Hi, we’re David Head and Adam Paine, specialists in anxiety and motivation. AMA

Hello!

I find that most coping methods available emphasize the irrationality of fear and anxiety. The premise seems to be, “remind yourself that you don’t need to be anxious about this thing”. My problem is that sometimes the things that give us the most anxiety are perfectly rational fears- illness, political unrest, mortality, financial worries, etc. Obviously the specific concerns will be different for each person. But, what methods are available for managing anxiety with a rational cause? You can’t convince yourself it’s irrational, but you also need to be able to live your life.

Hello,

I agree, a lot of our anxieties are based on real-life issues. If a client of mine is worried about something, like losing a job, I don't tell the client that won't happen. Sometimes people do lose their jobs, and it wouldn't be realistic or fair for me to tell them it couldn't occur.

Instead, I ask the client to focus on how they would cope if this thing did happen. I'll ask the client to imagine how they would "cope well" if they did lose their job. How would they deal with it in a healthy way? What could they tell themselves about the situation that's supportive/helpful/constructive, what would they do to get back on track or deal with it? I'd ask about past experiences when they faced adversity and were able to overcome it, and we could use their experiences from those times to build a healthy narrative for how they would cope with future problems. Then I'd have them work on repeating this healthier narrative each time they think about the issue causing anxiety, rather than thinking about how they can't cope. Over time, this healthy narrative becomes the default thought when they think about a potential future problem. A healthy view of overcoming adversity is what I consider a cornerstone of resilience.

In Victor Frankel's book, Man's Search for Meaning, he writes about human resilience, and that we can adjust and cope with just about any circumstance. It's important to remember we are alive today because each of us, our ancestors (whose DNA we share), and our species have already overcome countless challenges, and there's far more evidence that we can overcome adversity than there is that we won't . If we weren't able to overcome problems, none of us would be here right now.

What advice would you give to someone who experiences ruminating thoughts? Edit. Generally speaking

Hello,

Great question! I use this analogy with clients a lot:

If you had a dog that you let it run wild all day every day in your home (destroying furniture, eating things it shouldn't eat, barking excessively, etc.), and then one night you randomly decide you want to have peace and quiet, do you think that dog would immediately start to behave? Probably not, right?

Our mind isn't any different. Most of us don't think of our mind like this, but it requires training. If we let our brain "run wild" all day, it's understandable that it will still want to ruminate even when we don't want it to. Training our brain is like training a new pet, it just takes repetition and patience. Meditation can be a good way to reduce rumination, but you could also just start trying to focus on what you're doing in the present moment more often rather than letting the mind drift off somewhere else!

Why do this on a Saturday morning when most unmotivated people will still be asleep?

😄 Good point! We'll be here for the next few hours, so hopefully some folks are awake before we leave!

And while I’m here, I have a 4 week old and it’s been very difficult to get things done and I find myself frustrated with myself for not accomplishing more on a daily basis. Any tips for getting motivated and staying mindful on only a couple hours sleep?

Hey,

I feel you man! That's definitely something that comes up for a lot of my clients with a new baby/small kiddos. Honestly, the first thing you can do is be realistic with yourself. Having a newborn is hard work, and everyone ends up feeling overwhelmed by this, even those that think they know what to expect. It's a huge life change, and it takes time to get a new sense of normalcy, be patient with yourself.

Next, I would focus more on consistency than results right now. So if you want to start/maintain a habit, start small. For example, if you want to start reading every day, don't worry about how many pages, just focus on picking up the book once per day around the same time (i.e. 6pm), and same place (i.e. the chair in the front room). The daily goal is just to pick the book up, if you read anything, that's a bonus. Too often we focus on results rather than the habit, which causes us to feel overwhelmed and we don't even start. And if you miss a day, that's alright.

Don't be hard on yourself if you miss a day, instead focus on giving yourself positive feedback when you actually get to the thing you want to do. Think about how you are speaking to yourself when you think about these things you want to accomplish. Are you being a supportive mentor/coach to yourself? Or are you being overly critical of yourself? People feel much more encouraged to do something with positive reinforcement than criticism, and that's true regardless of whether it's coming from someone else, or it's in our own head.

Just another parent (single parent, three girls) checking in. You have a 4 week old...

It's hard and exhausting and it doesn't stop until they sleep through, around 2 years old.

Reprogram yourself. You're doing fine, and absolutely nothing else matters.

What worked for me was visualising my 60th birthday party, and 'remembering' all this from that perspective, trying to figure out if any of it really mattered. Vanishingly little of it did...

Be kind to yourself. It's hard, and that's ok. You can let a few things slide for a bit.

I love you.

I totally agree! Great advice!

Has anyone ever said what a missed opportunity it is to not have opened a joint practice called Head Paine Therapy?

Lol!!!!! Nice!

there is still opportunity for this...?

We might have to consider a name change for the practice!

Can you talk about weekly cycles of anxiety? I work myself into absolute anxious misery every Sunday and Monday morning worrying about the work week. Sometimes it's hard (that's life) but usually it's fine by Monday at noon. This has been true since I was a child. How can a person break this cycle?

Yeah, Mondays are often a stressful day for a lot of us. I often suggest to my clients to work on their morning routine. I notice a lot of people wake up and immediately start doing something stressful (checking emails, checking personal phone, watching news, etc.) I'd strongly suggest have a block of time in the morning where you don't look at work, or even your personal phone/devices. Spend some time in the morning meditating, exercising, going for a walk, and/or reading a book (an actual paper book, and nothing too stressful!), and avoid screens. You should have a similar routine every day, even days you don't typically get stressed out. I also encourage anyone with high anxiety to be mindful of caffeine intake, as it exacerbates anxiety symptoms.

I also talk with clients about their inner dialogue regarding their thoughts about the days they get the most stressed. A lot of us either don't pay attention to, or don't realize how much our inner dialogue affects our emotions. It can be helpful to write down some of these thoughts when you are feeling the most stressed, and then writing a better way to think about it next to the negative thought. Try to make a habit of repeating the more positive thought to yourself when you get anxious about this. Our thoughts affect our emotions, and our emotions affect our behavior, that's the basis for cognitive behavioral therapy.

Stretching first thing in the morning! It's relaxing and will have your body feeling/working better! Plus it'll help you wake up. After that I try to just get my things in order. Brush teeth, bathroom break, fix lunch, pack a breakfast for later, and take care of any other little chore. Boom instant sense of accomplishment first thing Monday morning. Something I figured out with my counselor.

This feels like good advice but it's hard to kill that voice in your head that's like "why are you wasting time stretching/meditating? The sooner you get to work the sooner you'll be finished!"

Yes, definitely! I hear that from clients all the time. The problem is that this type of thinking bleeds into other parts of life and the person ends up feeling pressured about any future task, many of which can't be completed immediately. Even if you start work a little earlier, there will still be more tomorrow, more the day after that, and so on. Learning to pause and sit with the internal pressure to start something "right away" helps break the cycle of always rushing and reacting anxiously.

I also see a lot of clients, (more often men, but not always), who get irritable when they rush through their day without taking breaks, or without having some time in the morning to ease into their day. Then at the end of the day, they are anger and in a bad mood, and this causes problems with their home life. Or they just end up feeling anxious even when they finish work for the day.

It's exhausting to spend one's life always feeling they need to react to anxious feelings, it can consume a person's life and causes a lot of problems in the long-term professionally and personally.

Why is ADHD commonly associated with anxiety and a lack of motivation? If you could recommend just one thing (but medical but habitual like mental exercise, meditation, socializing, etc) to someone struggling with these issues, what would it be?

Just a disclaimer here:

This question, as well as several others in this thread, should really be consulted with a doctor. Maybe these guys have good intentions and or maybe they're just trying to promote their company via AMA, but they are in way over their head with a lot of the questions they're being asked. Neither of them have the proper training to be answering these questions, and it shows.

They call themselves psychotherapists, but that is not a protected title. You don't need to have a specific degree or pass certain licensing exams, or anything for that matter, to call yourself a psychotherapist.

It looks like one has a degree in social work and the other was working as an events planner until 2013, so I'm not sure how you get "over 10 years experience" from that.

What they're doing here is actually pretty irresponsible. Be careful who you take advice from on Reddit. See a doctor. Or at least check someone's credentials.

Hello 240to180,

Thanks for being here. FYI, as other's have stated below, we're both licensed therapists, I'm a licensed clinical social worker (protected title) and David is a licensed professional counselor (protected title), we both have masters degree's in our field and extensive training, education, experienced and have completed years of clinical supervision under other licensed mental healthcare providers. We both have state licenses and have completed master's programs that meet national standards for our fields. Take care!

What are the most common driving factors behind chronic lack of motivation? Does it seem to be tied to anxiety or are they more commonly independent issues?

Anxiety can definitely be a factor, chronic stress/anxiety actually causes other higher functions of the brain to shut down, such as the parts responsible for motivation. Much of our brain slows down when we are experiencing high/chronic stress, and that can leave us feeling fatigued and unmotivated.

Depression can also be a major factor, and I find that depression is often the result of chronic anxiety.

Physical health is also often a factor, I always ask new clients to get a physical with their medical doctor. I've had clients whose motivation was affected significantly due to thyroid issues, low testosterone, vitamin deficiencies, etc. I always advise my clients to get a medical rule-out.

I also find a lot of people set too high of expectations for themselves and this prevents them from ever starting a project. I tell my clients to focus more on consistency with a new habit rather than results. For example, if you want to start reading regularly, just focus on reading one page a day, and if you find you aren't doing that, then just one paragraph, or just one sentence, or just holding the book in your hands once a day! The idea is to make the task so simple that you can at least do it consistently. Once you can do something regularly, you can start to build on it. You don't need to worry about how many pages you're going to read every day if can't even pick the book up regularly! Make it simple so you can actually do it and feel good about it.

What would you say are the best techniques to treating forms of anxiety through counseling, are there some that are more effective then others?

Hello,

I find that mindfulness and cognitive behavioral therapy help the most. Anxiety is usually about wanting to control something or worrying excessively about something in the future we can't yet do anything about.

High anxiety folks are thinkers, always considering different outcomes and they usually have a repetitive negative inner dialogue (also called automatic negative thoughts) about the things they are worried about. In cognitive behavioral therapy, the main concept is that our thoughts influence our emotions, and our emotions influence our behavior. So by changing the repetitive negative thoughts, we start to feel something different over time.

Mindfulness/meditation is also very helpful, and it's something I teach all my clients. I've been meditating for years and it's helped with my own anxiety tremendously!

What’s your view on Dialectic Behavioral Therapy?

I used to co-lead DBT groups, and I still use it a lot in my practice. It's very skill-based, and some of the skills are more helpful than others, but I frequently teach my clients skills about communication. Overall, I think it can be very helpful and practical for people looking to manage emotions and/or looking for better ways to communicate with others.

My therapist tells me I have a lot of attractive qualities - and I agree with her. But even though I tell myself I have these good qualities every morning - like she suggests (blah blah CBT) - I can't help but want to have every good quality. It's an interplay of perfectionism and self-esteem which fuels my anxiety in groups.

Anyways. I can't help but feel like CBT is just a way to trick the mind into settling for 2nd best. Is there another framework I can use? How do you help clients who have self-esteem issues due to wanting to be perfect who do not respond well to CBT?

I work with a lot of high achieving professionals who often express something similar. They feel if they aren't hard on themselves, they won't progress in their lives. A lot of us think in all or nothing terms, "either I'm perfect or I'm terrible". I don't encourage clients to stop trying to be better, I totally support self improvement and am working on myself all the time. I encourage clients to learn to be happy with themselves AND to work towards being better at the same time; that's called a dialectic, two things that seem to be opposites but can be true at the same time.

Here's an answer for you in case you don't get another one, I posted this in another comment:

No matter what my rational mind was telling me, it didn't change how my body and emotions reacted. What I suggest is helping yourself the way you might help your friend or family member, if they were really down and feeling helpless. To respond to your emotions and reactions as not something that you need to attack, but with curiosity about why we do xyz and less judgment. These are some of the principles of Acceptance and Commitment Therapy and Compassion Focused Therapy, which I suggest looking into if traditional CBT methods don't work for you.

I definitely agree, this is a great answer!

Disclaimer - Not an expert.

You are constantly thinking about being the best but I'm not sure if anyone is the "best". What does it mean to be the best? Every one has qualities, skills and flaws and blind spots. Maybe instead of noticing your flaws, you need to notice the flaws in others just to understand that even the person you respect most has flaws.

You don't have to be okay with all your flaws either. Maybe you can list out what you expect from yourself and what you want to be the best at. And then chart out how you can achieve those goal. However, you should pick at most 2 things at a time. Maybe knowing that you are constantly making an effort to improve will help your anxiety and give you a boost. Maybe add your recent accomplishments to your list of qualities.

I may be making things worse, so please take this advice with a truck full of salt. I hope you get a reply from some more knowledgeable people.

Totally agree, "best" is very subjective, and doesn't really exist objectively in the universe, it's just a social construct.

And if we look at human history, or even different cultures in the present, we'll see that what we consider "better or best" changes dramatically from one time period or culture to another.

Thank you for doing this AMA! If this is out of your lane, no worries at all.

I have an 11 year old with ADHD. He's a great kid & does about as well as a kid in his circumstances could do in virtual school, but I feel like I see signs of anxiety in him in the way he gets down on himself for various screw ups. I try to encourage him that everyone has shortcomings & that's part of being human (and I'd be a liar if I didn't own up to my own shortcomings of letting my frustrations get the better of me at times), but I sense in him something I've always had myself: deep down, I hold myself to perfection & have a hard time both accepting my own mistakes & listening to others' encouragement.

I would absolutely love any advice about helping him (and me, if I'm being honest) learn to forgive himself & be less anxious over his shortcomings?

Hello,

Good question. I know that must be hard to see him having a hard time. That's great you are so open and honest about yourself! Kids learn how to view/talk to themselves based on how their parents view/talk to themselves. I can tell a kid he's smart all day long, but if I later call myself an idiot for a simple mistake in front of the kiddo, that's the part he will remember. The child will learn "if I make a mistake, I should call myself an idiot" because that's what he saw me do. Giving kids reassurance and positive feedback is great, but make sure anything you do for your kid (or want him to do for himself) you are also doing for yourself!

I think parents often put a lot of pressure on themselves to be perfect and have all the answers for their kids, but this can be intimidating to a child. If a child thinks their parent doesn't make mistakes or have shortcomings, or sees the parent chastises herself excessively for a mistake, he kid may not feel comfortable talking about their mistakes/shortcomings. It's much healthier to be open about out shortcomings to children, and let them see that it's OK to be imperfect even as adults. We are all works in progress, and if we want our kids to fully accept themselves, talk openly about their feelings, have a healthy inner dialogue, and ask for help, we have to be willing to do this as adults and let our kids see us be vulnerable, open, and imperfect.

How do you cope with anxiety when it's situational?

I've always been anxious internally but at this point it's exacerbated by situations outside my direct control. I'm basically at the level where if I could sleep 24 hours a day, I actually would. Meditation doesn't work for me, I can't quiet my mind.

How good is a basketball player at shooting free throws if they only shoot them during a game? They will probably be terrible. In order to hit free throws during a game (when there's a lot of stress), they practice in the gym during practice or by themselves when it doesn't matter and there's no pressure.

It's the same for dealing with anxiety, if you only use meditation or another coping skill during a stressful situations, it's like a basketball player who only shoots free throws during game time.

To be good at something, you have to practice it when you don't need it, then you can have a chance to be good at it when the pressure is on.

To what extent can stomach issues like unexplained nausea be linked to anxiety?

Good question!

The human body isn't built for chronic anxiety, but we experience it because we've built a society that creates a lot more stress than we would experience if we were still hunters/gatherers living in the wild.

When we are in a chronic stress state, our body actually starts to shut down "secondary" bodily processes, like digestion/hunger (which can result in nausea), immune system, hormones that regular skin/hair, etc. I've seen anxiety affect people's physical health in a lot of ways, and nausea/stomach issues have been common for many of my clients. When we're experiencing anxiety, the body thinks our life is in danger, so it doesn't prioritize our stomach/digestion/hunger as it thinks we're about to die. (Who need to digest food if a lion is about to eat you, right?)

Our brain considers any anxiety life threatening (remember, even though our society has evolved, our bodies/brains are pretty much the same that they were 200,000 years ago), and so the brain prioritizes blood flow, oxygen intake, muscles tensing in preparation for the fight/flight response. The fight/flight response is only supposed to be short-term (which is how animals in nature experience it) , but since our world has so many new stressors that don't exist in nature (money, school, work, etc.), we end up being stuck in this state much longer than nature intended, and due of this, we often experience physical health issues like nausea/stomach issues because of it.

Important!! I always recommend anyone who is experiencing physical health issues to see a medical doctor to rule-out any medical problems, even if they think it's psychological. You always want to be sure there isn't an underlying physical health issue that needs medical attention.

This may be a stupid question, but is it possible to naturally be more anxious/high strung? I'm trying to differentiate it from anxiety generated from/after a specific incident.

Thanks for doing the AmA. :)

Hello,

Not a stupid question at all! Sure, there are genetic, environmental, and even evolutionary reasons why we may have high anxiety.

Genetic: there's a strong link between our genes and mental health, and the evidence for this continues to build over time. Some of us can be more prone to anxiety just like others may be prone to headaches, seasonal allergies, etc. And there's often a family history of similar symptoms/diagnoses for mental health issues.

Environment: A big part of how we deal with our emotions comes from what we observe as kids. We call this "social learning", if we see our parents getting anxious in response to a variety of situations, we "learn" that this is how we should respond. While this type of learning can sometimes be helpful and necessary, (e.g. seeing a parent be anxious when crossing a busy stress), adults also often inadvertently "teach" us emotional responses that aren't always helpful (e.g. worrying excessively about something they can't control or likely won't ever happen).

Evolution: Anxiety was very important for our ancestors who lived in the wild. If a caveman stays relaxed when a tiger is near, he might end up getting eaten. But another, more anxious caveman ran away when he first saw the tiger. So the second cavemen lived to have children, while the eaten caveman did not. In the wild, anxious individuals were often favored by natural selection, and therefore, went on to have children. So we are all prone to some degree of anxiety, because our ancestors needed it to survive.

2 questions

1) someone I know continuously says they know they need to talk to someone, and has several numbers to call to set up appointments, but even after a month or 2 of saying they're calling, they still haven't, and haven't lost the numbers either. How can I help them take that final step?

2) any advice on motivation to create healthier habits? Like working out a few times a week, go for a jog, healthy eating, good morning routine, etc.

Good questions!

1. I know that can be frustrating to see someone who could benefit from help, but hasn't taken the steps to get it yet. First, I would ask if they actually want any help with this. They may not actually want/need help setting up an appointment, and if not, you don't need to spend your energy on something they aren't asking for. You may already be helping a lot just by listening to them. I would ask more questions and validate their feelings rather than trying to sort this our for them. If their lack of getting professional help is starting to affect you or your relationship with this person, focus on the positive benefits of them getting help, not on the negatives.
   
2. Start small and focus on the habit rather than results! Too often I see people who want to start a new habit, but they go all-in too fast. Sustainable habit change is gradual, don't try doing too much too fast. For example, if you want to start jogging, don't worry about how many miles you run or how long, just focus on getting on your jogging shoes and jogging for any amount of time on a regular basis. The run itself can be as short as you want, don't worry about the results, just focus on doing it consistently whether that be daily/weekly, whatever. Make your new habit very easy to accomplish! So easy, that it would be ridiculous NOT to do it. You can always build on it later, and focus on the results once you can do the new habit regularly. If you do something regularly, a part of the brain called the basal ganglia will take over and the new habit becomes routine. We all already have a lot of daily routines that are automated by the basal ganglia, brushing teeth, tying shoes, starting car, etc. If you do anything consistently, the brain will start to automate it.

What part(s) of the brain control our feelings of anxiety, self-esteem, and motivation?

Cool question.

Anxiety primarily stems from the amygdala, the fight/flight center of the brain. This is often what people call the "reptilian brain" since it's an older part of brain.

Motivation can come from different parts of the brain, but primarily from the frontal cortex, which is the more evolved, "newer" part of the brain. Humans have the most evolved frontal cortex, which allows us to perform more complicated actions than other animals. The frontal cortex let's us think about planning things, abstract thinking, recognizing and regulating emotions (like negative emotions that may cause us to procrastinate or give in to distractions/unhealthy habits).

Self-esteem, (I'm not as familiar with this), but from what I've read it looks to be in the frontal cortex as well, more specifically in the frontostriatal circuit. Reference: https://academic.oup.com/scan/article/10/3/364/1653348

I have recently taken some FMLA from work due to anxiety and stress, which I think is further impacted by me being perimenopausal. Can you comment on how hormonal fluctuations might be impacting my anxiety and motivation at work? I’m hoping to be back on the right track after some time off.

Hello,

I can't say this is an area of expertise for me, but I have definitely seen how hormonal fluctuations have affected mood.

While hormonal issues alone are more of a medical issue that need to be addressed by a physician, excessive stress can definitely exacerbate physical health problems, such as hormone issues.

I've seen some clients go on FMLA due to stress and it's definitely helped them. I encourage people to really try and "wind-down" with this time. Some people are so used to being busy and stressed out, they create ways to be stressed even during their time off.

When a client is on FMLA, I encourage them to use the time to really decompress, reduce stress, get good sleep, eat well, exercise, totally disconnect from work or other stressful activities, and spend less time on screens (especially social media and news!).

Are you going to make a firm called "Head Paine"?

Maybe, we'll see!

1. Have you pre-submitted this AMA to the nominative determinism section of New Scientist?
2. What are your thoughts on the recent paper about an Occupational Depression Inventory [Link to paper] [Link to reddit thread]?
   • To what extent do you think that stress is intrinsic to individuals, rather than being a function of their social environment (whether at home or work)?
3. Adam, you mention work/life balance. What are your thoughts on the aphorism "Do what you love, and you'll never work a day in your life."?

Hello, great questions!

1. Lol, no we haven't submitted this to New Scientist, maybe we should! I've never thought about that for myself, maybe my name is why I'm in this line of work!
2. The ODI looks promising, it's short and sweet and to the point. It would be nice to see how it performs with a wider range of professions though.
3. I think genetics and environment play a role in stress. Our individual genes, how we saw anxiety manifest and dealt with in adults during our childhood, and our current environment all contribute. I also think there's a pretty solid evolutionary argument for why we are all so prone to stress (anxious cavemen stayed alive, carefree ones got eaten). But I ultimately think it's a complex combination of difficult to quantify factors that determine how we experience stress on an individual basis.
4. Work/life balance. I'm reading Tribe of Mentors, and one of the contributors mentioned something very similar to this. However, I tend to disagree. I love my job (if I didn't I probably wouldn't spend my Saturday on reddit talking about it!). But I am very protective of my personal time. I've seen so many people get burned out with work (even jobs they love) and how a lack of work/life balance affects their relationships, health, and happiness. Jobs tend to be stressful, even ones we enjoy, and I think everyone needs to have an off switch.

What recommendations do you have for the countless number of people with mental health issues that can't afford treatment?

Hello,

I know that's really tough to need a service and have it be out of reach due to financial reasons. It's definitely a struggle, and I always feel for folks in this situation. (I was in the same situation for many years myself).

While paying privately for therapy is expensive, many therapists take insurance, which can help reduce the cost considerably. I recommend PychologyToday.com as you can search for a therapists based on the insurance type and location.

Some employers offer employee assistance programs (EAP) that will pay for a certain number of sessions with a therapist. You have to ask your company's HR department if they have this and how to access it.

If using insurance or an EAP isn't an option, I'd look for a sliding scale therapist, someone who offers a reduced rate for those who can't afford it.

Also, most cities/counties offer free/low cost mental health services, and often universities or group counseling practices have students/interns that offer reduced rates.

Here's an article with more information on the topic: https://www.nbcnews.com/better/health/mental-health-services-how-get-treatment-if-you-can-t-ncna875176

Hope this helps!

My question is regarding the relationship between mental health and motivation for seeking help. If mental health issue prevents the person from being motivated to take that first step, for example too depressed and therefore unmotivated to seek a therapist, continue sessions with a therapist, or seek out a psychiatrist or doctor who can prescribe medication. What recommendations do you have for someone motivating themselves enough to take that first step to seek help?

Hey,

That's a tough one for sure. It's hard to get help when the symptoms make it nearly impossible to do anything. This is a common problem for anyone who has experienced depression.

Getting a therapist/doctor takes time and energy, no doubt. Sometimes it's helpful for someone in this situation to start small, spend small chunks of time (5 minutes, 30 seconds, etc.) of time looking for a doctor/therapist, rather than thinking it has been be done all at once. Most of the time when we can't get something done, it's because we are looking at a big goal (i.e. getting a new therapist) and feel overwhelmed by it, rather than thinking about one individual task (i.e. do one google search for therapist or doctor near me).

I'd also get them to use anyone they have in their support network, family/friends/roommates that may be able to help.

What’s your best advice for someone who recently got broken up with?

That's always tough, I think we've all been there. I encourage my clients to lean on others in their life after a break-up and to focus on self-care and be easy on themselves. Break-ups really hurt, and it's often hard to see into the future because we're overwhelmed with pain. But things do get better, the sadness we feel from a break-up diminishes just like every other negative emotion we've felt.

After a break-up, it's totally natural to feel some depression, but if it doesn't start getting better on it's own, I'd recommend looking for a mental health professional to talk with. I've had a lot of clients work with me after a break-up, and I saw a therapist myself years ago for a similar situation.

While break-ups really suck, they have been some of the most motivating experiences in my life. Being rejected or broken up with causes a lot of pain, but I use that pain to push me to be better.

What is the best way to help a friend or loved one while they are having an anxiety attack?

In my personal experience: Be available. Supportive but not overbearing. Remain calm. Remind them of things they can do that are personally comforting to them. For me, it's playing guitar - it helps because it shifts my focus from panic rhythm to musical rhythm that I am engaged with.

This is good advice. I also recommend asking them prior/after the panic attack what's the most helpful way to support them next time they have a panic attack.

I also find that most people who have panic attacks are already experiencing fairly high anxiety on a regular basis, it can be helpful for the person to think about ways to keep their baseline anxiety level lower rather than only trying to relax during a panic attack.

Thank you for doing this! My question is:

Have you witnessed an influx of new patients during the pandemic? How effective is online therapy? Do you find advice to be overlapping between patients?

Hello, great question!

Yes, we have definitely seen an influx during the pandemic. This year in general has been pretty stressful so a lot more people seem to be seeking counseling.

I had always been an in-person therapist prior to the pandemic and wasn't totally sold on online therapy. However, I now really like it, and so do my clients. At first, both myself and my clients missed meeting at the office, but now most of them prefer online therapy. It's more convenient, no traffic (we're in Austin so the traffic is a bummer!), and several of them have told me it's more helpful to have therapy in their natural environment (their home) where they experience their stressors. I'm totally onboard with online therapy now, I love it and I feel it's very helpful to my clients.

Overlapping advice: The advice I've probably given the most during the pandemic is: "keep a routine!!" A lack of routine is one of the most common issues I see affect people's mental health. In nature, all animals are on a routine (sun comes up=wake up, sun goes down=sleep). But with artificial lights and screens and working from home, many people's routines are completely thrown off. And with the pandemic, this has been even more of an issue. Try to keep to a basic routine as you had prior to the pandemic. Keep a similar routine for sleeping/waking, meals, exercise, starting work/ending work, watching tv, etc. It may seem silly, but I've seen healthy daily routines make a world of difference to people's mental health!

What has been best motivation advice for people with ADHD? (I'm in my final year of college and looking for an internship too.)

Sorry if that's too broad of a question.

Hello,

For my ADHD adult clients, I always recommend reading "Driven to Distraction" by Dr. Hallowell. It's a great book for adults with ADHD. It talks a lot about different/healthier ways to think about and cope with ADHD.

One of the main things the book addresses that I recommend this to my ADHD clients, is to have a daily routine for personal/professional tasks. ADHD folks (and a lot of non-ADHD people) often lack routine, but it's one of the best ways to get things done regularly. This is especially true for mundane tasks they may procrastinate.