All of us have this tendency to focus on the negative. Living in this busy world, we often find that our thoughts are on worries, the things we need to do, where we made mistakes, and on and on. It’s one of the reasons why positive affirmations are considered a part of many depression treatments. By telling ourselves every day things like “I deserve to be happy,” we can restructure our minds to believe it.
Affirmations can seem silly to those that have not done them before, but the research into them – although limited – is largely positive. It’s a key component of cognitive restructuring. We, as therapists, often have people with anxiety and depression repeat these affirmations to themselves every day to essentially rewire their minds so that they learn to see the world in a more positive and hopeful way.
Starting Affirmations Early – Before They Are Needed
What some researchers are doing is looking to see if components of psychological treatments, like affirmations, can help not only treat different mental health conditions, but actually prevent them. To study this, researchers looked at one of the most at-risk populations for depression: college age women.
They had half of the group learn behavioral interventions that included positive affirmations, while another group acted as the control. They then followed up with his group at various intervals over the next 18 months. The group of college-aged women that utilized treatment tools like affirmations had lower depression scores and higher self-esteem across the board when compared to women in the control group, indicating that treatments like positive affirmations were powerful enough to potentially prevent depression and depression-like symptoms.
Are Affirmations Preventative?
Research into affirmations is limited. Even in the above study, affirmations were given with a variety of other behavioral interventions, so it’s unclear if affirmations alone would have had much benefit. Similarly, usually when performing a research study, it is better for the control group to have some type of inert treatment to compare it to. Since the control group had no treatment at all, it’s difficult to say if the existence of any treatment would have provided similar results, no matter what it would be.
But there is plenty of research to suggest that affirmations can actually be quite powerful, especially with our tendency to think negatively. Those that are looking to give themselves a positive mental health boost in their lives should consider seeing if daily affirmations can provide them with some help in boosting their confidence, happiness, and self-esteem.
In today’s world, there is often a societal focus on the effect of menopause on women’s mental health. But what is not often talked about is perimenopause, and the effects of perimenopause on mental health.
Menopause – the end of a woman’s natural fertile period – is typically between the ages of 45 and 55. It is marked by often drastic changes in hormonal levels that, at least during the transition period, affect how a woman feels both physically and emotionally.
But perimenopause begins much earlier. Perimenopause is when the body begins to have hormonal shifts related to menopause but are still often many years away from menopausal onset. Some women experience perimenopause as young as their late 30s, and most women will experience it by the age of 40 to 44.
During this stage, women are still able to have children and still having periods, but their bodies are experiencing hormonal shifts and changes behind the scenes as it prepares for menopause later in life.
Perimenopause Effects on Mental Health
Because perimenopause begins at a younger age – sometimes as much as 12+ years before menopause begins – many women have no idea that they’re experiencing it, and many doctors do not talk to women about their changing bodies. Perimenopause remains an often silent part of the culture.
So it can be surprising to women in their mid 30s to mid-40s when they begin to have mental health symptoms they did not have before:
Anxiety
Depression
Trouble Sleeping
Mood Swings
The degree and severity of these symptoms differ from person to person, and lifestyle and experiences still play a role. But if a young woman in her late 30s/early 40s starts to notice that they’re feeling more anxious, or they’re having hot flashes, or they simply do not feel as emotionally healthy as they did before, it is possible that perimenopause may be to blame.
Other Factors to Consider
Now, during this same phase, women may be undergoing changes in their lives that may also have an effect on mental health. Many women have children by about 40 which adds stress to one’s life, and that is an age when there could be stresses with marriage or career that might be affecting a person’s mental health. Similarly, changing bodies can come with their own stresses, as reminders of aging and decreased fertility can affect health and wellness as well.
The Perimenopause Age and Mental Health
It is not always clear if anxiety, depression, or other mental health issues are the result of perimenopause, affected by perimenopause, or developed entirely independently. But what is clear is that it can be a stressful time, and those same mental health issues can affect someone’s ability to feel comfortable and confident within themselves.
Even mental health issues that are caused directly by hormonal changes can be addressed using psychotherapy, which is why it is so important for anyone that feels like they’re struggling to control their emotions, no matter their age, consider working with a trained psychologist or counselor. No mental health issues need to be permanent, and while it is useful to be aware of what perimenopause can do, it is also useful to treat it.
Many people with panic attacks develop a condition known as “agoraphobia,” which is best described as a fear of being out of the home or in places that are unfamiliar. One of the reasons that people with panic disorder may develop agoraphobia is because they start to avoid places where they feel like they might have a panic attack.
For example, if they have a couple of panic attacks while in the mall, they may stop going to malls. If they have it in a restaurant, they may stop going to restaurants. Over time, they become limited to very few places, and some people have a trauma response that makes them not want to leave their house at all.
But the problem is not just that people start to avoid places because they’re afraid they may have panic attacks. The problem is that they are often correct – if they did choose to go to a place that they feared, they would be very likely to have a panic attack. That is because panic attacks are self-fulfilling in a way that is caused by the symptoms of the attacks themselves.
How Panic Attacks Become Self-Fulfilling
Panic attacks are intensely physical anxiety events. When a person suffers from a panic attack, they often have rapid heartbeat, chest pains, light headedness, and a series of physical symptoms that can be so severe, they can be genuinely convinced that something is wrong with their health.
Because panic attacks are such overwhelming physical events, a symptom of persistent panic attacks is known as “self-monitoring.” People with panic attacks tend to pay attention to how their body feels at any given time in order to see if a panic attack is coming. If they start to feel the symptoms of a panic attack, it will often cause distress and anxiety – which then contributes to the attack.
In addition, people with panic disorder also develop what’s known as “hypersensitivity.” That means that they feel things stronger than other people do. While most people might not even notice a small pain or bit of discomfort, a person with panic attacks will not only notice it, but will feel it stronger. Both of these symptoms are also more likely the more anxious a person feels.
That is how panic attacks become self-fulfilling and reinforced. Let’s use the example of library.
Someone with panic attacks is worried they may have a panic attack at the library.
Because they’re worried, they’re a bit more anxious.
That anxiety causes them to experience a very mild sensation somewhere on their body.
Because of their hypersensitivity, the symptom feels worse than it otherwise might.
Because of their self-monitoring, they always notice it immediately.
That causes them to experience strong anxiety, worried a panic attack or worse is coming.
That anxiety triggers a panic attack.
Now their fear of going to the library is reinforced, and they may not go anymore.
This cycle can occur to anyone, even those without agoraphobia. Eventually, many people with untreated panic disorders will start to avoid places because of fears they may have an attack, or they may experience attacks more often because they have become self-fulling when they are out and about.
How Do You Stop the Self-Fulfilling Nature of Panic Attacks?
There are many ways to approach panic attacks and panic disorder, and you and your NYC therapist at Flourish Psychology will work to find the approach that makes the most sense for you. We may deploy treatments like cognitive behavioral therapy (CBT), rational emotive behavior therapy, gestalt therapy, positive psychology, and more.
CBT, specifically, is often used to treat panic disorder, and many of the treatment approaches are specifically about addressing these issues:
Monitoring your body for sensations.
Misinterpreting those sensations.
Avoidance behaviors.
Many psychologists have identified these issues as some of the main reasons that panic attacks keep recurring. So, your therapist will provide you with actions that you can take to address these issues. Some of them may be uncomfortable – for example, you may have to put yourself “at risk” for a panic attack again as you stop avoiding places that caused them.
Your therapist may even have you mimic some of the same symptoms that you’ve had before that have triggered panic attacks. For example, if you get dizzy with panic attacks, you may be asked to make yourself dizzy so that you can learn how to calm yourself when you experience those sensations.
The approach that we take will be based on your specific situation, but much of addressing panic attacks comes from breaking this self-fulfilling panic attack cycle.
Depression can happen to anyone. It is a condition that can occur gradually, as a response to life trauma or inability to cope with stresses. It can also occur suddenly, after a major loss or struggles at work or in a relationship. As therapists for depression in NYC, we know that there is no “type” of person that may struggle with depression.
Yet the data does show that lawyers experience depression more so than nearly any other profession. As many as 28% of lawyers show signs of depression – more than 1 in 4, a 400% increased risk compared to the general population – and many others experience work stress and anxiety that could lead to depression someday.
The data is clear: lawyers have a higher rate of depression than almost every other career. Understanding why this may occur is one of the first steps toward addressing it.
Risk Factors for Depression in Lawyers
Because depression can happen to anyone, there is not necessarily a single reason that attorneys may be more prone to depression, or a single cause that can be identified in order to address it. But there are many factors that are likely at play, and any combination of these can be a contributor.
Binary Success – One reason that lawyers can struggle with depression is because the career itself is based on binary success. You either win, or you lose, with rarely much middle ground in between. You’re constantly in competition with someone else, and – depending on your specialty – someone’s money, health, or life may be directly tied to you winning. Even the best lawyers lose cases, and that can hit people very hard.
Peer Competition – Similarly, many lawyers feel in constant competition with their peers. Not only is that true in the courtroom, where you are tasked with trying to “beat” someone as part of your role, but also those that are trying to grow their practice are in competition for clients and revenue. Those comparisons and that competition can lead to a considerable amount of stress.
Financial Concerns – Though not true of every specialty, most lawyers receive payment at seemly random times, going for months – or sometimes years – before getting paid for a case that you’ve been working on. That inconsistency means a lot of challenging times financially, navigating banks and debt to pay your staff before hoping that you receive payment on time.
Lack of Sleep – Sleep is critical to our mental health. Many lawyers struggle with sleep, either because they’re working too late at night or they are heavily focused on their cases and struggling with insomnia. No matter the cause, a lack of sleep makes people more prone to depression.
Lawyer Characteristics – The same strengths that draw people to the legal profession may also make them more prone to depression. For example, “perfectionism” is a common quality of those drawn to law, and perfectionism is considered a risk factor for depression. This would mean that there may be some self-selection involved in why lawyers experience depression.
These are only some of the many reasons that lawyers may be more prone to depression. Drug and alcohol abuse and relationship issues are also more common among lawyers, both of which also put people at greater risk of depression.
The Challenges of New York City
Lawyers all over the United States are going to be more likely to have depression based on that factors outlined above. But we are in NYC, and here in NYC, these same pressures are multiplied considerably. Manhattan and Brooklyn are home to some of the most “high powered” lawyers in the entire world, and that means that attorneys here face tough legal battles, bigger stakes, and even more pressure to compete and succeed in this environment.
Depression Therapists for Lawyers in NYC
Flourish Psychology has a team of carefully selected NYC therapists led by Dr. Sadi Fox. Our private practice recognizes your unique experience as an individual, and seeks to use the best possible treatments to support a recovery that is sustainable and actionable for your long term mental health. Contact Flourish Psychology today to schedule an appointment.
We hear many people say that “the mind and body are connected.” We often feel this in ways that are hard to describe but noticeable when we see it. There are some situations in which this link is incredibly apparent, such as the way that many of us feel “depressed” when we are sick with the flu, or the way we feel generally unwell when we feel sad or nervous.
But we’re still discovering ways that our bodies and minds are linked – often ways that we still do not fully understand, but can prove nonetheless. One such example is the way that over-developed and under-developed muscles, especially in the core and posterior chain, can lead to developing some fairly significant anxiety symptoms.
How Could Muscle Development Affect Anxiety?
We spend a lot of our time leaning forward. We slouch when we sit and watch TV. We slouch forward in the car. We slouch forward when working on our computers. Now, with smartphones, we even slouch forward when we walk and stand. We also do all of this while we exercise less and – even those that do go to the gym – tend to focus on the most visible muscles, such as the chest, the abs, and the biceps.
What’s happening to many of us is that some of our muscles are tightening and overdeveloping – often in the front of our bodies. On a physical level, this can cause all sorts of challenges, such as a hunchback and back pain as we age. If you feel like your lower back is often achy or your shoulders are frequently tense, that is an example of what these issues can cause.
Entire textbooks have been written about the ways that this affects our body – causing our muscles to not communicate properly, increasing stress on the nerves, and so on. But our focus here is on how these underdeveloped muscles can cause anxiety, and one of the many ways they do this is by causing dysfunctional breathing.
When your front muscles are tight and your back and core muscles – especially those on the back side of your body, like the glutes – are underdeveloped, it leads to poor posture and shorter, shallow, and less consistent breaths. These breathing pattern problems lead to a host of different issues, most notably, hyperventilation:
We breathe in too much oxygen.
We breathe carbon dioxide out too quickly before we have a chance to make more.
We *feel* like we are not getting enough oxygen, leading to attempts to draw in more.
We start to experience lightheadedness, rapid heartbeat, and other symptoms as our bodies need a certain carbon dioxide/oxygen balance to work efficiently.
If you’ve ever had a panic attack before, some of these symptoms will sound familiar. That is because hyperventilation is a key part of a large number of panic attack symptoms. Without the right oxygen balance, our bodies also become stressed.
What happens next?
When our bodies our stressed, we start to experience more anxiety and stress as well. Sometimes, this can lead to full-blown panic attacks. But even in those that are not prone to panic attacks, it can make us feel more stressed and anxious generally – even though we may not entirely understand why. When we’re faced with other types of stress and anxiety, they may also feel more severe, as our bodies are already starting from a more anxious baseline.
All of this because of posture and muscle strength.
Does This Mean a Gym Will Cure Anxiety?
We now know that our posture and our muscles are linked to issues like breathing and anxiety. But does this mean that all we need to do to reduce it is to go to the gym and work on our squats? Will strong glutes cure anxiety?
Typically, no. Once we have developed anxiety, poor breathing habits, and other mental health challenges, we often need professional support in order to learn to manage them effectively. Similarly, while we know that poor posture and poor muscle development can lead to anxiety and stress, we also know that anxiety and stress can lead to poor posture.
People with depression, for example, are far more likely to slouch their shoulders and hunch their back. This postural change ends up causing tighter muscles in the front of the body and weaker, stretched muscles in the back, leading to poor breathing habits. But in this situation, the depression came first. Exercising our muscles could theoretically help relieving some of the symptoms, but the depression would still be present.
Still, it’s important to recognize that our lives benefit from holistic healthier living. When we take care of our minds and our bodies, we are more likely to see an improvement in our quality of life.
Cognitive behavioral therapy, known as “CBT,” is considered the gold standard psychological treatment for several mental health conditions. CBT is especially effective for anxiety. At Flourish Psychology, we believe in creating a personalized approach to treating all mental health conditions, but for many of our patients, CBT is the best primary treatment choice.
But why is CBT so effective?
Benefits of CBT – What it is and Why it Works
CBT has been extensively researched by universities across the United States. It has been the primary therapy choice on the West Coast for decades. Other therapeutic modalities remained more popular in places like NYC and Brooklyn, like psychodynamic theory, but recently CBT has overtaken them as well as the top choice for most psychologists.
Cognitive behavioral therapy isn’t one specific approach, but rather many different strategies that are all related to addressing cognitions (thoughts) and behaviors. Guided by your therapist, you’ll use strategies that include:
Identifying behavioral patterns.
Challenging thought accuracy.
Creating goals and problem solving.
Activating emotionally healthier behaviors.
Learning relaxation techniques.
Within these are even more techniques and strategies, such as reducing “fortune telling” behavior, journaling, interventions for emotional reasoning, and more.
What makes these techniques so effective is that they are directly related to the thoughts and patterns commonly associated with all forms of anxiety, and they provide those solutions with other benefits that include:
Faster – While there is plenty of benefit to seeing a psychologist for ongoing treatment, CBT itself can provide faster results than almost any other studied form of psychology.
Goal Oriented – You and your anxiety therapist will be specifically trying to reach measurable goals, and will be able to see and track your progress along the way.
Present Focused – There is benefit to talking about your past and future. But when you need help now, what matters most is a present-focused approach, like CBT.
Anxiety itself affects the way people think and act in ways that contribute to even more anxiety. CBT addresses these directly and head on.
Above all else, CBT is evidence-based. This is a form of therapy that has stood up to rigorous psychological testing, so we can deliver CBT with confidence when we treat our patients here in NYC.
About CBT Therapy with the Brooklyn Therapists at Flourish
What matters is your recovery. CBT may be the gold standard, but maybe your specific treatment needs silver or platinum. Our goal is to talk to you to identify what approach makes the most sense for addressing your struggles and your needs.
But there is no denying that for anxiety CBT is one of the best ways to support our patients, and our therapists at Flourish Psychology can provide CBT in ways that encourage your recovery and help you move forward in your life. Learn more about Flourish by contacting our team today.
Location: 300 Cadman Plaza West Floor 12 - Brooklyn, NY 11201
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