By Annika Miyamoto

• We drink to celebrate

• We drink after a bad day

• We’ve even designated a special time during the day, recognized by all, known as “happy hour”

Like everything else, there are both positives and negatives associated with alcohol consumption which is a relationship unique to each person who partakes.

But sometimes we drink because we are bored, lonely, or just because. Before we know it we might have:

• gained some unwanted weight

• or experience an increase in daytime irritability due to poor sleep

• or in extreme cases have run-ins with the law because of alcohol

Any of this sound familiar?

Despite popular belief that being an “alcoholic” is an actual diagnosis, this is not true.

The Diagnostic and Statistical Manual 5th edition (DSM 5) which mental health folks use to guide diagnosis recognizes “substance use disorder” which encompasses a wide range of mind altering substances. To qualify for a diagnosis of substance use disorder, a person must meet a minimum of two criteria from a long list of descriptors. Depending on how many criteria points a person meets they qualify for mild, moderate, or severe levels of substance use. 

Abstinence is not the only route of treatment for substance use disorder due to alcohol (although may be most appropriate in extreme cases such as DUI or etc.). Just as each person’s relationship with alcohol is unique so is the treatment. In most cases, it is a personal choice as to how to approach one’s concerns about their alcohol use. Some folks explore specific environmental triggers that cause them to drink, some learn alternative coping skills to manage stress, while others choose to explore deeper emotional root causes. The closer the treatment mode reflects personal preferences the better chances for lasting changes in most cases. 

If you are wondering whether alcohol or other substances are becoming problematic in your life speak with your doctor or a mental health provider to discuss potential solutions. 

By Andrea Zorbas

You may of heard of the serenity prayer:

Grant me the serenity to accept the things I cannot change

The courage to change the things I can

And the wisdom to know the difference

Control is a central feature of anxiety. When we feel we have no control or little control, we often get anxious. When we break it down, we can only control some things and other things we have to let go. 

The next time you feel anxious, ask yourself: Is there anything I can do about x problem?

If the answer is Yes, then try to be pro-active with the problem. If the answer is No, then it’s time for you to practice acceptance of the unknown and having no control. The practice of letting go, which can be quite freeing. If you notice yourself ruminating, gently remind yourself there isn’t anything you can do, and to come back to the present. Being mindful can help alleviate those feelings of anxiety. 

By Neko Milton

Emotions about holidays can be a polarizing time of the year. While many embrace the festivities, others see this time as nothing but stress and anxiety. Often during the season of giving we are expected to don our Santa hats and participate in acts of selflessness. Well what about having some compassion for ourselves? 

Well what about having some compassion for ourselves?

Approximately 40% of adults are riddled with social anxiety around the holidays. Eating poorly and drinking excessively can also exacerbate issues like stress, anxiety and depression around the holidays. It is important to remember to take some time for ourselves. you may feel pressured to be everything to everyone. But remember that you’re only one person and can only accomplish certain things. Sometimes self-care is the best thing you can do — others will benefit when you’re feeling less stressed.

• Reflect on aspects of your life that give you joy

• Go for a long walk

• Get a massage

• Take time to listen to your favorite music or read a new book

All of us need some time to recharge our batteries. Be mindful and focus on the present rather than dwell on the past or worry about the future.

By David Shepard, Psy.D.

When someone is anxious or threatened their breathing speeds up in order to get ready for danger.

Other symptoms of anxiety could include:

• Sweating

• Rapid heartbeats

• Feeling hot

• Feeling afraid

• Difficult breathing

• Feeling lightheaded

• Trembling

• Tingling

One of the best ways to reduce anxiety is relaxed breathing

Relaxed breathing signals our bodies that it is safe to relax. Relaxed breathing is slower and deeper than normal breathing. It happens lower in body, coming from the belly rather than the chest.

So how do I perform relaxed breathing?

To start, it is bests to find a comfortable sitting or lying position. If you feel comfortable doing so, close your eyes.

Start to breathe through your nose rather than your mouth.

You want to deliberately slow down your breathing:

1. Breathe in to a count of 4

2. Pause for 2 seconds

3. Then breathe out of your mouth for a count of 4

To know if you’re doing it right, pay attention to what part of your body is rising. When you are breathing in, your stomach should be filling with air so it should be rising. Your chest should not be rising. As you breathe out your stomach should be coming in towards your body as the air is being pushed out of your body. A good way to monitor if this is happening is to put your hand on your stomach as you breathe in and out.

Aim to do relaxed breathing for 5 to 10 minutes.

How often should I do relaxed breathing?

Relaxed breathing can help decrease anxiety in the moment you are struggling with overwhelming anxiety. But it can also decrease overall anxiety if practiced regularly.

Doing relaxed breathing has also shown to help decrease depression and insomnia.

It is recommended to perform relaxed breathing at least once a day to help reduce symptoms of anxiety.

If you would like to learn more about decreasing your anxiety and becoming more relaxed, please contact us at Therapy Now SF to book a free consultation.

By Annika Miyamoto, MS

It is a common perception that a person with depression moves around in daily life with a sad face, slumped shoulders, and conveys an overall sense of having been defeated in life.

However, depression does not always present in this way and many folks might be surprised to learn that depression can manifest in many different ways.

Different ways depression can present

• Have you ever found yourself constantly irritable over trivial things?

• Feeling tired, sluggish, or just plain “blah” on a daily basis?

• Or have you ever felt so overwhelmed by life that getting out of bed in the morning is difficult?

Irritability or agitation and overall fatigue are symptoms that may indicate the presence of an underlying depression. Many folks who experience these symptoms with busy lives find ways to adapt or cope, sometimes in healthy ways (e.g., meditation) or not so healthy ways (e.g., alcohol, unhealthy foods), when the truth is that there may be a solution to these struggles.

Depression can be the result of a chemical imbalance within the brain and environmental factors as well. Environmental factors can especially have a significant impact in how a person feels even if they have never experienced depression before. For instance, a breakup with a romantic partner or a change in employment are just some of the events that can emotionally blindside us.

But it doesn’t always require a major life changing event to spark a depressive episode and it may be the result of a chemical imbalance in the brain or other physiological changes within the body.

What you can do

Recognition of symptoms is key!

• Consider making an appointment with your primary care physician and/or licensed therapist

• Read more about depression via the internet, books, or podcasts

• Get adequate sleep

• Eat well

• Exercise, even if it’s a brief 10-15 minute walk around the block everyday

• Avoid alcohol or substances as they can worsen depressive symptoms

• Be patient with yourself

By Pooja Mamidanna

Self-care? What exactly is it? I am sure most of us have heard either a friend, partner, family member, colleague, therapist, or a doctor use this word to us. Well the term self-care can be subjective to everyone based on how they decide they want to engage in their self-care. 

The way I educate my clients about self-care is the connection between the mind (mental/emotional), body (physical) and spirit (prayer/meditation). These are the essential domains of one self-care. So, it is important when we think of engaging in a self are activity we think of self-care as holistic component touching each of these three domains.

As I have gotten older over the years, I have realized the imperativeness of deliberately making time for myself, making this part of my daily discipline. I have a morning self-care routine ( that involves a 21 minute yoga/meditation practice as soon as I wake up and then I work out at the gym)  afternoon self-care routine ( where I take a 15minute walk around where I work during my break making sure I get some sunlight) and night self-care routine ( as soon as I come home from work  I take a really nice hot shower and I end my night before is sleep with a body scan/breathing exercise) .

These are a few essentials I educate my clients on that are important to keep in mind when thinking of self-care:

Technology is a big NO-NO

It is really important to pay attention how you start your day and how you end your day, most of wake up in the morning and the first thing we do is check our phone, or that is the last thing we do before going to sleep. Research shows that so much radiation is not good for your body, as the radiation that transmits from cell phones/all the electronic gadgets can increase one’s anxiety. It is important to engage in some relaxation activity when you wake up (helps set the tone of your day) and when you go to sleep (helps you relax).

Engaging in a healthy nutritious diet

We are what we eat, so in order to feel good we need to make sure our body is getting the right kind of nutrients in the food chain.

Getting Enough sleep

We need at least 7-8 hours of sleep, it is important we don’t use any technology 30 minutes before we sleep as the lighting can affect our sleep cycle.

Tips for healthy sleep hygiene.

Exercising

• walking

• running

• dancing

• sports

• gym

• hiking

• etc.

Tips for Mental Health Benefits of Exercise.

Engaging in any mindfulness activity that helps you learn how to be present in this moment

• Breathing

• walking

• art

• taking a hot shower

• reading a book

• cooking

• etc.

Tips for Mindfulness Activities.

Thinking about the positives when things are tough (focusing on what’s right) and not what is wrong only

Creating a gratitude list asking yourself to name three things you were proud of that you did that day? or three things that made you smile today?

Tips for Gratitude.

Getting some sunlight daily

Taking breaks during your workday going for a short 10-15-minute walk.

Drinking enough water

Engaging in a pleasurable activity

• Meeting friends

• Going to the movies

• Shopping

• etc.

Here is an Activity list that can help think of more self-care activities.

It is important that we make time for ourselves. Only when we take care of ourselves and make that conscious effort will we better be able to be with others in our lives, perform at work/school, and have an overall better emotional, mental, physical and spiritual wellbeing. It is essential to engage in some self-care activity daily (that is part of our daily discipline). The analogy I use with my clients when I am educating them about self-care  is asking them to think about it like the way we brush and floss are teeth daily to take precautions for our oral hygiene; similarly we need to take this step in our daily self-care to take care of our mental health wellbeing. 

I encourage you to start setting up a daily routine starting with a few activities  (paying attention to how you feel before and after) and then slowly ramping up ( the more you set time to take care of yourself and make it a practice I promise you , those are the times you will look forward to in your day ). Research shows that it takes 6 months to make or break habit (in time and with practice you will get this down). Patience is a virtue as always.

By David Shepard

Most of us want to be successful in life, whether that is in our careers or in relationships. If you want to be successful in life, you will need confidence. Confidence boils down to the positive feelings you have about yourself. For many people self-confidence seems mysterious. They feel like either you have it or you don’t. If you don’t have it, good news is that confidence can be developed and nurtured.

Self-confidence is determined for the most part by what is going on in our minds. Our minds are like a personal talk-radio station that is constantly broadcasting a steady stream of thoughts that compare, encourage, criticize, evaluate and judge everything inside and outside of ourselves. This self-evaluating, talk-radio mind has two sides: positive and negative. The positive side is all about broadcasting approving and encouraging messages about ourselves. I can get this job. I deserve all the love my wife is giving me. When on the negative side, messages are disapproving, discouraging and self-defeating. I don’t know what I’m doing. I will never be able to find someone that will love me.

The more negative things we say about ourselves, the more we disconnect from the positive side of our minds, which then results in increased stress and self-doubt. When the negative side persists, we end up being yanked off our success path. In order to remain on a successful path, we must disconnect with our negative side and increase our connection with our positive side.Our positive side supports us on our path to be the best we can, which results in accomplishments and confidence.

If you would like to learn more about increasing your connection with your positive side to improve your confidence and success journey, please contact us at THERAPY Now SF to book a free consultation.

Dr. Anlie Reichel from Therapy Now SF introduces 'New Moms Back at Work,' where new moms can come together, share experiences and get support.

Dr. Andrea Zorbas, founder of Therapy Now SF, introduces the San Francisco therapist practice.

Anxiety is more easily recognized by its effects on our emotional wellbeing and is linked to symptoms such as: racing or obsessive thinking, constant worry, indecision, and jumping to the worst-case scenario. However, it can be hard to recognize how anxiety effects our physical bodies.

Anxiety does not only live in the mind.

As the mind and body are closely connected, emotional turmoil often manifests in physical symptoms such as upset stomach, dizziness, fatigue, increased heart rate, and panic attacks, among others.

Physical manifestations of anxiety can be disconcerting and lead people to worry about whether their physical health is in danger which, in turn, exacerbates the emotional symptoms of anxiety. Recognizing the connection between your anxiety and physical and emotional symptoms is the first step towards healing.

Below are some examples which illustrate possible physical manifestations of anxiety. The symptoms have been underlined, and anxiety triggers are listed below each example.

Example 1

You are preparing to give an important presentation at work and really want to do a good job. The CEO will be in attendance and you’re hoping to make a good impression. You’ve been working hard and, as presentation day approaches, you notice that every time you go to edit your presentation your heart starts to beat faster, maybe your hands get shaky and you start to feel dizzy. Or, when you walk past the conference room where your presentation will take place you notice your stomach cramps and suddenly you feel nauseas. For some reason, every time you pass the CEOs office or see them in the hallway you suddenly get hot start to sweat. You’re confused because you feel in good health at any other time in the day and worry there might be something physically wrong with you.
 

Triggers of anxiety here include: working on the presentation, the conference room where presentation will take place, seeing the CEO and their office.

Example 2

You’ve been having some relationship troubles with your partner and you’re worried they might be seeing someone else. Over time you start to notice that whenever you watch a tv show where someone is being unfaithful it’s suddenly hard to take a full, deep breath and you feel a tightness in your chest. When you see your partner checking messages on their phone a wave of panic washes over you and you get cold and worry that they might be messaging a new love interest. At night, you have a hard time sleeping and find yourself creating endless scenarios in your mind (rumination) where you find out your partner has been cheating or imagining the day they finally break up with you.
 

Triggers of anxiety here include: witnessing infidelity in the media, message alerts on your partner’s phone and perceiving them as being secretive about the messages. 

If you’d like to learn more about physical and emotional manifestations of anxiety and speak to a professional in the Bay Area about how to manage them, contact us at Therapy Now SF to book a free consultation.

According to the American Psychological Association anxiety is “characterized by feelings of tension, worried thoughts and physical changes”.
 

With as simple of a definition as the one above, you might be thinking, “Everyone must have anxiety then!” And the truth of the matter is, everyone does- At varying degrees and varying times throughout life. Anxiety can be a normal reaction to stress, uncertainty, life changes (present or anticipated), relationship troubles, pressure at work, and many other common challenges which arise in life.

Anxiety is the brain and body’s response to a perceived threat.

To learn more about perceived threat read our post titled “Why do we get anxious?”

What are symptoms of anxiety?
There are two categories of anxiety symptoms

Mental/emotional symptoms:

• Obsessive thinking (known as rumination)

• Excessive worry

• Intrusive thoughts

• Difficulty concentrating

• Difficulty making decisions

• Excessive self-doubt, self-criticism

• Feeling of impending doom

• Desire to avoid certain social or physical situations

• Feeling powerless
  

Physical symptoms:

• Rapid heartrate

• Feeling shaky or tingling sensations in body

• Dizziness

• Stomach cramps, nausea or diarrhea

• Tightness in chest

• Feeling short of breath or unable to take a full breath

• Hot or cold flashes, sweating

• Feeling wound up and/or restless

• Difficulty sleeping

• Feeling fatigued or weak
  

How do I know if I need to see a professional about my anxiety?

As mentioned above, everyone experiences symptoms of anxiety from time to time related to stressors and transition, and usually anxious symptoms dissipate after the stressful event has passed.

However, you may want to consider seeking professional help if:

• Your symptoms persist for more than a 5 to 6 weeks after the stressful event

• Your fears and worries become generalized to broader situations (i.e. Instead of being anxious about your upcoming work presentation, you now become anxious when thinking about or attending work in general)

• The severity of symptoms begins to impair your ability to function or carry out day-to-day responsibilities
  

A therapist can work with you to identify the cause of your anxiety and learn strategies to manage mental/emotional and physical symptoms through evidence-based methods such as Cognitive Behavioral Therapy (CBT), Mindfulness, and EMDR among others.

If you’d like to learn more about how therapy can help and speak to a professional in the Bay Area, contact us at Therapy Now SF to book a free consultation.

Anxiety is the brain and body’s response to a perceived threat. Though you are not actually in danger, your brain and body are telling you it’s time to seek safety.

There are 2 types of perceived threat which anxiety reacts to:

1. Physical harm: Your mind/body registers “threat” of physical injury or death

When your mind/body registers a threat to physical harm it activates the sympathetic nervous system (SNS). The SNS begins a chain of reactions where the heart begins to beat faster and sends blood flow to legs and arms, breathing becomes shallower and your mind zeros in on the perceived threat to prepare the body to either run to safety or fight in self-defense. Or, if you become overwhelmed with fear you may freeze and become stuck.

Common examples of anxiety concerning physical harm: fear of heights, fear of flying or driving, fear of enclosed spaces, fear of being in crowded spaces.

2. Existential or social harm: Your mind registers threat of disapproval or rejection by peers or loved-ones, loss of social status, or damage to reputation.

With existential or social anxiety, though there is no threat of physical harm, your mind still engages the sympathetic nervous system in an attempt to “protect” you. This can be confusing because, in the absence of a physical threat, it can be hard to understand what is causing your body to react.

Common examples of anxiety related to existential/social harm: fear of public speaking, general social anxiety.

What are triggers?

Triggers are reminders or cues connected to the perceived threat, which elicit a stress response in the body and sets in motion a combination of physical and mental/emotional symptoms which indicate “it is time to seek safety!”

 When managing anxiety, it is crucial to identify your triggers and the symptoms they cause, to begin the process of calming your mind/body by distinguishing between perceived and actual threat.

 For more information on anxiety symptoms, read our blog titled “What is anxiety?”

How can therapy help?

If you find that your anxiety becomes persistent and begins to interfere with your day-to-day life, a therapist can offer a compassionate and non-judgmental space for you to talk about the challenges you face. A therapist will help you identify your triggers and work collaboratively with you to determine the best and most effective coping strategies to fit your lifestyle.

If you’d like to learn more about how therapy can help and speak to a professional in the Bay Area, contact us at Therapy Now SF to book a free consultation.