Online Mental Health Resources

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News of the COVID-19 (coronavirus) pandemic can be stressful and social distancing might limit people’s typical coping skills and therapy access. I compiled this list of online mental health resources that I hope you’ll find useful. All are free except for the self-help books listed at the end. Distant Together is a website with mental health resources specifically geared toward coping during the pandemic. You can find a therapist who practices empirically-guided treatments here.

1. Guided Audio Relaxation Exercises (e.g., diaphragmatic breathing, guided imagery, mindfulness visualizations, progressive muscle relaxation)

2. Guided Audio & Other Self-Compassion Exercises (e.g., coping through self-soothing instead of self-criticism, allowing rather than avoiding emotions)

3. Dialectical Behavior Therapy (cultivating acceptance, paced breathing, mindfulness/effectiveness, opposite action to change emotions)

4. Crisis Survival Strategies from Dialectical Behavior Therapy (self-soothing, improving the moment, reducing emotional vulnerability)

5. FearTools (an app with cognitive-behavioral therapy exercises for coping with anxiety)

6. WoeBot (an app with cognitive-behavioral therapy and other types of exercises for coping with mental health concerns)

7. The Psych Show with Dr. Ali Mattu – 10 Quick Anxiety Relief Techniques

8. Posts from My Psychology Today Blog (What to Do With Worry, 5 Ways to Deal with Distress, 9 Strategies for Overcoming Overthinking)

9. Crisis Text Line

10. Suicide Prevention Lifeline

11. Kindle-able Self-Help Books with cognitive-behavioral therapy frameworks: Show Your Anxiety Who’s Boss by Dr. Joel Minden and Feeling Good by Dr. David Burns

 

 

When Gratitude Gets in the Way

While research on the effectiveness of gratitude interventions appears mixed, there’s a shared wisdom that being thankful for what you have is good for you. Most of us have had experiences where something stressful happens (e.g., a minor car accident, an argument with a friend), and we gain perspective by stepping back and appreciating the positive aspects of our lives.

But I’ve also observed instances when gratitude gets in the way. I’ve had friends and therapy patients start to talk about something that bothers them and then they cut themselves off and say, “But I know other people have it worse, so I shouldn’t complain.” I get the impulse–I do it too. I think it serves the purpose of displaying self-awareness or maybe mitigates fears that you’ll be judged as having petty concerns or maybe you think telling yourself that will make the feelings go away. To be sure, there are times when people could use a more zoomed-out perspective and appreciation for their lives. However, I’ve observed this approach hindering progress and worsening well-being too.

The pattern is usually that a person experiences distress, they try talking themselves out of it being a big deal, and then they end up avoiding actions that would actually help them feel better and improve the situation (e.g., leaning on a friend for support, doing something healthy like exercising, gaining clarity about painful emotions, problem-solving, going to therapy). If you’ve tried to address a situation by telling yourself that you should be more grateful and the feelings persist, it’s time to try something else. It doesn’t mean that you’re an ungrateful person for recognizing that you’re bothered by something despite all the people who have worse lives (and by the way, many of the people I’ve heard say this have had objectively terrible things happen to them!). It just means that you’re human and affected by the events surrounding you. Acknowledging your experiences and directly addressing them is a healthy way to deal with them and not an act of self-indulgence.*

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*I think it’s really hard to make any general statements when people can be all over the spectrum of gratitude and stress responses and vary from situation to situation, but thought I’d write this out for people who happen to fit into this kind of scenario.

 

 

A Note on the Tragedy at Douglas High School

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All school shootings are heartbreaking. The one at Marjory Stoneman Douglas High School hits close to home. I grew up in the town neighboring Parkland. I have seen many of my friends from high school express similar sentiments: Douglas was our “rival” high school, but we all got to know each other in middle school and were friends. We hurt for our friends. Most of us still have connections with the area. Our family and friends live there. We can vividly picture the details revealed in the news because we’ve been in those locations. Most of us remember being there without fear that a mass shooting like this could ever occur.

For parents who lost their children in the shooting, this must be an absolute gut-wrenching nightmare. I hear my parent friends saying that they worry about mass shootings when they send their kids off to school. The things that they used to tell themselves to reduce their worry (e.g., we live in a safe town, the school prepares with active shooter drills, the school has security in place, armed resource officers are on campus) start to lose their power when a mass shooting like the one at Douglas happens. The fact that school shootings are statistically rare in an individual risk sense provides little comfort to concerned parents. All children deserve to go to school in safe places, and parents shouldn’t feel like they’re putting their kids in harm’s way simply by sending them to get an education.

For the family, friends, and people directly affected by gun violence of all kinds…no words suffice. I have nothing but compassion, sympathy, and motivation to do my part to address this painful problem. The loss of a child is unfathomable, and I send nothing but love your way. I will conclude with two suggestions for coping, in case they’re helpful to anyone.

Connect

In the face of painful emotions, it can be tempting to withdraw and isolate oneself…to avoid processing or thinking about hurtful realities. While taking time to oneself and breaks from tragic news are components of healthy coping, it’s important to balance that out with taking time to connect with others about your feelings. Interpersonal connections are crucial to good mental and physical health. Communicating with others during stressful times helps to remind us that we’re not alone in our experiences, that we have people who we can depend on, and that there are many kind people out in the world. The American Psychological Association’s press release provides additional resources for coping in the face of this tragedy.

Contribute

This Twitter thread spoke to me. It says that we must act in the face of tragedy 1) to reduce the number of people who are victims in the future and 2) to show our children that we care enough to keep trying. When we take action, it can provide hope in times of despair – for ourselves and for others. Over 10,000 people have already joined a Mobilizing Marjory Stoneman Douglas Facebook group. Over 100 mental health professionals in Florida have said they’re willing to donate time to provide therapy for Douglas students and their families. There is a benefit concert being organized to help victims’ families. There is a fund to help Marjory Stoneman Douglas victims. Students and teachers who survived are courageously speaking out, organizing groups, and planning rallies and marches. People are pulling together to contribute what they can with their diverse resources and talents.

Let’s remember these students and staff and find ways to honor them. Let’s lean on each other for support in the wake of this tragedy.

10 Tips for Writing

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Raymond Tucker, a clinical psychology graduate student at Oklahoma State University, suggested the topic for this blog post and co-wrote it with me.

The late A. P. J. Abdul Kalam, former physicist, aerospace engineer, and president of India once wrote, “Writing is my love. If you love something, you find a lot of time for it. I write two hours a day, usually starting at midnight; at times, I start at eleven.” For me (Ray), this sounds about right… well…. not the first half of the quote… or most of the second half actually… well, really just the starting at midnight part is spot-on. My association with writing during graduate school may not be quite so romantic. Hours of fumbling over sentences, second-guessing work, and responding to endless amounts of track changes, red pen scribbles, and obscene suggestions made by Reviewer 2 (it’s always Reviewer 2) has, at times, left me considering the option of hurling my laptop out of our third story laboratory window.

However, developing skills as an efficient writer is of the utmost importance for a young scientist. It is the goal of this blog post to detail some writing “tidbits” to help young scientists become disciplined writers. Honestly, our goal could most easily be accomplished by telling you to read Dr. Paul Silvia’s book, How to Write A Lot. His book details common misconceptions about writing and important characteristics of highly successful writers. Our hope is to cut some of Dr. Silvia’s thoughts into easy-to-digest chunks, as well as add some insight of our own.

  • Schedule your writing time and guard it ferociously. Schedule when and where you will write. Although this simple scheduling can help you stay more disciplined (even if only 15 words make it onto your Word document), this tip is only helpful if you guard your writing time. Treat it like a meeting with your laptop that simply cannot be rescheduled. Would you cancel a meeting with the Dean? Nope! Heck, name your laptop Dean if that helps. Just guard this time.
  • Writing does not always need to occur in one sitting or during large periods of time. It is easy to get in the habit of saying things like, “I do best when I can sit down and just write the whole paper.” This may feel true, but likely is not. Writing every day, even for 10, 15, or 30 minutes helps keep information fresh in your mind and prevents the dreaded procrastination writing binge that can negatively impact the quality of work produced. Dean Laptop will appreciate more consistent, short periods of attention in comparison to sporadic, long work dates.
  • Know that you are likely to inaccurately predict how long your writing task will take you to accomplish, and just write when you can. This definitely goes along with the previous point, but does expand by noting that predicting time needed to complete a writing task is an imperfect science. One way of behaviorally avoiding a writing project includes feeling like it will take forever to finish and that you need to block off a large chunk of time to write. The opposite can be true. Putting off a writing project because you believe it will only take an hour or two may be another way to avoid buckling down with Dean Laptop and crossing off a project on your to-do list.
  • Be prepared for additional writing time. If you are a graduate student, you know the life of 101 meetings with professors, mentors, clients, and supervisors. These meetings are with pretty busy people which result in them occasionally getting canceled. Always take your writing to meetings or times you work with a client in case you wind up with some unexpected free time. Dean Laptop is highly mobile and enjoys your unexpected company.
  • You learn to write from BOTH writing and reading a lot. This is a sentiment that has been expressed to me (Ray) by advanced graduate students and leaders in the field. Of course, you learn from receiving feedback on your work, but you also learn to write by reading the works of others, especially those who are more advanced than you. I especially appreciate Dr. Thomas Joiner’s advice to make a habit of reading outside of your discipline. This not only helps you develop innovative research ideas, it potentially exposes you to very different writing styles. Read outside of your discipline, not only for content, but for writing structure and style. Dean Laptop is not only a great place to save your written work, but pdfs of others’ works as well.
  • Know that writing distractions can take many different forms. Writing procrastination is definitely a shape-shifter. Sometimes its disguise is fairly easy to see through, taking the form of Netflix binges, texting, and knee-jerk tweeting, pinning, Facebook creeping, and Instagramming. These distractions/procrastination vehicles can be pretty easy to spot. Sometimes the writing procrastination shape-shifter brings its A-game. Nitpicking outlines, fiddling with fonts and formats, and believing that you have not read enough yet to begin writing are all potentially shapes of this behavioral avoidance of the nitty-gritty task of writing. Reflecting on how you might avoid writing can be important. Below are some of our personal ways of avoiding quality time with ol’ Dean Laptop:
    • “I write best when I am at the coffee shop. I will have to go there to finish this.”
    • “I can definitely write with Orange is the New Black on in the background.”
    • “I don’t feel inspired to write.”
    • “My laptop is almost out of battery.”
    • “I haven’t printed out the Gordon et al. (2010) article yet.”
    • “I will write this weekend.” HA!
    • “I am feeling (insert psychosomatic complaint). This wouldn’t be my best work.”
  • Understand that struggles during the writing process are common and that perseverance is key. It’s important that you don’t misinterpret the experience of having difficulty with writing as an indication that you are incapable of writing well. To the contrary, many award-winning, accomplished writers have openly discussed the challenges they have faced. For example, Felicia Day wrote about the process of writing her award-winning web series, The Guild, in her New York Times bestselling book You’re Never Weird on the Internet (Almost).

Every second of writing that script felt like walking barefoot over shards of glass. I would write a bit and then I would sob, wanting desperately to erase what I’d just written…Then I would force my fingers to type more, every word feeling like I was bleeding from every orifice. I was engulfed with fear of making mistakes, of writing something stupid…I was, in short, terrified of the process. It was not fun. What drove me to continue? Sheer obstinate grit. (pp. 142-143)

Similarly, Ta-Nehisi Coates said that during the process of writing Between the World and Me, he felt “total despair” and thought, “I am about to fail and everyone will know it.” He stuck with it, and Between the World and Me went on to become a New York Times #1 Bestseller and earn a National Book Award in 2015. Coates also won a MacArthur Genius Grant in 2015 for his work. Coates shared more of his advice on writing and struggles with the process here and here.

  • Remove obstacles caused by perfectionism. There is an old saying, “Perfect is the enemy of good.” I (Katie) try to keep this in mind as I write. In particular, this means that I start typing what I am going to write well before the sentences are formed “perfectly” in my head, knowing that effective writing is typically the result of a process that involves multiple revisions rather than the first thing that comes to one’s mind on a topic. Secondly, I set time limits on my other tasks (preparation of teaching materials, responding to e-mails, blog posts) that allow for high quality (but not perfect) work, so that I can protect and prioritize writing time.
  • Use exposure to overcome writing anxiety. Worry about writing can come from multiple sources. The biggest areas of anxiety for me (Katie) come from a concern about being unable to complete a project and worry about other people (e.g., co-authors, reviewers, etc.) not thinking my work is good enough. When anxiety strikes, our urge is usually to avoid – avoid writing, avoid sharing your work with others, etc. The most effective way I’ve found to counter this anxiety has been to treat it like I would clinically – repeatedly put myself in these situations until they don’t feel as scary. Putting myself in positions where I need to complete projects with tight timelines and share my work with others teaches me that I can, in fact, handle these aspects of writing, even when it means receiving criticism of my work and other types of pressure.
  • Create interpersonal accountability for your writing. Publishing is often viewed as one of the main responsibilities for academics, and yet, it can be the hardest activity to get to in light of the clearer expected timelines for other responsibilities (e.g., meeting with students, teaching). For me (Katie, again), one of the most helpful strategies has been to work collaboratively with others who are expecting writing from me within a specific time frame. Setting these dates and goals, particularly when others are aware of them, increases my motivation to find the time to write despite all of my other responsibilities. This group can be other grad students, professors, co-authors, or just other individuals who have projects where they benefit from checking in with others. I often use this strategy with my lab group.

By no means are all of these suggestions easy to accomplish. Just like any good skill, practice is key. We hope you can test drive some of these tips and see what helps you become an effective and disciplined writer. We wish you the best of luck in your academic pursuits!

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Ronda Rousey’s Fight with an Eating Disorder

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I recently read Ronda Rousey’s book My Fight/Your Fight. In case you’re not familiar with her, I will list a few of her accomplishments: she is a former UFC champion, an Olympic bronze medalist in judo, and an ESPY Award recipient of both the Fighter of the Year and Best Woman Athlete awards. A few of the personal reasons that I connect with Rousey’s story are that I also started judo as a young girl and am a black belt in it (unlike her, I am not currently in my prime fighting condition); I, too, moved from a warm-weathered coastal city to a smaller town in North Dakota; and, like her, I really value authenticity both for myself and in other people. I admire Rousey for the numerous difficulties she has overcome, her position as one of the most dominant athletes of all time, and the barriers that she broke through by not letting people stop her from pursuing her dreams in a male-dominated field.

The two aspects of Rousey’s book that are most relevant to our lab’s research are related to her father’s tragic death by suicide and her past with an eating disorder (she reportedly had bulimia nervosa that began when she was an adolescent). Rousey speaks openly and compassionately about her father and how his death by suicide impacted her. I recommend reading about it in her own words in detail in her book or briefly in a piece she wrote at this link. Here, I will focus on three points about eating disorders from her book:

  1. There is a common misperception that people with bulimia nervosa are fragile.  I can’t imagine that anyone would describe Rousey as anything other than exceptionally mentally and physically tough. You can see it in her judo matches and UFC fights. She is remarkably resilient despite the numerous hardships she has experienced (born with her umbilical cord around her neck, overcame a significant speech problem, lost her dad, and much more). Despite her obvious and immense strength, she suffered from bulimia nervosa for years before recovering. Her openness about her past helps to decrease public perception that eating disorders result from weakness.
  2. Rousey offers insight into the factors that she believes contributed to her eating disorder, and they are consistent with what we know from scientific research. Being an athleteholding perfectionistic standards, feeling dissatisfied with her body, having low social support (which she experienced when her bulimia nervosa started), and fasting (which Rousey did to make weight for competitions) all elevate the risk for developing and continuing to have an eating disorder.
  3. In her book, Rousey states that she no longer binges or purges, no longer fasts to cut weight, that she typically maintains a healthy weight (rather than striving for an unhealthy low competition weight, as she did in the past), and that she now has a positive view and appreciation for her body. Like Serena Williams and other female athletes, people have attempted to criticize Rousey’s body by saying that she looks masculine. She responded to this by saying that her body was “badass” and “there’s not a single muscle on my body that isn’t for a purpose…” She raised money for a charity that focuses on mental health issues including body image, and her positive message about body image is spreading. Beyonce played the speech where Rousey said these things during a performance, and Demi Lovato (who also recovered from an eating disorder) has also expressed admiration for Rousey. There is hope for recovery and thriving after an eating disorder. If you or a loved one needs treatment for an eating disorder, there is help available: 12, 3, and 4.

I will conclude with a fun fact for us folks who live in North Dakota. Ronda Rousey’s first full sentence was, “I like North Dakota more than California.” (p.18 of her book)

Grandma & Science Agree: Social Connections are Good for Your Health

There’s an expression in academia that goes something like, “You don’t really understand something unless you can explain it to your grandmother.” The implication is that you should comprehend something so deeply that you can then transform your knowledge into such a simple explanation that even your grandma would grasp it. Understandably, some view this particular saying as insulting to grandmas. I laugh when I hear it, because my grandma is one of the most knowledgeable and intellectually-interested people I have ever met. So, for me, explaining something to my grandma is quite easy. Frankly, she does most of the work for me.

In honor of her birthday, I thought I’d share a major life lesson that my grandma has explained to me, rather than the other way around. My grandma is the type of person who really listens to people when they’re talking, pays attention to their stories, empathizes with them, and strives to connects fully with them. She makes an effort to nurture relationships with family and friends like no other person I’ve met. She took each of her 11 grandchildren on vacations just to have quality time and make special memories with all of us. Every other year, she rents out rooms for all of us near the ocean so that her children, grandchildren, and now her great-grand-children, can get together from different regions of the country and spend time together. She flies around the country to attend graduations, weddings, and school plays. She keeps in touch with friends and neighbors who she met decades ago through letters, phone calls, and Skype.

Anecdotally, these efforts seem to be very beneficial for our family’s health. Scientific research suggests that my grandma’s approach works for others too. Our lab’s research tends to specifically focus on the detrimental effects of loneliness and social isolation as related to poor mental health outcomes, particularly disordered eating and suicidal behavior. Research suggests that physical health is impacted by these factors as well. For example, a recent meta-analysis examining data from 70 different studies revealed that people who experienced loneliness and social isolation had a greater risk of dying during study follow-up periods than individuals who reported lower levels of loneliness and social isolation (the average follow up period was ~7 years). Importantly, the effects existed even when statistically accounting for other important factors, such as having health problems at baseline and smoking. The authors concluded, based on the evidence, that loneliness and social isolation should be listed as risk factors for public health concern along with other typically identified factors such as physical activity, diet, and substance abuse.

I’ll conclude by saying, thank you, grandma, for explaining it in a way that this academic could understand. Science agrees with your wisdom about the importance of nurturing relationships for a healthy life, and I am thankful to have a strong role model in mind as I try to understand and alleviate loneliness through my work.

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Cracked, Not Broken: Surviving and Thriving After a Suicide Attempt by Kevin Hines

I have known some aspects of Kevin Hines’ incredible story of surviving a jump from the Golden Gate bridge since I saw the documentary The Bridge in 2006. He has since become a powerful mental health advocate and well-known speaker. When I heard that the North Dakota Chapter of the American Foundation for Suicide Prevention had invited him out to speak in Fargo this year, I was absolutely thrilled.

When I saw his talk last week, I was moved by Kevin’s honesty, depth of knowledge, compelling storytelling, compassion, humor, and message of hope. Eager to learn more about his story, I bought his book, Cracked, Not Broken. The book impacted me on many levels, both personally and professionally. Here are four of my favorite aspects of the book:

  1. Kevin’s story is honest about what it’s like for him to live with a chronic mental illness (bipolar disorder). I feel that people who misunderstand the nature of mental illness might believe that once something as dramatic and miraculous as being a rare survivor of a Golden Gate bridge jump occurs, a person has restored hope, and all is well. Kevin makes it clear that the struggle did not end there. At times, he continued to experience suicidal ideation and other symptoms to the point of needing hospitalization in the years following. His perseverance and ability to thrive through continued struggles is inspirational.
  2. His description of a mental disorder as something that a person has rather than something that a person is is very effective and will certainly help me in communicating this message to students and clients in the future. For example, Kevin talks about how he did not want to die by suicide, but his mental illness took over and led him to think and believe things that were untrue.
  3. Societal stigma contributes to the desire to deny that we ourselves or people we care about are afflicted by mental illness, which creates obstacles to wellness. When courageous people like Kevin share their experiences, it makes others more comfortable with speaking openly and asking for help. In his book, Kevin says that it is likely that he would have been functioning better sooner if he followed the mental health treatment plan given to him after first being diagnosed. There were many factors that most of us can relate to that contributed to his denial (as he refers to it), and I think this is helpful for generating compassion for loved ones and clients who struggle with acceptance too.
  4. Expanding on my first point, stories of change and success are often oversimplified. They are boiled down to one key magical element that forever changed a person and the course of their life. Kevin tells his story in a manner that accurately reflects the complexity of living with mental illness. He highlights the many factors that maximize his chances of thriving (e.g., medication, therapy, adequate sleep, healthy eating, regular exercise, not using alcohol or nonprescribed drugs, social support, his faith). Kevin talks about how much work it is for him to stay well and that despite his commitment to wellness, outside factors sometimes interfere (e.g., a medication stops working). He has plans for dealing with those situations too (e.g., reaching out to a trusted love one, going to the hospital). I wish it wasn’t so hard to stay well for people afflicted by mental illness, but I appreciate Kevin’s honesty about the numerous factors involved.

If you get a chance to see Kevin talk, I highly recommend it. You can also see some of his presentations by searching his name on youtube. His book is available on Amazon. I’ll close with a music video for a song that I learned about from his book. It’s based on his life, and he is featured in the video:

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We Should Talk About Mental Health Out Loud

A graduate of our lab, Betsy Sand, recently sent me a thoughtful e-mail about an obituary that is being shared widely through social media. What struck Betsy (and then me) was that the obituary explains that a 22-year-old man, Clay Shephard, tragically died a week and a half ago due to a drug overdose. This is unusual, in that many times when an individual’s cause of death is related to a mental disorder, the cause of death is not listed at all or only acknowledged in a vague way (e.g., s/he died at home). Not only does this obituary include the cause of Shephard’s death, but it also details the struggles that his family experienced as they tried to help him. Like most obituaries, they describe his strengths, accomplishments, and what they’ll miss most about him. They conclude, “To all children, this note is a simple reminder that there are people who love you, with everything they have and no matter what you do – don’t be too afraid/ashamed/scared, too anything, to ask for help. To all parents, pay attention to your children and the world that revolves around them – even when the surface is calm, the water may be turbulent just beneath.” The full obituary is online here.

People are responding in a variety of ways to the openness of Shephard’s family. Personally, I am moved by their honesty. I admire their courage and efforts to decrease stigma about mental disorders even as they grieve and make themselves vulnerable to public criticism (and, fortunately, also open to public support).

The title of this blog post is derived from a statement that one of my sisters told me about earlier this year. Dana Perry, Oscar-winning filmmaker of the documentary “Crisis Hotline: Veterans Press 1” said, “We should talk about suicide out loud,” during her acceptance speech. She dedicated the film to her son, who died by suicide. The film and acceptance speech make a compelling case that raising awareness through open dialogue is crucial to suicide prevention. If you’d like to see the speech yourself, she begins speaking at 1:37:

What gets in the way of talking about suicide and other mental health issues out loud?* Many people fear social disapproval and withdrawal of support from others. This is understandable. The prospect of criticism, backlash, and lack of support following the loss of a loved one must be incredibly painful. It doesn’t help that there are public incidents of this happening, such as the hateful messages that Zelda Williams received on Twitter after her father, Robin Williams, died by suicide.

Our lab (led by the thoughtful student that I mentioned at the beginning of this post) wanted to scientifically examine the impact of including mental disorder-related causes of death in an obituary. Participants in our study** were randomly assigned to read one of three fictional obituaries, which were identical except for the stated cause of death (i.e., cancer, drug overdose, or suicide). They were then asked to make some ratings about the deceased person. Here’s what we found: participants who read obituaries stating that suicide or drug overdose was the cause of death rated the deceased person as significantly more blameworthy, weak, cowardly, selfish, and sinful than participants who read the obituary that stated cancer was the cause of death. Keep in mind that the obituaries were identical except for the cause of death.***

The stigma is real. The fear of rebuke is supported by people’s experiences and backed by data (ours and others). I believe, as Perry said, that we need to talk about mental health out loud to reduce stigma. And I’ll slightly modify it to say that we need to talk about mental disorders out loud and accurately. One observation I’ve had with regards to perceptions of mental disorders is that when people are thinking about someone who is struggling, they often use themselves as a reference point. “I felt really bad in the past too, but I would never do that.”  The that can be drug use, binge eating, obsessions and compulsions, suicidal behavior, panic attacks, or a number of other things. Using ourselves as a foundation to understand others is not always the most helpful approach. In this case, while many people have experienced depression, most people have thankfully not been in a severely suicidal place or directly observed it in another person. As I’ve learned and interacted with more people with mental disorders through my work, I have no doubt that their mind and body are not functioning in a way that most mentally healthy (or even people with relatively less severe mental disorders) could even imagine. Mental disorders have an incredibly powerful influence on the mind and body (e.g., intense physical agitation in the case of acute suicide risk), especially when the disorder is very severe.

One objection I hear to this notion is that I, and others like me, are arguing that people don’t have any will, responsibility, or choice in their decisions. Yes, people with mental disorders still have choices about their actions and those choices are strongly emphasized in evidence-based treatments (e.g., motivational interviewing). However, the science is clear that not all choices are equally easy to make for all people in all situations. One of several possible examples includes the fact that drug craving continues to occur in one’s brain even after the cessation of drug use, and that genetics affect how likely an individual is to try and enjoy drug use, physically making drug abstinence more difficult for some individuals as compared to others. If we understand the crucial truth about how mental disorders strongly influence behavior rather than misattributing it to character flaws of the afflicted person, then treatment can be more precise and effective. Just as many of us consider how medical conditions (e.g., traumatic brain injury) and certain mental disorders (e.g., schizophrenia) have the potential to significantly interfere with decision-making, I hope that increased awareness can lead to understanding the powerful influence of other mental health conditions.

The humility needed to acknowledge that we don’t truly know what we would do if we were in another person’s situation doesn’t come easy. It involves uncertainty and vulnerability. Death, perhaps especially by suicide or a drug overdose, is scary to most of us. Our natural reaction is to want to distance ourselves and our loved ones from being at risk for those similar situations. My desire for this as strong as it is for others, “Well, that could never happen to our family, because…,” but humility opens us up to looking beyond blaming mental disorders on a person’s character. This actually empowers us to see true risk factors and do our best to reduce the chances of similar fates in our loved ones to the extent that we can control. It allows us to listen to our friends and family in a more nuanced way, to more fully understand their suffering, and to understand what will actually help them.

Another major objection that comes up when someone calls for reducing stigma is the notion that we are arguing to deny the dangerous consequences of medical and physical conditions by telling people it is “okay” to be that way. That would be a complete paradox of my intent to improve people’s health with my work. The goal in removing stigma is to prevent additional suffering by tearing down obstacles to treatment. Those obstacles may be removed by basing judgments and actions on science rather than stereotypes. Research suggests that education helps to reduce stigma, but that in-person contact is even more effective. We can educate ourselves about mental disorders before making judgments, and I, like others in my field, believe that mental health professionals are responsible for making it practical for people outside of the field to learn accurate information about mental disorders. With regards to in-person contact, we all already interact with people who have or have had mental disorders, but often do not know it. If people speak out loud about mental disorders, then stigma would likely be reduced by virtue of the fact that we each know people with mental disorders who defy negative stereotypes.

As Thomas Joiner has pointed out, it is possible to retain the useful fear of suicide (e.g., death often involves physical pain, loved ones experience great emotional pain when they lose someone to suicide) while simultaneously diminishing the stigma that leads to being disgusted, repelled, or otherwise afraid of the person who has the suicidal thoughts. I believe this principle applies to other mental health conditions as well (leave the fear of the dangerous behavior intact but reduce the blame on the person for having a mental disorder). I have hope that we’re moving in a positive direction with decreasing stigma surrounding mental health. I hear my undergraduate students talking more openly about mental health than I remember from when I was in college, and there is some research that reflects this change too. I believe that more honest obituaries, such as the one that Clay Shephard’s family wrote, contribute to this effort by spreading truth about mental disorders.

If you or someone you know needs help, please visit our links page for resources.

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*I am talking about this in the context of seeking help and acknowledging the cause of death when it is related to a mental disorder. Some treatments for suicidal behavior (e.g., dialectical behavior therapy) recommend against talking about details of suicidal behavior in group treatment, and there are media reporting guidelines with the same intention of preventing triggers for individuals who are already suicidal. They emphasize not romanticizing suicide or discussing details about the method of the person’s death. They are available to read in full here. (Update: Recent research on media reporting guidelines challenges the notion that discussing specifics about suicidal behavior leads to increased risk. You can see the article here.)

**In an effort to make the post smoother to read, I have not included citations in APA format. However, my scientific claims are linked to articles that support them. Readers who are interested can click on them, or contact me for more information.

***Examples of some resources that dispel these myths about substance dependence, suicide, and psychology in general are available.

Humor & Mental Health

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Last week was hectic.  I was sleep-deprived and stressed out by the time Friday night rolled around. I was so drained that I very briefly considered going home to collapse in my bed instead of going to see the Daily Show Writers Stand-Up Comedy Tour. But, I went, the show started, and I laughed for 90% of the following hour (pausing only to breathe and to hear them introduce each other). After the show, I was happy and energetic. My mood and energy level transformed into complete opposite states within an hour.

This got me thinking about two things: 1) if you get the chance to see these comedians, do it – they are extremely funny, and 2) in light of my experience on Friday, I wondered if there was any existing research on humor use for emotion regulation purposes. There are a number of different ways that therapists use humor strategically with clients (e.g., irreverence and opposite-to-emotion action in dialectical behavior therapy, reframing in cognitive behavioral therapy), but few studies dismantle therapy components and examine humor specifically.

I did a literature search and picked three articles that met the following criteria: 1) they appeared interesting and applicable, 2) they were published relatively recently, and 3) they involved rigorous scientific methodology. I listed the main finding of each study below (click on the study for citation information):

These findings are exciting because, if replicated, they have the potential to help people understand how to use humor to improve their mental health in more precise, effective ways.

In conclusion, I will leave you with a video in case you want to try out any of the 3 points above:

Note: I was inspired to write this for Mental Health Month Blog Day, which is 5/20/15 this year.

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Body-Positive Playlist

My class created a body-positive playlist that you can access here.*

Eating disorder researcher and clinician, Dr. Christopher Fairburn, likened having an eating disorder to having a DVD play on repeat in your head. Once you are in recovery, the DVD can slip back into your head and influence your thoughts and behaviors. The key for relapse prevention is to work with the client to recognize when this happens, so that they can cope effectively. This is a simplification of the concept, but Dr. Fairburn said that clients really resonated with it, and that they often consequently felt empowered to “eject” the eating disorder DVD if they noticed it was in “play” mode again. He said that one major way that clients do this is by seeking social support (e.g., planning an activity with a friend) and through healthy distracting activities (e.g., going to see a movie). Dr. Fairburn also mentioned that some clients have found that having a body-positive music playlist helped them. I thought this was a great idea and asked the students in my Abnormal Psychology class to submit body-positive songs.

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*I have screened out songs and videos that may be offensive or inappropriate, but it’s possible that I missed some.  If you see a video that you find offensive or inappropriate, please let me know, and I will remove it.

If you are concerned that you may have an eating disorder, please seek help through information on the Links page or by e-mailing me at kathryn.gordon@ndsu.edu for referral information.