop around! It should feel like the right fit.

I'm still working my way through my inbox, and will respond to those who I can over the coming days. If you'd like to ask me directly, join me and an amazingly supportive community at my stream - I'm on (pretty much) every night!

Thank you all for showing how much this matters. Let's keep the conversation going!!

Comments: 1386 • Responses: 48  • Date: 

makancheeze2377 karma

I find that gaming is the only time when im not anxious and can actually focus on one thing. What something i can do to apply this ti the rest of my life?

dr-mick2700 karma

I love this question because I frequently help people do this.

Take a look at what skills you're applying in video games, because they can directly translate somehow. Is it helpful to know that you have attainable goals? Perhaps you feel more at ease knowing that you have space to mess up/die? There's something calming about something being on your terms - in this case video games. They can be a wonderful reminder to persist through adversity and also that mistakes inevitably will happen, so there's no need to apply so much direct pressure on yourself.

Also - talk to people about this. Invite them into what video games mean for you and that they help with your experience. People you trust should be able to support you and help you find ways to translate it. A therapist who understands video gaming could do this as well!

Nai75557 karma

My 13 year daughter suffers with anxiety and depression, which sometimes results in self harming. I try and help her with find ways to “get out of her head” as I call it. She’s an amazing artist so I encourage this. However, am I just putting a bandaid on it and not really helping her out? She won’t go see anyone, says she’d rather just talk to me. I don’t want to force the issue for fear of creating more anxiety.

dr-mick936 karma

That makes a lot of sense - and I appreciate that you care so much about her and her anxiety. This is a common theme in my practice: let her know it's okay to be anxious. And when her anxiety tries to convince you otherwise, hang in there and be loving, warm, and supportive. Anxiety actually diminishes if you acknowledge it and have a good relationship with it rather than an oppositional one, so I would caution you way from coming at it with "go away, anxiety" as a response. More of a "hey - i see you're here - what are you wanting for me? How can I listen to you but also be boundaried about the way you are influencing my interactions?"

If it gets severe enough - I highly recommend therapy. Especially if you feel lost - she may not like it, but her safety is more important and she will thank you some day!

ferociousrickjames554 karma

Hi Dr Mick, my therapist passed away unexpectedly over the summer. I want to find someone new, but want to make sure I find the right fit. What is the best way to do this? Are there things I should be on the lookout for?

dr-mick604 karma

Shop around! It's like a primary care physician. If you don't gel with a therapist, move to the next one. There's no shame in it, and nobody says you have to stay with one once you find it.

I recommend asking friends and family if they've had good experiences to start. Then, check psychologytoday.com and narrow your search down to the issues you'd like to talk about. Read the profiles and see who speaks to you and give them a call! Trust your gut if it doesn't feel right - you're under no obligation to continue with somebody that doesnt make you feel safe/heard

Rectorol335 karma

My SO and I play video games or D&D as our main hobby and have for the 8 years of our relationship. While we do go to family gatherings and a few parties a year we tend to not stay long as neither of us enjoy engaging in social activites in large groups.

However sitting down at a table with a few people and playing D&D or gaming for hours is fine and we have a great time when we aren't at work or doing the necessary things in life (eating, sleeping, exercising, medical stuff, etc)

Our parents accuse us of wasting our time but we enjoy spending this time with each other and a few close friends. What's your go to response of gaming in general being a waste of time?

dr-mick354 karma

I obviously think it is NOT a waste! If you love it, and it's a shared experience with you and your SO - more power to you :)

Too-Much-Good257 karma

Extreme anxiety can be completely paralyzing for some people. As someone who knows people with anxiety is there anything you can do to help someone else through an anxiety attack?

I know I can make them worse, but can I also make it easier?

Also how unhealthy are video games for children?

dr-mick430 karma

Awesome questions!

Yes - you can help. The most important thing, above anything else, is to reassure the person that it is OKAY to be anxious. We don't get to decide our feelings - they happen. They tell us something. Anxiety is actually a highly protective emotion and it's there for a reason. So, hang in there with the person - encourage them to hang in there too. Anxiety becomes far less of an overwhelming emotion if you have a good relationship with it rather than an oppositional one. In fact, avoiding anxiety or trying to stuff it makes it worse over time.

And that question is hugely dependent on context. In my experience, video games are more harmful if parents or guardians don't take the time to discuss them and monitor what their children are doing, both in game and online.

dr-mick291 karma

Additonally - if the person is having a full-on panic attack, grounding is the way to go. Touch them (if that's okay) and direct their focus either to you or to something tangible. Be soft, warm, and reassuring and whatever you do, do NOT get angry at them or short. That makes it worse - panic attacks bring a lot of shame for people. Also don't reason with them - just be emotionally supportive until they calm down on their own :)

AaranPiercy224 karma

My girlfriend had a lot of issues with anxiety and depression over the years. I've always thought that if I could get her to play a game that she enjoys, it could really help her.

Do you have any advice for beginning the process? How can I help her over the first hurdle of finding the right game for her and trying it.

dr-mick271 karma

Awesome question - I agree that it could help!

BUT make sure you remember that video gaming is a skill, and that any time a person learns a new skill it induces anxiety. If she is already anxious, this will probably be even more pronounced. Hang in there with her - be patient, remind her that it's okay to be anxious. She'll get better! Video games are a fantastic way to fight through distress tolerance. Your love and support will go a long way - give it a shot!

dr-mick59 karma

Understand that it will probably be anxiety-inducing. Video gaming is a skill, and one that takes time to develop, so if she is already experiencing anxiety that will likely ramp up. So, the game itself doesn't matter so much as your support through that anxiety will. Be patient, be caring, and let her know it's okay to be anxious and that she is capable of figuring this out even if it makes her anxious. And make sure you don't put pressure on the games to be a "cure".

I absolutely agree that it could help - and i wish more people would look at it as an option! Good luck to you :)

just-a-koala183 karma

Any tips / mental exercise that you could recommend for immediate relief from anxiety / obsession of a thought?

Thanks so much in advance!! 🙏🏼

dr-mick380 karma

Remind yourself that it is OKAY to be anxious and that the anxiety is there for a reason (often protective). Remind yourself that you are capable of being productive and the person you want to be even if anxiety is around, and that a compassionate heart and mindset toward your anxiety will go a long way :)

totallynotsupahpie164 karma

I find it interesting that games that give me anxiety like X-COM are far more enjoyable than life giving me anxiety via unfortunate circumstances. Is it because video games present the player with inherently winnable (usually) scenarios? Or is it something else?

dr-mick240 karma

A big part of this is because you are making the choice to play a video game, so the anxiety is essentially at your own will. Real life anxiety, unfortunately, doesn't work that way (at least not often!).

There is also probably something to the idea that you are inherently able to challenge the anxiety or situation and come out on top - but that actually is a beautiful metaphor for handling anxiety in real life! You can do awesome things and be anxious at the SAME TIME, which is usually a foreign concept to people when i first make the suggestion.

DunsparceAndDiglett140 karma

How often do you experience the "Hi everybody! Hi Dr. Mick" Simspsons joke?

dr-mick155 karma

This is literally the first time, lol

Chtorrr128 karma

What was the most surprising thing you found in your research?

dr-mick278 karma

The wide variety of roles video gaming can play in people's lives without others knowing it. And how infrequently people talk about those roles and the deeper meaning people make out of video gaming. It truly is misunderstood by many who do not play video games!

saunterdog125 karma

I love video games! So does my 17-year-old brother, who is on the spectrum and completely addicted to them. He’s doing a little better, but how can my parents allow him to use video games as a good stress-reliving outlet while balancing a healthy lifestyle that includes less dependence upon his games?

dr-mick168 karma

Talk with him! Be involved! Take the time to understand why he likes the games and what role they play for him. My guess is there is a lot of engagement on levels that your parents or others might not readily recognize. If limiting gaming, people need to know what they are actually limiting rather than just quantity.

BestBakedPotato87 karma

My dad absolutely refuses to believe that therapy helps. Even though I'm living proof that it does, he thinks all the time I spent at therapy was wasted money and pointless. How do I get him to at least understand the upsides of therapy?

dr-mick83 karma

That can be a tough battle. I think, as much as you can, listen to the vulnerability behind those defensive meaning making systems. Therapy and the idea of it brings up a lot of shame for people...shame worth listening to. If you can do that, there may be a chance he will come around (at least to the idea - even if he may not go himself).

eclecticsed59 karma

I've seen arguments claiming that media like certain video games leads to greater stress, anxiety, and anger, and others saying the exact opposite - that these games provide a healthy outlet for emotions that might lead to such problems. I gather from your description that you probably lean toward the latter. But do you think there are certain games that provide a better release for stress and repressed emotion, and that some should be avoided? And finally, do multiplayer games show any appreciable difference in the effect, either positively or negatively?

dr-mick61 karma

So many good questions here.

  1. Yes, the opposing viewpoints are in large part because of a relatively small amount of literature about the issue. I really wish more people would do it. I think it depends largely on what a person is trying to get out of playing games and what role/purpose they are serving in the person's life. Also, if gameplay is left unchecked by parents of children, for example, it can run along a path that might not be so great.
  2. Yes, i fall toward the latter because i think most people don't take the time to really consider the role video games can play in a person's life. This is SO HUGE and cannot be understated.
  3. I think it depends on the person - i wouldnt say any game is better than another. It depends on what kind of fulfillment the person is seeking/getting and what kind of emotions and behaviors are being rewarded/punished
  4. It depends on the social engagements that happen in them - how does the person interact with strangers, what do they use the online space for, etc.

Dlinquent54 karma

My boyfriend uses video games constantly. He says he uses them to unwind after work as we both have stressful jobs, but I worry that the video games are taking over our relationship and causing conflicts and even more anxiety for him because he gets very emotional over them. Any tips for finding ways for him and I to de-stress together?

dr-mick74 karma

This is a wonderful question.

Talk. Communicate openly. And be supportive. Cliche, maybe, but this goes sooooooo far. The game is likely filling some sort of role, may even be deeper than you realize, so that's worth having out on the table. Ask how you can work as a team to handle what anxieties your relationship and you individually are facing, and of course, seek couples therapy with somebody you trust if you need it! There's no shame in it!

Spatula15154 karma

When you say video games, do you mean people who say they use it as a device to cope or people who go overboard and lose touch with reality? Being as busy as I am now, video games are one of my last hobbies I can pick up and go as I please all while decompressing for a bit. That being said, what demographic do you see most? Mid-20s men?

dr-mick127 karma

For video gamers, I see a lot of adolescents, but adults are sprinkled in there too. Mainly cismales. However, I do find that a lot of LGBTQA+ people use video games to explore identity and have a safe space to feel comfortable and explore interacting with the environment in a way that's closer to their truth. In fact, I'm in the midst of writing a paper about using video game characters as transitional objects when facilitating the coming out process!

g_jonsson44 karma

Hello! Thank you for making an effort to reach those that don't even know that they are in a risk group yet. Addiction to playing video games is very real but often overlooked as weakness of character or weakness of will or just laziness.

I myself struggled with coming to terms with my addiction. Even moderate doses of gaming can easily turn into all night runs that leaves me exhausted and barley functioning.

My number one factor in succeeding in staying away was when I became a father. My kids and family and work take up my whole life, and I let them. It's wonderful.

My 5yo is just getting into video games herself, she plays Minecraft and occasionally apps like Toca Kitchen or Lego games. I'm afraid that if I engage in playing to much with her I might slip into old habits and just keep playing.

Do you have any suggestions or strategies that I can apply to help myself avoid relapse? I don't want to limit her game time only because of my own history. She currently gets 1h of gaming after dinner and chores, before bed.

Thank you!

dr-mick48 karma

First of all - congrats on being a father and for working through your addiction! I'm glad they've been a wonderful addition in your life :)

Your willingness to monitor yourself and be open to the idea that you could "slip" is a huge strength. I would encourage you to seek a therapist out for support in that endeavor if you need it! And as far as her limiting her - it's your prerogative as a parent! I think healthy boundaries and consistency and your mindfulness of her wellbeing are all great!

darkstar188138 karma

Hey Ryan,

Education psych grad student and teacher here. In my recent experiences, I have found that many parents are teaching their children to be more egocentric, and less flexible and adaptable to environments. For example, we have parents who believe its their job to dictate to the teacher what their child will and will not do, and if their child has negative behaviors, the parents will quickly victimize their child. What are your thoughts on this?

dr-mick62 karma

I see this a lot. Parenting is so hard, and it's ripe with vulnerability. I think parents outsource the lack of control they feel into trying to control the environments their children are in such as school (this obviously doesn't apply to all parents - but I do see it frequently). This is a huge issue that is honestly difficult to grasp and address in a reddit comment, but I do think parents are often quick to avoid holding their children accountable because it doesn't feel good to do that - but from a behavioral standpoint it's necessary - as is consistency across contexts!

Ryanjl198537 karma

Is CBT still the most “cutting edge” /effective therapy for anxiety?

Can a person with anxiety really ever fully recover?

What’s the simplest advice you could give to help me stop being so damn anxious???

dr-mick54 karma

Yes - CBT is one of the empirically supported and overall tends to get positive feedback.

And depends on how you frame "recovery" - anxiety is a part of life! It's all what we tell ourselves and how we manage it and build a relationship with it.

Stop telling yourself you have to stop - build a more partnered relationship with your anxiety - understand why it's there (often protection) and remind yourself that you can set boundaries with it, but that anxiety is a part of life that all of us face. It gets louder when we try to avoid it!

ExertHaddock32 karma

What's your favorite video game?

dr-mick74 karma

Well, I do have a destiny tattoo, so I would probably have to say that.

But I also have an N7 tattoo - so Mass Effect is in there. Star Fox 64 too. And the Division! So many good games.

MuvHugginInc31 karma

What do you think about self-therapy?

dr-mick58 karma

I think we could all use an outside perspective - most therapists have a therapist of their own!

It's hard sometimes, we get wrapped up in our own stuff and we bias ourselves and put pressure on. I do think that finding outlets like video games can be helpful though!

kawaiian31 karma

Do therapists have a boss? Are there metrics that each therapist has to meet? How does your work grade you on your performance?

dr-mick60 karma

Ummmm not really. More of a practice owner. Depends on the practice in terms of metrics, but we make a living based off of how many clients we see a week. Honestly, insurance companies are more of a boss than anything - reimbursement rates and such are a pain to figure out and dictate a lot of times how much income we pull in.

I grade my performance on whether people keep coming and I frequently ask if therapy is working for them. People have the right (and absolutely should) bail on a therapist if they aren't meeting their needs and especially if they therapist isn't asking for or attending to feedback

SteppingOnAcorns28 karma

I cannot stop thinking and recently my conversations are running some what dry, I seem to have lost my confidence. I think almost constantly and it's effecting everything, my ability to take in information an even silly little things like playing games, I've started playing pretty poorly. My thoughts are getting scarily violent at times and I've been having suicidal thoughts so strong I actually see the image. What do I do and how can I stop this?

dr-mick25 karma

First of all - if you need to talk to somebody about suicidal ideation, the national suicide prevention hotline is available 24/7 if it becomes intrusive to the point where you may act, call 911 or go to the nearest emergency room.

I would encourage anyone experiencing this to seek out professional help - there is no shame in it! Psychologytoday.com is a great place to start.

Eblan8524 karma

I am suffering anxiety attacks all the time. They either paralyze me or make me walk around the house for an hour or so. I smoke weed to cool my nerves. I am currently going with a very good therapist and Ive seen progress. But weed always seems to work better than the meds Im given. Whats your take on this issue? Also my therapist is anti-cannabis so he wants me to quit smoking lol

dr-mick55 karma

I've heard this frequently. I'm glad to hear that something helps calm the anxiety - though in my experience, anxiety can actually build to be more intolerable over time if a person doesn't give themselves a chance to see that they can handle it without aid. Anxiety management is mostly distress tolerance, and people do much better with anxiety if they have a more amicable relationship to anxiety and show themselves that they can still be productive and be who they want to be even if anxiety is hanging around. I'm not anti meds by any means, but I do advocate for people hanging in there with how miserable anxiety can feel a bit longer than they might realize they are able to do to show themselves that it really isn't as horrible of an emotion as it seems - in fact, it's often a protector!

Phillybane20 karma

Hey Ryan, my life is constant stress (probably because i don't know how to act when another human being speaks to me)... I go home and immediately get on my Madden football game to go head to head with other players (instead of going to the gym or learning something useful with my time)... just recently I've learned that the first thing I do is go home and play video games because it gives me an opportunity to win... where in my real life I feel like I lose all the time. I like how I have to think of schemes to win a football game and how even though the players i have suck i can use them the right way and win.. I feel like a god when I do that. However..

I start yelling at people over the mic (often times even kids and I'm ashamed of it) but it helps me release my anger and frustration in my real life. A bunch of F*** Y**s and you suck! I'm tired of doing this. It seems like I can't stop either... I tell myself day after day I won't go home and play... aaaaaand I'm yelling at 12 yr olds again. Any advice for someone like me?

dr-mick14 karma

First of all, I appreciate your willingness to share - as you might expect, i would recommend seeking somebody out to talk to about this! Sometimes it feels safer to be angry at anonymous people in contexts we feel as if we have more control in. There are some strengths in the skills you identified that somebody could help you take advantage of outside of Madden. Your anxiety is worthy of validation - and believe it or not, we all have control over what we tell ourselves about it and what we do with it - a good relationship with it helps it be a healthier process!

CarterLawler19 karma

Hi, Dr. Mick!

I'm a guy who needs therapy. My hurdles are twofold. One, my wife is very much a 'man up' kind of personality whenever I am feeling down.

Two is that I'm so cynical (or broken, I don't really know) that I can't trust a therapist. They are there in a chair telling me what I want to hear because that's what puts the insurance money and copay in their pocket. Anything good anyone says to me is (in my mind) placating, and that includes someone who I'm paying to say those nice things.

Is there a way out of the catch 22 here?

icecop34 karma

Hey dude, as a therapist myself, no one is paying us to say nice things. And if that’s some therapist’s basic MO, they suck. We should help you recognize what you are doing well (that maybe you don’t realize), as well as help uncover what’s holding you back, flaws in your thinking, propose different options for behavior, etc etc. It’s meant to be challenging but eventually fulfilling. Positive reinforcement is an important part of the process, just like in training dogs lol.

If you really want to seek therapy and its benefits, just try to find someone with a good fit to your style. Therapists come in all sorts of personalities, not just the quiet, touchyfeely stereotype. Sorry for the ramble :)

dr-mick18 karma

^^This! Thanks for the assist icecop!

abbie_yoyo18 karma

Can we hear some examples of these therapeutic cliches and why you feel they are harmful?

dr-mick23 karma

That we only are out to collect insurance money - that we will only tell you what you want to hear - that we are these old people that sit in a room and analyze and judge you - that therapy has to be uncomfortable and push you past your limits in a way that isnt safe - that we are all trying to work on our own issues through others - etc.

Personally, I have a hard time with how formal the process can be - in the sense that a therapist wears a suit, assigns a bunch of academic reading, stuff like that. We are people too - people that care deeply and want to help you find what's best for you and facilitate that process.

Yes, there are some not-good therapists out there, for sure - but I love the idea of challenging the status quo about therapy, it's accessibility, and the overall environment it happens in

goofyphucker15 karma

What is your experience when it comes to dealing with social anxiety, and what methods of treatment have you found to be most successful? It seems like a very common mental health issue, which is becoming more and more prevalent, yet is widely overlooked or downplayed in some way.

dr-mick8 karma

Great question - social anxiety is a bit unique because the immersion and building of distress tolerance is a bit more difficult and has far more variable of an environment and potential reaction.

Exposure can help this a lot, but it needs to be scaffolded in a way that goes just ever so slightly beyond the person's pace. It's helpful to work on baby steps with types of social environments, and sometimes it's helpful to fixate on the "facts" and observable feedback that often suggests that you aren't in the spotlight in the way you might think, and that there's a lot of room for flexibility. I think of social anxiety as being the result of "too many options" as opposed to "not enough" in terms of how to interact with people. Start small and be willing to actually internalize feedback that suggests you're cool to be around. That's a general description but the best I can come up with without a specific case!

putkaaa13 karma

What's your thoughts on meditation as a treatment for anxiety and depression?

dr-mick20 karma

If that's your jam, go for it! There are therapists who are truly excellent at using this. There's no one-size-fits-all treatment for anxiety and depression, but i wholly advocate for acknowledgment and building a good relationship with it!

TalkingBackAgain11 karma

Hello Dr_Mick, you're doing great work helping people with anxiety and about that I had one question: seeing as you are into gaming, do you ever see a means for games, actual games, to have content that could act as a guide to people with anxiety [and other] disorders, such that they could use it to deal/cope with that experience?

Have you read 'Gateway' [1977, Frederick Pohl]?

dr-mick17 karma

That is a pipe dream of mine to advocate for using games to build distress tolerance. Video games provide a lovely platform to set goals, handle adversity, and fight through pressure - external and internal. I hope some day i can have big enough of a platform to build awareness toward this.

I have not - I'll check it out, though!

PanicPixieDreamGirl11 karma

These days I tend to wake up in the mornings with horrible, nauseating anxiety that almost paralyzes me and doesn't go away til the afternoon. I've had anxiety problems all my life. But how do I stop this one? :(

dr-mick13 karma

That's a super tough question for me to answer without knowing you or working with you as a client, but I will say that you might consider taking time to listen to it. The drive is often to make it go away, but that makes it worse over time. I know it might seem counter intuitive, but listen to what it wants for you, and the vulnerability behind it.

Xejicka11 karma

I saw an article saying that playing Tetris helps with anxiety. What are your thoughts on this?

dr-mick12 karma

It certainly can! Video games in general can help build distress tolerance - Tetris is no different.

superboyk10 karma

I feel anxious especially while playing games, I've been trying to game more but I just can't lately.

Is there a way that daily anxiety causes depression?

How is anxiety affected by long term abusive parents?

What about if there are negative association of games as waste of times and such for the parents

dr-mick9 karma

Yes, anxiety can be linked with depression if it is maintained in such a way by ourselves or by others as "not okay". that can feel very isolating and lonely and breed depressive symptoms. Among other things that are case-by-case.

Abuse brings along with it a lot of internalized messages that we carry. As kids, the only way to make sense of abuse is to be ego-centric. When we become adults, our brains develop to a place where we make meaning of that. It's hard to detach from those messages, which is why a therapist can be super helpful in figuring that out.

As far as the message about video games - spend some time asking yourself what your truth is - and live it even if it means you might go against the narrative of your parents! You don't have to carry that message if that message is invalidating to your experience.

MuramasaEdge10 karma

Hi doc, thanks for your time. Have you dealt with Avoidant Personality Disorder alot and if so, do you have any commonly successful advice for someone who is just about understanding what this is and how best to proceed with it?

Thanks for everything you do.

dr-mick9 karma

I do not have much experience with that, to be honest. I would recommend seeking a thearpist (if you havent already) that does have experience with it. The little I know of the disorder is that anxiety can be quite co-morbid with it. But, at the end of the day - there is NO shame in the diagnosis, especially if it helps you (or the person you're talking about) find the support and help they need and deserve :)

Lolztallestmidget9 karma

I feel that a lot of people want to be in therapy but struggle to know where to begin. Also, in the US there is the idea that therapy is extremely expensive and therefore not an option for people without healthcare. What steps would you suggest people take to find a therapist? What options would you give to people with limited income?

dr-mick8 karma

The very first thing i would suggest is to talk to friends and family to see if there is anybody they trust. Next, try a site like psychologytoday.com - you can filter to find exactly what you're looking for.

There also may be a sliding scale clinic in your area - especially if you are near a university with a counseling or MFT program. Google "sliding scale therapy" with the name of your area and see what comes up!

putkaaa9 karma

How much of anxiety and depression do you think is associated with nature and how much with nurture?

dr-mick15 karma

Hard for me to say in any way scientifically - but from my clinical and lived experience, nurture plays a MASSIVE role. They way we maintain anxiety for ourselves and others is often what allows it get to a place where it feels insurmountable. I can tell you that nurture is what often plays a role in managing anxiety and making it better though, for whatever that's worth!

Riothegod18 karma

I was recently diagnosed with ADHD-PI and i’m currently on 38 mg of Concerta. Since starting my culinary course however, i’ve noticed i’ve had a few panic attacks (hyperventilation, sense of impending doom, crying). I have no history of anxiety until now. Do stimulants cause anxiety, or have I just simply found myself in bad circumstances?

dr-mick13 karma

Stimulants can induce anxiety - I would make sure you talk to your therapist/psychiatrist/general practitioner to see if the way you are experiencing it is normal or if it might be worth a shift. They'll know how to address this with you!

meradorm8 karma

What are some good strategies to get over avoidance coping?

dr-mick9 karma

I would recommend finding a therapist who is trained in exposure therapy/CBT and would be willing to go at your pace with that/ also encourage you to slowly push past thresholds and build up distress tolerance!

SovereignPhobia7 karma

Do you have any hypotheses or posits about what has caused the increased frequency of anxiety/anxiousness as a mental health issue in contemporary society?

dr-mick9 karma

Social media is a huge part of this - I don't think anxiety gets enough representation in the media or in general. ALL of us have anxiety, but NONE of us are generally allowed to talk about it. We are told it's shameful or that if you're anxious you can't do great things - but that isn't true! I think it's because we've set an impossible standard and that gets reinforced over time. That's why I'm trying to do my part to break that down!

TheSoberCannibal6 karma

Life was all good until one day I got sick, then very sick. 4 years later I'm almost completely bed bound with a rare degenerative disease. I lost my job, my friends, my hope of raising a family, and all my then recreational activities. Video games are one of the few ways I have of maintaining a social life, and are absolutely the only sense of adventure or pride I ever get anymore.

Fairly often people will conduct polls in game related reddits asking if people are depressed and I hate it. It feels like all depressed gamers are lumped together with the conclusion inevitably being drawn that gaming causes depression. I'm not disputing that I'm depressed (now) but I want people to recognize that gaming is one of the very few positive things I have left and have HELPED me instead of harmed. I think, like therapy, gaming also gets a bad stigma in this way and I'm happy to see educated people like you u/dr-mick setting the record straight.

I wanted to ask, do you ever recommend video games to non-gamers who are seeing you as a therapist?

dr-mick6 karma

First of all - thank you for sharing. That sounds like an immensely difficult time and process. I'm also glad that gaming has been helpful for you, and I hope that if you have a therapist or are interested in finding one that they will see that as a strength and not suggest you shy away from it. Gaming absolutely has a bad stigma (so does therapy) so the combo can be a double-whammy.

Though I don't do it often, it's something I would absolutely consider. It never hurts to suggest or ask if they might be interested!

chichi-lover6 karma

I am interested in learning more about your upbringing/education career. I find myself with a passion for helping my IRL and gaming friends with anxiety. I have been juggling the idea of returning to schooling to grab a higher degree from my bachelors in arts. What did you go to school for and what did you do after schooling to get where you are today?

dr-mick5 karma

I got my bachelor of science in human services which laid a foundation then i went for a masters in marriage and family therapy which trained me to conduct therapy. After that, i decided i wanted to teach supervise and do research so i pursued a PhD. I encourage you to look into it! there are many careers available in mental health so pursue the one that speaks to you the most :)

To answer the last question - a LOT of networking and not being afraid to advocate for my interests and what I believe in. It helps when academia becomes soul crushing (it's difficult)


Hello and thank you for doing this. Do you have advice for someone who wants to begin treatment but is worried about being put on the wrong dosages/types of medicine (while looking for the right one) and the problems that could come from that?

dr-mick8 karma

That is a fantastic question. Find somebody reputable. Psychiatrists live and die by word of mouth. If at any point you feel uncomfortable or like it's moving too fast, either let the therapist know or stop seeing them (if they are unresponsive to that).

Sometimes meds are trial and error - so find a person that you truly feel comfortable with who can also take the time to explain what to anticipate and why they are doing what they are doing.

cosmololgy2 karma

Do you have any thoughts on the recent overwhelmingly popularity of fortnite?

dr-mick6 karma

It builds a HUGE sense of community. It's tugged on all the right strings - it's cool to know, cool to be good at, it's popular on Twitch. The sense of belonging in fortnite is amazing.

Jasperbeardly112 karma

How would you recommend I try to help a schizophrenic adult that doesn't listen much and loves video games? Muchas gracias. English is not my first language.

dr-mick3 karma

I would recommend seeking out a therapist who is qualified to work with schizophrenia and also has some knowledge about video games. Be supportive if there is resistance - the idea of therapy can bring up a lot of shame for people.


What games do you play personally?

dr-mick3 karma

Destiny, No Man's Sky. The Division, WoW are my staples right now. Wanting to get into Divinity 2!