Micropsychosis: Temporarily Losing Your Mind

loses their minds 

Have you ever heard someone say that they “lost their mind”? Perhaps you’ve even witnessed a seemingly normal person “lose it”, such as the JetBlue pilot in 2012 that had to be subdued by passengers because of sudden, erratic behavior during a flight, or when a flight attendant on an American Airlines flight began speaking erratically over the intercom.

There are multiple medical conditions that can trigger psychotic like episodes such as brain tumors, thyroid conditions, fever, infection and substance abuse. There are also multiple psychiatric conditions that can cause a person to have brief psychosis such as bipolar disorder and major depression.

However, there are times when relatively healthy people can for an incredibly short amount of time, lose touch with reality, becoming paranoid, hearing voices, having a sense of depersonalization (a state in which one’s thoughts and feelings seem unreal or not to belong to oneself, or in which one loses all sense of identity) or derealization (a feeling that one’s surroundings are not real).

This condition is called micropsychosis and generally last only a few minutes to a few hours and typically occurs during times of heightened anxiety and/or stress. Afterwards, the person goes back to him or her normal self and may never have an episode again. It’s not to be confused with a brief psychotic episode which by definition last longer, typically one day to a month and is not re-occurring.

Micropsychotic episodes are what I think often happens when someone goes into a rage and is seemingly out of control. Afterwards, many of them can’t remember what happened, or feel as if they were watching themselves do things as if it were a movie.

Whenever someone who has never had a psychotic episode suddenly has one, it usually takes them and everyone by surprise, but in retrospect, there is usually some early symptoms that may have gone unnoticed or ignored. Often times it’s the way someone is dealing (or not dealing) with stress.

While having a micropsychotic episode may actually be quite a normal psychological response under some extreme stressful conditions, there is probably some underlying condition that needs to be investigated, even if it’s just talk therapy to help deal with stress or a visit to a medical doctor to rule out a medical condition.

Below is a video of a character with Borderline Personality Disorder and her Micropsychotic hallucination. A funny title for this video would be, “How To Make Your Hallucinations Disappear”.

Five Ways To Combat Worrying

11794235_1009941262372072_3241828875963410031_o

“Worry is the direct descendant of the need to be in control. We cannot see everything. We do not know everything. It’s impossible for us to control everything…” –Iyanla Vanzant

Worrying is a natural part of life. Occasional worrying is actually a good coping skill that helps us plan ahead. However, worrying too much can become counterproductive, distracting and damaging to our mental and physical state.

Most of the things we worry about aren’t likely to happen in the first place, yet we waste vast amounts of emotional energy on them.

1 out of 10 people worry excessively. Extreme worrying can be a symptom of a mental health issue such as depression or generalized anxiety disorder. Some people who worry constantly and their worrying derails their lives may have a chemical imbalance and need medication, therapy or both.

For many of us, we worry because we want to control a situation, person or outcome that we usually don’t have that much control over. Worrying a lot usually means that you are trying really hard to control something, yet worrying usually doesn’t do anything to help or change the situation, it just causes us more emotional anguish.

Here are five tips to help combat worrying:

  1. Allow yourself to worry in small increments: I’ve told clients who worry a lot to designate one part of their day as their worry time, that way their worrying doesn’t build up nor do they worry throughout the entire day.
  2. Try to problem solve: Worrying is a poor attempt to solve a problem. It simply doesn’t work. Instead of wasting the energy on worrying, try to think of solutions to the problem you are worrying about.
  3. Learn to deal with uncertainty: Uncertainty is just a part of life, sometimes random things just happen, but many of us are unwilling to except that. We have to know and/or be in control of things that we simply can’t be. The faster we learn to deal with uncertainty, the easier it will be to stop worrying and the easier it will be to actually deal with the unexpected.
  4. Stay in the present: When we worry, we aren’t actually enjoying what’s going on around us now. We are so far into the “what ifs” of the future, that we are missing out on the great possibilities of right now. You can acknowledge your worries, but that doesn’t mean you have to allow them to pull you in. Meditation and mindfulness activities can help ease some of the stress from worrying and bring you back to the present.
  5. Get out of your head: You may find that putting what you’re worrying about down on paper helps release some of its power over you. Some people keep a worry journal next to their bed so that if their worries keep them up at night they can just jot them down on paper and “release” them. Guatemalan worry dolls, for example, are dolls based on a legend where children in Guatemala make dolls to tell their worries to and the doll “takes” their worry away.

“I have spent most of my life worrying about things that have never happened.” -Mark Twain

10 Mindfulness Techniques You Can Start Using Today

IMG_148084419922650Most of us spend a lot of time feeling pain, guilt or regret about our past and anxiety about our future. We can get so wrapped up in this past and future thinking that we don’t even enjoy the present moment we are living in.

Mindfulness is a form of self-awareness that helps brings us back to the present moment. It is taken from mindfulness meditation which is based on Buddhist meditation principles. It the past decade or so it has become very popular, especially as part of dialectical behavior training which has been successful in treating borderline personality disorders.

The basics of mindfulness helps us to pay attention to the present moment and disengage from the mental clutter and chatter that is almost always filling our minds.

How many times have you found yourself at a party, in a meeting, on a date even playing with your kids and yet while you are physically there, mentally you are somewhere else. You are in your head, dwelling on your past, thinking about the future and not living in that very moment. We have so much going on in our lives today that it’s hard to live in the present.

We are with our spouses, but thinking about everything we have to do at work tomorrow so we aren’t really hearing what they are saying or we are doing a task we do regularly, but are just going through the motions and not really paying attention to what we are doing (which is one reason accidents happen).

I have to admit that there have been many times when listening to a client that my mind will wonder. I’ll start thinking about my past, I’ll start thinking about what I have to do later that day and before I realize it, I’ve missed a good portion of what that client was talking about (it’s bad I know, but it happens… therapist are human too). I have to fight with myself sometimes to stay in the present, to not allow the clutter and chatter in my brain to take me anywhere else, but to remain in the here and now which takes practice.

As a matter of fact, during group therapy, being in the present and being mindful are two of my 10 rules. Often times when one group member is talking, some of the others will drift off to their own issues, their own regrets over the past and anxieties about the future to the point that they can’t offer support and encouragement to the group member who was speaking because mentally they weren’t there.

Here I’ve listed 10 ways to help you start being more mindful and to start living in and enjoying the present moment today.

  1. One Minute exercise: sit in front of a clock or look at your watch for exactly one minute and focus all of your attention only on your breathing and nothing else. Sounds simple, but your mind will tend to rebel and try to fill itself with all kinds of past and future thoughts. Resist it, focus simply on your breathing for one minute. Once you have this down pat you can start extending it by another minute up to five minutes or even longer!

  2. Take a shower. Showers can be relaxing and can be a mini vacation away from everything and everyone else. Feel free to use your imagination and picture yourself standing under a tropical waterfall.
  3. Speaking of water, sticking your hand in some warm water and concentrating on the sensation on your skin is not only a great way to bring you back to the present, but it is also helpful for de-stressing because it brings your brain a sense of comfort. If you aren’t near any warm water try rubbing your hands together to get a similar affect.
  4. Listen to music, calming music preferably and music you’re not familiar with is best, but really listen to it, not just the words, but the sounds of the instruments and the rhythm of the beat. Even familiar music can sound new again when you truly are present with it.
  5. Mindful Eating: Most of the time when we eat, we aren’t really paying attention to what we are doing. We are distracted by our mind, the television or anything else. In mindful eating, you sit down with no distractions, paying full attention to every bite you select and put into your mouth being aware of its color, how it smells, how it taste, the different textures, how it feels in your mouth. You may be surprised at how your food actually tastes different once you slow down and focus on it and possibly, how little of it you actually need to fill full. If trying this for an entire meal is too hard, try doing it for the first two bites of each meal.

  6. Mindful Walking: This is similar to mindful eating accept you take a walk and allow yourself to only focus on what is happening right now. How the ground feels beneath your feet, how the wind and/or sun feels on your skin, on how the leaves look and sound on the trees, even observing other people. It’s also good to pay attention to your breathing as you walk to help keep you present and centered.
  7. The acronym R.A.I.N. is used to describe a more advanced technique for when you are feeling unpleasant emotions where “R” stands for recognizing when a strong emotions is present, “A” is to acknowledge the emotion (instead of denying or running from it), “I” is to investigate where the feeling is coming from by checking in with your mind, body and feelings, and “N” is to non-identify with what’s there, meaning to not allow the emotion to define you or control you, but to understand that it is just another passing emotion that doesn’t have to control you. RAIN is about staying with your emotions and then letting them go, not dwelling on them or doing things to try to escape them, but acknowledging them and then allowing them to leave. It can be challenging to stay with your emotions and still let them go which is why this and the next technique are both considered advanced, but once you practice and can use them effectively, they can be life changing.
  8. Most of the time before we know it, our minds are racing, we are thinking about the past, the future, anxious, and just going through the motions of our daily routine. This is when we need to find time to S.T.O.P. which means to Stop what you are doing, if only for a minute, Take a breath and pay attention to your breathing, allowing it to flow in through your nose deeply and out through your mouth fully. You can try imagining breathing in a cloud through your nose and blowing it back out through your mouth. Observe your thoughts, feelings and emotions. Know that you can observe them, but they are just thoughts, feelings and emotions, that doesn’t make them facts they are not permanent. Often times recognizing, observing and letting thoughts, feelings and emotions go will work much faster than any psychotropic medication can in alleviating anxiety and depression. Lasting proceed with something supportive and positive such as talking with a friend or exercising.
  9. Un-tunnel your vision. A lot of times when we are stressed it’s because we are focusing on a single point that eliminates or obscures all other options. Try extending your arms all the way out until you form a “T” and then wiggle your fingers. Slowly bring your arms back in until your fingers are insight and then extend them again. Repeat this. Playing with your peripheral vision can help your brain to remember to expand and to remember that their are other options and possibilities other than that single point it’s currently focusing on that’s causing you stress.
  10. Come up with your own ways to be mindful and in the here and now! There are so many different ways we can practice being in the moment and there is no better way than finding something that works best for you.

A lot of our discomfort comes from worrying about the future and beating ourselves up about the past, but the past is gone and the future has not happened yet. Living happens in the moment we are in right now so taking some time to remember that and appreciate the present will definitely make our entire life experience richer.

Setting Up A Coping Skills Toolbox

My Journal
My Journal

Today I read a sign that said Sometimes you’re the statue, sometimes you’re the pigeon. It served as a good reminder that not everyday will be a good day.

It’s helpful that in anticipation of those not so good days that we have a set of healthy coping skills easily at our disposal, a “toolbox” if you will.

What are coping skills?

Coping skills are basically behaviors that we have developed to deal with times of distress. Some of those behaviors are positive (i.e., exercising) while others are negative (i.e., smoking). Positive coping skills allow us to deal with life stressors in a healthy way while negative coping skills generally make us feel better temporarily, and then either make us feel worse or lead to bad consequences.

People in recovery have probably heard of a coping toolbox before, it’s something that we usually have them work on in anticipation of relapses, temptations and set backs. I am not just talking about recovery from drugs or alcohol, but recovery from a mental illness, codependency or whatever it is you are trying to overcome.

Even if you aren’t in any form of recovery, having a coping skills toolbox can prove to be an invaluable asset when you have to face those not so good days.

Naturally, we all have coping skills we have developed over the years. Some we are conscious of and some we are not. Many of our coping skills are unhealthy or  ineffective. People who use substances, cut themselves, etc., are all using coping skills that are unhealthy.

The trick is to develop healthy coping skills that we are conscious of so that we can use them when we are having a bad day or feel ourselves headed in that direction. People who have a toolbox that is filled with positive coping skills are better prepared to deal with life stressors.

Because each person is different, one persons coping skills may not work for everyone, but it is useful to try different healthy coping skills to see what does work for you and to put those into your “toolbox” so that you can have a collection of visual or written cues to help you when you are having one of those days where you feel more like the statue than the pigeon.

Positive coping skills are a great way to reduce anxiety and depression and bring back a sense of balance and peace during times of distress.

It’s good to think about and start putting together your toolbox when you are having a good day, before a stressful event happens when you still have the energy and creativity. It’s like putting together a hurricane survival kit (for those of us here in Florida), you don’t wait until a hurricane is here to put together a survival kit, you do it before a storm even develops so that when the hurricane is knocking on your door, your kit is already prepared.

Here are some of the coping skills in my toolbox:

  • Journaling– I love keeping a journal as a way to express my thoughts and feelings, especially when I have a difficult time figuring them out and when I feel like I can’t talk to anyone else about them.
  • Creative writing– sometimes it’s helpful for me to put some of the distress I am going through into fictional characters or situations that may mirror mine. It helps to sometimes work them out in a fictional setting before applying them to my real world or just to vent and play things out without the real risk of harm.
  • Drawing/sketching– art therapy is a great way to release tension or explose your thoughts and emotions. Sometimes I just take a scratch sheet of paper and sketch, nothing in particular, but it helps ease my mind.
  • Exercising– I love to workout, but when I am stressed, working out becomes therapeutic. Sometimes I think it is the only way I have remained sane for so long 🙂 .
  • Meditation– sometimes I just sit steal and don’t try to think, feel or solve anything. Amazingly, sometimes just sitting still and doing nothing for five minutes resolves multiple internal conflicts I was having.
  • Mindfulness– focusing on the here and now often takes away angst I am feeling about the past and future. Just allowing myself to be here and reminding myself that I am exactly where I am supposed to be, allows me to release built up tension.
  • Distraction– sometimes I allow myself to just “change the channel”, virtually taking a mental break from whatever is bothering me. I may play a video game, read a book, call a friend, anything and often that distraction is enough to either allow those bad feelings/thoughts to pass or to put them in better prospective.

This is definitely not a definitive list, it’s just some of the tools I use in my toolbox. I know other people have included music, knitting and yoga in their toolboxes. What are you going to put in your coping skills toolbox?

Presidential Election Stress Disorder

The morning after the first presidential debate between President Barack Obama and Governor Mitt Romney, I got a long text message from a very good friend saying that she was extremely stressed about the debate and all the negative things being said in the press about President Obama’s performance.

This friend asked me to give her some encouraging, professional advice. I was a little stunned because I have never had anyone tell me that they were so stressed out about an election that they wanted professional advice to help relax.

Soon afterwards I had an older woman tell me that she couldn’t sleep the night after the debate because she was so stressed and she also watched the cable news channels incessantly.

This got me to start paying more attention to presidential election stress and noticed it was all around me.

At work, coworkers vented about their frustration either with the President or with Mitt Romney. At the barbershop, the car wash, at the grocery store… everywhere I went I seemed to over hear people stressing in one form or another about the upcoming election.

Some people are engrossed in the election almost every waken hour. They are glued to CNN, MSNBC, FOX, or whatever channel. When they aren’t watching television they are online either reading articles or engaged in back and forth bickering in cyberspace.

Even when they aren’t doing those things they are either talking about the election, or spending too much time thinking about it.

If this seems a little obsessive, that’s where presidential election stress goes from normal to presidential election stress disorder.

Even my mother told me that she was stressed about the election and of course her television seems to be stuck on the cable news channels as well. She’s had trouble sleeping because she is worried about the upcoming election and talks about it endlessly to whom ever will listen to her so I gave her the same advice I gave my friend.

1. Disconnect– sometimes we have to turn off the television and get off the internet where we are too easily bombarded by campaign ads, political arguing or other things that can trigger our presidential election stress.

This includes Facebook, Twitter and other social sites where it’s easy to get pulled into political debates. At the least, watch something funny, silly, or interesting that has nothing to do with the election, and the same goes for websites.

2. Get out of the house– exercise, go for a mindfulness walk and appreciate the moment of now. Look at flowers, breath in the air, close your eyes and listen to what’s around you, shutting out all other thoughts about the past or the future, only the present.

3. Focus on you- get back to doing things you enjoy doing such as reading, writing, drawing, knitting, whatever it is you enjoy doing that can take your mind off of the election.

This upcoming presidential election is extremely important, I agree. It makes since that so many people are personally vested in their party or candidate of choice. It’s okay to be passionate, but it’s not okay to be angry, stressed, or depressed over the election and if you are, it’s time to take care of your self and take a break.

On Teenage Suicide

Suicide is definitely one of those unpleasant subjects that many people would like to pretend doesn’t exist or at least can’t happen to someone they know and love.

As a matter of fact, one of the most depressing and yet helpful books I’ve ever read was entitled: Psychotherapy with Suicidal People.

On Suicide

Suicide is the second leading cause of death for people between 14 and 25, and about 30,000 people in the United States commit suicide each year.

Since I’ve been working in the mental health field I’ve counseled literally hundreds of people who have either attempted suicide or have thought about suicide seriously enough that they needed hospitalization to keep themselves safe from themselves.

I’ve also assisted in crisis counseling at various schools. It’s extremely depressing to walk into a huge auditorium filled with grieving students and staff after a young person has taken his or her life.

Why Do People Commit Suicide?

This is a question I get asked very often and the answer is simple, yet complex. According the American Foundation for Suicide Prevention, 90% of people who commit suicide had a diagnosable mental illness, but there are other reasons including:

      • Psychological Disorders (i.e., depression, bi-polar disorder, agression, schizophrenia)
      • Bullying
      • Stress
      • Work
      • Money
      • Relationships

For teenagers, bullying seems to be an increasing reason to why teens commit suicide. It’s truly tragic that we live in a society that today is so connected that bullying takes on a whole new life.

Kids are now not only getting bullied at school, but in cyberspace where everyone can see, and yet no one seems to be doing anything.

On December 27th, 2011, Amanda Cummings, a 15 year old, stepped in front of a bus and killed herself after being tormented mercilessly by her bullies. A suicide note was found in her clothes.

I recently starting counseling a teenage girl who’s 20 year old brother hung himself with a dog leash last week. I didn’t know him, but from what she’s said it sounds like he may have had some struggles with depression.

He had gotten into a fight with his girlfriend and told her he was going to kill himself, something he apparently had threatened many times so she didn’t take him seriously. They found him less than an hour later hanging from a tree in the backyard.

And not too long ago here in Orlando, a man killed himself after getting in a fight with his girlfriend, telling her he was going to kill himself, and then drove the wrong way on the interstate killing himself and another motorist in a head on collision.

Other times, there may seem to be no precipitating events.

Two years ago I went to assist in suicide counseling at a high school where a popular and seemingly happy lacrosse player took his own life.

His friends and family were all blaming themselves for not knowing that he felt so sad and alone, but there weren’t many signs as far as I could tell, he seemed to be hiding his emotional pain and struggles very well.

However, in most cases there are signs to look at for.

Suicide Warning Signs Include:

      • withdrawal from friends and family members
      • trouble in romantic relationships
      • difficulty getting along with others
      • changes in the quality of schoolwork or lower grades
      • rebellious behaviors
      • unusual gift-giving or giving away personal possessions
      • appearing bored or distracted
      • writing or drawing pictures about death
      • running away from home
      • changes in eating habits
      • dramatic personality changes
      • changes in appearance (for the worse)
      • sleep disturbances
      • drug or alcohol abuse
      • talk of suicide, even in a joking way
      • having a history of previous suicide attempts

Sometimes the reasons people don’t recognize the signs of suicide is because they are in denial, especially when it comes to those close to them. When dealing with suicide, denying that someone is in need of help can cost them their life.

Suicide Prevention

If you know someone who is thinking about, talking about or you think may be at risk for suicide don’t ignore them. Often times there is a misconception that people who talk about suicide don’t end up killing themselves, but this is untrue.

Many people who end up killing themselves have mentioned suicide to someone directly or in directly, so take them seriously.

If you believe there is an immediate threat call 911, they may need emergency hospitalization. Otherwise they can seek individual and family therapy and there is always the suicide hotline (1-800-SUICIDE).

Compassion Fatique

As a therapist there have been several times in my career when I have felt the classic symptoms of what is known as compassion fatigue, also known as secondary traumatic stress disorder.

Compassion fatigue is the gradual decrease in compassion one feels for others over time. It is common not only in people who have been affected by trauma, but also in those who work directly with people who have been affected by trauma including those working in helping professions such as doctors, nurses, counselors, and welfare workers. Compassion fatigue is also common amongst lawyers and there is growing concern that the general population is often subjected to compassion fatigue due to the media’s constant coverage of disasters, violence and suffering.

Compassion fatigue can also been seen in charitable given. Such as if there is a major earth quake today the number of people giving charity may decrease as people grow frustrated with the way donations are handled or with the sheer size of the tragedy.  

Signs and symptoms

People suffering from compassion fatigue often feel hopeless, anhedonia (have a decrease in experiencing pleasure), negative attitude, and ongoing stress and anxiety.  In some cases compassion fatigue can be so bad that it’s effects can be similar to post traumatic stress disorder, which is why it’s often called secondary traumatic stress disorder: the person experiencing secondary traumatic stress disorder may experience fear, anxiety, nightmares and avoidant behaviors after hearing about a traumatic event from a client/patient as if he or she had experienced the event themselves.

The person experiencing compassion fatigue can show decrease in productivity, self-esteem, feelings of incompetence, self-doubt, difficulty focusing and other signs that often resemble depression. These can effect both the persons personal and professional life.

Personal Experience

Usually I feel compassion fatigue after many months of intense, often frustrating therapeutic work, no vacation, and little to no outlet to express my feelings and thoughts about my work or even about my personal life. What happens is that I find myself becoming easily irritated, frustrated and aggravated. I tend to have less energy and patience overall, especially when it comes to dealing with difficult clients. All of this makes it hard to really be present during sessions and when I get home I find myself wanting to be left alone with my pessimistic thoughts about myself, my work and the world at large.

A good therapist recognizes these signs and symptoms and knows when to take a break before compassion fatigue starts to impact them, their clients and those around them negatively.  It is important for all of us to recognize when we are suffering from compassion fatigue so that we can start taking care of our self. Taking a break, a vacation, talking to someone or just disconnecting from the world for a while may be needed (i.e. if someone is suffering secondary traumatic stress disorder after watching hours and hours of footage of a terrorist tragedy on CNN).

We must all learn when we need to take a break and how to practice self-care, a discussion for another post. As for me, I’m taking on a lighter case load which is typical for me during the summer, and I am also taking a vacation in July as well as trying to get back to some of the things that make me feel at peace with myself such as reading, writing and drawing. I know that once I have taken care of myself, I will be better capable of helping others learn to also take care of themselves.