Passionate about helping people with anxiety and trauma. AMA!

What are your thoughts on psychedelic-assisted psychotherapy (MDMA and psilocybin specifically) for anxiety and trauma?

I haven't reviewed a lot of the research on this yet but I think it's very interesting and with the initial reviews I've done, it seems like it could be a promising tool if we can figure out how to do it safely.

Thanks for the response. :)

You’re quite welcome!

Have you had similar success rates with online sessions compared to conventional ones? How would you encourage people to seek mental health services, given the existing stigma associated with it?

Hi and thank you for your question! So, the simple answer is yes. The research is showing the efficacy of online counseling to be the same as in person counseling. That said, online counseling won’t be as effective for everyone because it’s not warranted for everyone. Online counseling is not conducive to actively suicidal people, people thinking of harming others, people actively experiencing psychosis, people with severe substance abuse issues, and people in crisis situations that may need more immediate support. These are circumstances where treatment online wouldn’t be effective. I hope this helps. Your second question is one I ponder daily. The stigma around asking for help is so deeply ingrained in many of our cultural narratives that it would be naive of me to think I alone could fully answer this question. My simple answer in this regard is to know that treatment is confidential and private between you and the therapist. You are never required to disclose your attendance at therapy and likewise, as a therapist, I will not disclose your attendance to anyone unless it’s agreed upon prior. There are, of course, a few limits to this statement that a therapist will Go over with you so you both understand them well. Other than finding solace in this privacy piece, I encourage everyone to be brave in finding help that works for them. Maybe it’s not therapy, maybe that’s a blog, a self help book, or an online group.

Hi! I typically don't try and get an answer on an ama but this hits very close to home. So here goes.

I started therapy this month biweekly for depression and anxiety. I instantly see value in it but notice that after each session once the catharsis has left I feel kind of bad. I sit there for an hour and just word vomit to the guy. I'm paying him, his job is to LITERALLY listen to me talk, but for some reason I feel like I've burdened him with my troubles.

My question is, is this something that other people deal with? Am I doing this wrong?

Thank you for asking because I know other ppl struggle with this. Your not doing anything wrong. Therapy relationships are unlike any other we have in our life. This, in part, is what makes them so rich and meaningful, but also hella awkward in the beginning. And confusing. Think about how you get to know other ppl... you can ask them questions about themselves, they self disclose. Therapists don’t really do that. So the learning about them happens much slower. You learn about them as they respond to you and frame things over time. Of course there’s some variability in self disclosure with therapists and yours may or may not like that. Therapists are unique individuals and many of us care deeply. You are not a burden.

In your opinion how many sessions should a patient attend if they think things are not working out with their therapist?

Talk about it right away with your therapist. Try to figure out what’s working and what’s not. You aren’t going to click with everyone and every therapist may not conceptualize things in a way that makes sense for you, your goals, and you life. If your sure it’s not working, Ask for a referral right away or keep looking!

Thank you.

Your so welcome!

Why are the not more focuses on hormonal problems when it comes to treating people with anxiety and depression?

It blows my mind the number of people I have meet (including myself) that suffered depression and anxiety in which therapy and other standard treatment did little or nothing, that got rid of the anxiety/depression or waa massively improved by simply fixing their different hormones that was out of balance.

And if you look at the symptoms of different kinds of hormonal problems, anxiety and depression are some of the most common symptoms, but I rarely really hear about this when it comes to how we try to treat people with anxiety and depression.

I share your frustrations here and I consider this to be a complex issue. I think part of it is that mental health is still fighting for legitimacy in the medical world and as such, our treatment models and treatment continuity is highly disjointed and compartmentalized. This is frustrating as a consumer of health care.

At the same time, therapists aren’t trained to look at the endocrine system. That’s totally beyond our scope of practice. However, I personally like to encourage all my clients to consider a full work out to rule out anything related to hormones, etc that might be contributing to mood. Because your right, there’s a correlation between mental health and physical health. A thyroid issue for example can wreck havoc on someone’s mood. It’s helpful to be able to label it properly rather than just thinking “I’m crazy”.

I also know there’s a lot of integrated medicine folks now doing really good work trying to integrate the body and mind more. We don’t have all the answers by any means, but it is a conversation that’s happening more. I appreciate your attention to this.

Hi Cristen!

Do you have much experience working with people suffering from "health anxiety" - whereby their anxiety convinces them that they might have issues with their physical health?

If so, what techniques might you employ to help individuals deal with this specific category of anxiety?

To worry about your health is a normal experience. But health anxiety, when the anxiety is out of proportion to the realistic chances of having a serious problem can definitely lead to distress and other time consuming behaviors - doctors appointments, tests, etc. While I have seen a few folks with this type of anxiety in my practice over the years, I wouldn’t say it’s been the bulk by any means. Some literature suggests that might be because those types of concerns tend to get funneled into medical settings instead. Regardless, I would say that the treatment needs to be focused not on whether the physical symptoms are real, but if you are responding to your stress response in a helpful or unhelpful way, reducing the need to check and seek reassurance around healthiness, and increasing coping and safety behaviors.

Hello Cristen.

Fellow BT owner here (2 actually) and a few questions:

1. My therapist believes that I have experienced some trauma in my youth and we have done some EMDR sessions (it's a very weird experience imo). However, I don't feel like my trauma remotely compares to that of someone like a combat veteran or an individual who has had horrible experiences. What makes up trauma and are there different levels that need different types of care?

2. I don't like medication, but my doctors insist that I take a bunch of pills. Are there alternatives to dealing with trauma, anxiety, depression, etc. without taking medication (besides therapy of course)?

3. What are some signs of someone dealing with trauma and how can you discuss it with them?

Hey! BT's are the best! I'm biased though obviously :) These are great questions!

1. You might have heard about 'big T" trauma and "small T" trauma. Some people use this to define trauma on different levels. Big T meaning events like war, natural disasters, rape, etc. that are commonly associated with a diagnosis of PTSD. I think of these as the culturally 'acceptable' events that lead to PTSD. Little t traumas are defined as highly distressing events that still affect the individual but don't otherwise fall into that other category - so it could be anything that holds personal relevance for you and made an impact on your life. using this categorization, "little t' traumas are often harder for us to validate personally but we shouldn't negate the fact that they did make an impact, like a footprint in the sand. I personally wish we had a better or different word than trauma when talking about this stuff. The word alone lends itself to people thinking of victimhood and that couldn't be further from the truth.
2. yes! I am a huge advocate for integrated body based care - trauma informed yoga, trauma informed massage, reiki, craniosacral therapy, acupuncture, are all great treatment adjuncts. somatic experiencing is also a great therapy treatment modality to look into.
3. Signs of trauma are hugely varied by the individual. Hypervigilance, flashbacks, depression, avoidance, panic attacks are some of the common ones. If you and your therapist are considering trauma as an impact on your life, be curious about yourself and your symptoms. I think this also speaks to the 'how' of having these conversations. Being open and curious is the best approach in my opinion. I hope this helps.

I have a friend who experienced a very traumatic childhood but he doesn’t want to see a therapist because he believes that talking about his problems will make him think about them more and ultimately make him feel worse. What would your response to that be?

This is a very common belief that I hear. It’s often an old coping skill that worked at one point. I would question whether it’s working or necessary now though. Moreover, research states the opposite is often true. In the initial stages of therapy, people report feeling better talking about things they often haven’t talked about often, or ever before. Regardless of research though, I believe it’s important ppl Get to therapy or self help spaces in ways they want too.

In terms of therapy, it’s important to know you never have to go to therapy and spill your whole life story right away. The therapeutic relationship is still a relationship that is built over time on trust. In the same way you wouldn’t tell someone you don’t know well your most vulnerable moments, you wouldn’t tell a therapist right away either. I believe we still need to earn trust even as therapists. (Of course there are more caveats in that statement, but generally speaking.) also, even if therapy isn’t a thing right now I wonder about self help books, blogs, community groups, etc that might be of interest. There are many ways for people to grow in insight and skills.

What are the best things to look for in a potential therapist?

Awesome question! This is ultimately a personal question and starts with your being comfortable with them. I also have other questions I would consider: Do you feel heard and listened too? Do they respond in ways that make sense to you and make sense for your goals? Do you feel like you are on the same page about what you're working on?

So, practically, what should someone do, who feels anxiety coming up?

Anxiety manifests in our thoughts, behavior, or in our bodies physiologically. So depending on how it’s manifesting for you, that tailors how we support you. If it’s in your thoughts, we need to learn thought stopping, challenging thoughts and reframing. If it’s in your body, I would suggest relaxation techniques, breathing techniques, and ways to relax the body a bit. If your finding yourself avoiding because of anxiety, some level of exposing yourself to the feared activity is warranted (exposure therapy). This is best done with the help of a therapist. Distraction and coping is always good to have a list of too- running, walking, stretching, painting, reading, journaling, etc. I hope this helps!

I want to know the answer to this, with the caveat: Breathing methods do not work for me (anymore).

Hi! Can you be more specific about your question?

How do I get started in therapy? I feel like I’m trying to start this journey alone

Good question! If you know anyone that’s been to therapy, ask them how they found their therapist. Also, if you have insurance you can always call and get a list of credentialed providers who take your insurance. This eliminates the financial barrier to a degree and then you get vet out people by calling asking how they might help you- ask for a consultation. Also, there’s psychologytoday.com which is a huge platform many therapists use to advertise their services.

I have anxiety/OCD and if I don’t do rituals right or feel an anxious episode coming up I usually subconsciously start chewing my cheeks/fingers (dermatophagia). I usually just get acrylic nails to try and combat it and it worked for a while and now I’m starting to chew around them. Is there anything else you can recommend to help fight this issue? I’ve had it my whole life and a psychologist used to help when I was in high school

OCD isn't one of the areas I consider to be within the scope of my practice. It does fall within an anxiety spectrum but is really its own specialty. I'm sorry I can't be more helpful!

Hi Cristen, Im 17 years old, and a year ago, I fell through a window, and the glass cut my arm really bad. Ive had surgery with 13 stitches, and im left with a fully functional(thank god) arm and a pretty big ugly scar. Ever since this happened, ive been having these intrusive thoughts. Whenever im going about my day, i would suddenly think: Im gonna slip and break my neck, or i would be carrying scissors and id suddenly think i would cut someone, or myself. Whenever i get thoughts like this, id always snap back out of it pretty quick. Im never scared of it, or scared it would actually happen, i just think its not really normal to be still having them, 16 months after the fact.

Now for my question, Have you seen or heard of anything like this? What would be the steps to take next? Have you any idea how to stop having these thoughts? Thanks for taking your time to do this AMA, best of luck to ya!

Wow. I'm so glad your arm is okay! Intrusive thoughts are definitely normal and from an adaptive lens, they are functional and focused on survival. With that said, I completely get that they can begin to feel disruptive, distracting, and distressful. Have you tried replacing those thoughts with something more functional for the here and now, challenging them and 'fact checking' them? And also practicing relaxation strategies might be helpful. If you have a trusted professional that you can talk to about this, I think that would be a good route too.

Why are you passionate about helping people with anxiety and trauma?

Experience and years in the field— I’ve come to believe that trauma is one of our deepest, under appreciated, public health concerns. While not everyone carries a diagnosis of PTSD (and shouldn’t), etc., the world we live in can be harsh, and we can be doing more to support. I see the effects of trauma on an individual level, community level, business level, and larger societal levels. Even having these conversations is new, right? We’re coming from calling PTSD hysteria. And PTSD is a relatively new diagnosis. I think it’s important to keep carrying the torch. We all have formative experiences that leave lasting impressions. While this in and of itself doesn’t necessarily need to be deemed traumatic, I understand that the stigma around the words “trauma” + “mental health”, etc. make it increasingly difficult for our us as individuals and society to acknowledge that the world DOES leave an impact on many of us. This creates a negative trickle down effect where wrongs, ways we could be supporting ourselves differently, requesting different support, and even having a different conversation about this is sometimes impossible. I also understand that many people do carry a lot of heavy stuff without anyone seeing that visibly day to day. I want to help educate folks, not to label themselves as traumatized or not- no. But to understand that many of our ways of dealing and coping with the chaos of the world are normal and adaptive. For me it’s about empowerment because at the root of trauma for many is the feeling of helplessness. If I can help to empower even one individual to challenge the negative connotations around mental health and really create lives that support their health as much as possible, I’ll be happy.

Also, do you have any recommendations for medication apps, for adults as well as children?

I love insight timer! It’s what I always recommend + personally use. There are tons of meditations on there for children and adults :) I hope you like it! If not, there’s headspace and also calm which I know quite a few ppl like too.

Hi Cristen! Thanks for doing this AMA.

I'm about to graduate with my BA in psychology (in 5 weeks!) and want to go into the mental health field to help people with trauma. Problem is, I have my own trauma/PTSD diagnosis. I'm planning to spend the next year and a half doing pre reqs for grad school and working through trauma therapy. I've been through CBT and DBT before but now we're looking at EMDR.

Do you think it's realistic for a person with a decent amount of personal trauma to be able to handle grad school (PMHNP specifically) and working in the field, especially after therapy? Thanks!

My simple answer is yes, I think it’s realistic. Trauma is not a life sentence. Nor is anyone perfect, nor should any field but especially ours expect that. I appreciate your awareness and that will bode well for you. Your path in education, rotations, etc might look different from someone else’s but who cares? Do you girl!

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The first thing with CPTSD is education, as it’s different from PTSD and other Disorders it’s often confused with. The good news is it’s a learned response and not characterlogical or an inborn diagnosis. With this education piece in mind I want to refer you to a book I found very helpful to begin to answer your question: Pete Walker: Complex PTSD: from surviving to thriving. This is a literal gold mine :) of info you can use to help support yourself.

I feel I have a good handle on combatting my overactive anxiety but a few symptoms seem to come back a few times a year and it’s scary. It’s always startling and exacerbates the problem. I ask “why now?” Or “what could possibly be the problem?” I get numbness only in my face nowadays and when I have these episodes it will persist almost all day every day for a few weeks. Is there any particular reason it only shows in the face and top of head like that or is it just based on the individual and just so happens to be like that?

This is such a good question. Have you ruled out a medical issue already? I always recommend ruling that out first just to be sure with a medical provider. Ruling out a medical issue, I can say I have seen very specific manifestations of a fight or flight response like your describing, specific to the individual. To answer “is there any reason” would be best done in the safety of a professional that is knowledgeable on anxiety and any other intersections of your life experience you find relevant. I hope this helps.

What does being healed from childhood trauma actually look like? I have been working hard to change my life and thrive instead of just surviving. I have lived in survival mode for so long I don't know what is realistically achievable.

This might sound like complete bullshit but I believe we get to decide what our healing looks like, what we will accept, and not accept in our lives in service of those dreams and goals. I believe anything is achievable. Human resiliency is amazing and I am in awe of it regularly. That said, If you feel like your on survival mode a lot and need help regulating your nervous system, I would look into mindful and body based practices (trauma informed yoga for example, meditation with an practitioner knowledgeable in trauma etc) to help with the nervous system regulation. Our amygdala’s are on overdrive with trauma, they over-perceive threats. It is* possible to retrain the brain, though, with time and repetition. This is HARD. But doable. I might also say healing from childhood trauma simply looks like feeling safe, feeling loved, and cocreating in your relationships.

Hello, thank you for doing this AMA.

My question is, whenever I speak for a slightly longer interval, let's say, 5-10 minutes? My breathing turns very heavy and my mind starts to go blank. I know it's not normal, do you think it's anxiety related or could be because I am going through depression? Thanks.

Hmm. This is my line of thought here. I’d want to discuss the etiology of the anxiety with a professional a bit more. I can appreciate your thoughts toward the depression piece. I’m also wondering about a specific phobia with public speaking (which by the way is one of the most common fears). What your describing sounds like a fight flight response so the good news is breathing strategies, cognitive therapy, and relaxation techniques can help!

What methods do you find best assist you from taking home the anxiety/trauma you are supporting? How do you best recharge and compartmentalize those things?

I do a pretty wide range of things. I meditate most mornings, I practice yoga, I ground myself between sessions with journaling or breathing. I also take time to stretch at work and do yoga quickly. I also like to walk outside if possible. Those are all grounding things to help me emotionally end the session and clear my head so I can be present for others fully. I like driving home from work in silence too. Other than these things, I’m a huge advocate for therapists doing their own therapy, and also getting regular consultations for cases. These are immensely helpful. I also schedule regular mental health weekends every 4-6 weeks where I basically do nothing to help my brain and body recharge.

What’s the best way to start wanting help? To start wanting to get well instead of just letting yourself get worse?

I always like to look at values for stuff like this. Take time to reflect on what they are, and how you might prioritize them. Then your values can act as “guide posts” for your actions and behaviors. If you need help finding language for your values, I know there are a bunch of worksheets online to help get you started!

I've have occasional episodes where I shut down when I get triggered / remember people who have used me, abused me, etc. What are some strategies or things I can do to cope with or come more to terms with what I've experienced?

This sounds like grounding is the place the start- ideas on this: holding cold ice cubes, taking a warm bath/shower, taking a cold shower, 5,4,3,2,1 mindfulness exercise, progressive muscle relaxations, balancing on one leg (or anything), diffusing smells, or using essential oils in general (smell is a very strong grounding sense). Remember that the shut down is trying to be helpful, so encouraging and compassionate self talk are also important. “Thanks for trying to help but I’m actually safe to be present in the here and now”. Also saying “that was there and then, this is here and now” while practicing any grounding exercises would be good. The brain needs help understanding your not in that time and place anymore.

Would you consider an extended period of social isolation a form of trauma?

If that social isolation happened without consent, I would have to say yes because that sounds like a hostage situation. If it’s social isolation with consent and motivation to do so, not necessarily.

What's your stance on controlled drugs for psychological problems? Do you think they help more than cause harm to the patients?

Controlled drugs have helped many people I’ve worked with lead lives they wouldn’t have otherwise been able to lead. They have helped people to feel more in control and capable, the value of that is priceless. I do believe controlled drugs should be monitored carefully for effectiveness on an individual level. For example, sometimes the side effects aren’t worth the symptom reduction to people. I understand that and work diligently to remember they are a tool to use. the conversation between someone using that tool and their treatment team needs to carefully weigh what success looks like and means to the client, and everyone treating that client.

Is there a specific meditation routine that you recommend?

I always recommend folks to start with what they are comfortable with and naturally more inclined to do, to get started. Meditation happens in a lot of forms- counting your breaths, counting while breathing, noticing the objects in the room, listening to the sounds around you, paying attention to your foot steps, etc. my opinion on this is that it’s more important to get in the habit and routine of including it in our day before we start down the road of what “type” of meditation to do. Also, how long doesn’t matter. 5 minutes is a start! And some days that may be all you have. Do what you can. Not everyone will agree with this. It’s just my philosophy and how I was taught.

i’m a 16 year old who’s also passionate about the same shit and i saw that you do therapy and whatever and i really want to do that with my life as well. so i was wondering a few things:

1) education wise, how did you go about? how well did you do in high school? and how much college did you attend?

2) how do you get started with the job? like how do you find a place to start working?

3) is it hard to not get too connected to patients? my worry is i’m going to get too overwhelmed by patients issues and let it effect my life when i go home.

4) is the pay good? i’m not looking for that much of a salary, but just enough to comfortably live

5) what are your hours? do you still have time to have a normal life outside?

6) why did you want to have this profession?

i know this is a lot and i get if you are uncomfortable answering some of these or just don’t want to. i’m just super curious and really admire people like you :)

Hi! Thanks for your questions. I’m always excited to talk about this slant on the lifestyle. 1. I got a bachelors in psychology from a college and then went directly on to get my masters degree in counseling psychology. So total 6 years, not counting the various trainings, etc that happen after that ;) I would say I was very average in high school, definitely not an over achiever and didn’t have all my first choices in school. 2. I started working in mental health while I was in college, on summer breaks. I wanted to see if it was as good of a fit as I was hoping it would be. I found work at a local autism support center and did TSS and wrap around work. Look for places and roles that don’t require your BA. I believe TSS work is still like this, and teachers assistants etc. 3. This is a tough one to answer. We are human and humans connect, especially in the context of a vulnerable relationship. One of the downsides I found to my graduate training is that it seemed to be implied if you “took work home” something was wrong. I disagree with this now. I think it’s a reality that some stuff is going to stick with you. Particularly with trauma work, it changes you and you have to be realistic about that. This means self care and boundaries with work are really important. 4. Pay depends on a lot of things: geographic location, degree, years of experience etc. I would say most positions pay a livable wage but what’s considered livable also depends on how much debt someone has and other circumstances. Pay gets better when you get your license and especially if you go into private practice. 5. I am 100% committed to having a life that I want and is balanced. I don’t work beyond 5pm and not on the weekends. I also only see clients 3 days a week now because I’m writing books and programs now. I’ve spent years going through burn out, over extending myself, doing more than I should, and making mistakes in this regard, - learning what works for me and what doesn’t. Learning what circumstances YOU need to provide the best care is personal and requires a lot of trial and error. Give yourself time and permission to experiment. I believe in my field and want to embody a lifestyle that is sustainable so that we can continue to do good work and care for ourselves at the same time :)