How to Tell If You’re Making Progress in Therapy

Reaching out for help to manage a mental health condition ー whether it’s an anxiety disorder or a mood disorder ー is a sign of strength. Therapy is often included in many different treatment plans. There are many types of therapy ー including cognitive behavioral therapy (CBT), biofeedback, art therapy, play therapy, couple’s therapy, family therapy ーand they all function a little bit differently. 

Regardless of what type of therapy you receive, therapy is an integral part of mental health care. 

According to the American Psychiatry Association, therapy “helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. Supportive psychotherapy helps [people] deal with issues related to their mental health conditions which in turn affect the rest of their lives.”

Therapy is very individualized, and because of its individualized nature, no two people experience therapy quite the same way. Building self-esteem, for example, can look different from person to person.

In fact, a common statement we hear is “I don’t feel like I’m getting any better.” 

That’s just the topic we explore in this blog. Below, Dr. Dan Guy shares the top signs that help you determine if you’re making progress in therapy.

Therapy Isn’t All or Nothing

Although we’d like therapy to “work” instantly, that’s not the way therapy works. Some people might even say, “I’m not 100% better after one session, so it must not work.”

This is an example of all-or-nothing thinking. 

All-or-Nothing Thinking is a Cognitive Distortion, and unfortunately, it’s derailed many people. All-or-nothing thinking means exactly what it says: everything is either a total success or a complete failure.  

Example #1 of All-or-Nothing thinking: 

“If I am not completely free of whatever ails me, then I (or that doctor or that therapist or that counselor has) have failed.  So, I may as well just quit taking this medicine, or stop going to therapy, and definitely stop the hard work of changing my lifestyle. There’s no need to keep exercising, going to bed earlier, eating better, practicing relaxation.  If I’m going to keep having depressive episodes, manic episodes, panic attacks, mood swings; why should I make the effort to make these changes that make me uncomfortable.”

Example #2 of All-or-Nothing thinking: 

“I’m still feeling anxious about going into the office, so therapy must not be working. I might as well stop going.”

Example #3 of All-or-Nothing thinking: 

“I just had my third panic attack month. This medication isn’t working nor is therapy. I thought I’d be free of panic attacks by now.”

All-or-Nothing Thinking happens when you view something (in this case, therapy) as either a success or a failure. The problem with this is that therapy (and the management of mental health disorders) isn’t just black and white. Progress can be measured in increments, not just “success” or “failure.”

Why Therapy Isn’t All-or-Nothing

In the moment (the moment where you think that therapy isn’t working and isn’t worth it), the emotional brain (much of which is in the limbic system of the brain) says, “It’s not worth it.”  

However, if you can just tap the brakes, take a breath, pause….the intellectual brain can kick in and point out some things that you may not be thinking of at that moment.

The intellectual brain ーmuch of it in the prefrontal cortex that is responsible for cognitive function ー helps you look at your PROGRESS from a couple of different angles (perspectives, etc.).

Focusing on the Progress You Make in Therapy: Duration, Frequency, and Intensity

Therapy helps you make progress, and as therapists, we know that the key to overcoming your obstacles is to focus on progress, not perfection. You can look at progress in terms of duration and frequency.

“Progress is not achieved by luck or accident, but by working on yourself daily.”

– Epictetus, Ancient Greek Stoic philosopher

Frequency

While the emotional brain says that therapy isn’t worth it if you’re 100% free of your struggles, the intellectual brain says, “How often were you having depressive episodes before you started treatment?”  Maybe it was once a week, or maybe it was once a month. Identifying your starting point allows you to assess any progress.

If you slow down and consider the questions from your intellectual brain, you may notice that you haven’t had a depressive episode for 3 months.  We are talking about FREQUENCY.  

If you are having fewer episodes because of longer periods of time between episodes, you are PROGRESSing. 

The chart depicted above, published in this study, shows the correlation between the number of weeks in therapy and the decrease in the frequency of panic attacks.

Duration

Next, your intellectual brain can say, “How long did this depressive ー or panic, mood swing, manic ー episode last.  You might notice that each episode used to last for days, weeks, months.  If you look at this last episode, maybe it only lasted for a few hours to a day or two.  This is DURATION.  If the duration of the episode has decreased, once again, this is PROGRESS.  

In the chart above, you can see that the duration of depressive episodes is greatly impacted by the type of care received: no care, primary care, mental health care services.

Intensity

Finally, your intellectual brain says, “How bad did your episodes used to be?”  If you rated your episodes before treatment, you might have rated it as an 8 out of 10 (SUD: Subjective Understanding of Distress), and this most recent episode was a 6.  While it may seem small, it is still PROGRESS. 

In the graph above, you can see how therapy (in the case of this study, exposure therapy) helped reduce the intensity of anxiety symptoms. That’s progress, indeed!

Change Is Hard … So Is Therapy

Remember, change is hard; therefore, therapy, at least GOOD Therapy is hard.  Progress can be slow; not like the weight loss commercials that claim you can lose 87 pounds in 5 weeks ー with a small print that says, “results may vary.”   

Often people in therapy are looking for an excuse to quit the hard work.  Then, they can look at their family and friends, and say, “Hey, I tried, but it didn’t work.  I gave it a shot.  Don’t blame me. Blame them.”  (By the way, blaming is another very common Cognitive Distortion that allows a person to stay stuck.)

The Three Keys of Progress: Frequency, Duration, and Intensity

The next time you want to give up, step back, and look at whether you have made progress in any of the areas of FREQUENCY, DURATION, OR INTENSITY.  Even if you have made progress in one area, it is still progress.  Give yourself some credit for your hard work, and don’t give up because you are too impatient.  Your family, your friends, your life is worth the hard work.

Getting Started with Therapy

NextStep2MentalHealth provides adult, adolescent, and pediatric mental health care, and our multidisciplinary team is dedicated to helping our patients with their mental health needs. Call us for an appointment or simply use our online scheduling tool.

About Dr. Dan Guy

Dr. Guy specializes in the treatment of depression, anxiety, mood swings, relational problems, issues pertaining to self-doubt and self-value, and ADHD. He is skilled in the use of cognitive behavioral therapy (CBT), solution focused therapy, and reality therapy. He also provides psychotherapy for individuals with bipolar disorder and some addictive behaviors. Dr. Guy has helped hundreds of individuals, couples, and families establish loving relationships, healthy communication, and effectively address mental health issues. As a trusted professional, Dr. Guy will walk beside you as you face challenges in your life and will guide you toward healing and fulfillment.

You can now book an appointment with Dr. Guy here or give us a call at our Louisville, Kentucky mental health clinic at 502-339-2442.

Boost Your Mental Health with These At-Home Activities

Whether you’re stuck at home quarantining after a COVID exposure or you’re simply settling in for a weekend at home, it’s always good to have a list of at-home activities that boost your mental health.

In this blog, we’ve curated a list of at-home activities that support your mental wellness.

Reading

Reading provides many benefits.

“Reading can even relax your body by lowering your heart rate and easing the tension in your muscles. A 2009 study at the University of Sussex found that reading can reduce stress by up to 68%.” (NAMI California)

Reading also provides a healthy escape from life’s daily stress. Unwind after a busy day with your favorite story or favorite characters. Reading also boosts empathy and understanding.

Need inspiration: Explore GoodRead’s list of relaxing books

Reading can be particularly helpful for individuals struggling with hard or sensitive issues. According to NAMI California, reading about similar situations can help teens work through tough challenges, including issues with bullying.

While reading your favorite fictional story can help you relax, there is also merit in reading non-fiction books, including those about particular mental health conditions.

Need inspiration: Read the top 13 mental health books of 2022

Gardening

Just because you’re at home doesn’t mean you can’t go outside! Spending time outside boosts your mood (and serves up a nice dose of vitamin D), but you can further support mental wellness by gardening. Gardening:

• Boosts your mood
• Boosts your self-esteem
• Improves your attention span
• Provides a good workout (and exercise helps alleviate symptoms of many different mental health conditions)
• Encourages social interaction

Get more gardening tips here.

Music & Family Time

Both listening to music and spending time with friends and family can support mental wellness. So why not combine both of these elements? You can:

• Watch a concert on TV
• Play your favorite music
• Set up an at-home karaoke session
• Play musical chairs (if you have little children at home who would like to play)
• Play music while you make dinner or while you eat
• Write a song to express yourself

Music can reduce your stress and lift your mood.

Movies

Granted, not all movies support mental wellness. That being said, watching certain movies can have a positive effect on your mental health.

Watching a funny movie can make you laugh and laughing releases feel-good endorphins.

But what about sad movies?

Games

Games, especially strategy games, can boost your mood, improve working memory, and support emotional regulation. Playing board games can be a good opportunity to talk and bond with children and teens — especially if they have a hard time opening up.

Getting the Help You Need

Reading, listening to music, reading, spending time with family, and playing games are all good wholesome activities that support your mental wellness, but sometimes you just need more support. Here at NextStep2MentalHealth, our multidisciplinary team provides comprehensive care for anxiety, depression, bipolar disorder, OCD, PTSD, and more. Whether you need therapy, coaching, or medication management, we can help you get the comprehensive treatment you need.

To get started, schedule an appointment today.

7 Things Teens with OCD Need to Know

Obsessive-compulsive disorder, more commonly called OCD, is a chronic mental health condition marked by intrusive thoughts and behavioral compulsions.

Here at NextStep2MentalHealth, our multidisciplinary team excel when it comes to diagnosing and treating OCD in teens. If you spot the signs of OCD in your teen, it’s never too early to receive professional help.

Here are seven facts that teens with OCD need to know.

1. OCD Is Common

According to the International OCD Foundation, there are about as many kids with OCD as there are with diabetes. That equates to about 20 teens in every medium-to-large high school who struggle with OCD. OCD is a type of anxiety disorder and can often occur with other anxiety disorders or depression.

2. Doubt and Guilt Are Two Hallmark Signs of OCD

TV shows and movies make it appear as though cleanliness is the only compulsion for people with OCD, but the reality is fear of germs or contamination is just one sub-type of OCD. Other sub-types of OCD include:

Doubt

Doubt is a driving force behind many of the compulsions to check and re-check. Doubt is defined as “doubting that you completed the activity even right after you completed it.” This can lead teens to constantly re-checking locks, homework, etc. Understandably, this can affect time management skills and even academic performance.

Guilt

Guilt is another excruciating aspect of OCD. People with OCD may feel guilty about anything, even if it had nothing to do with them. This can cause thoughts such as:

• “Did I offend John Doe?”
• “Did I inadvertently cause XYZ to occur?”
• “Am I a good person or a bad person?”

Other sub-types include counting, hoarding, contamination, false memory, and harm OCD.

3. Cognitive Behavioral Therapy (CBT) Can Help Treat OCD

Cognitive Behavioral Therapy (CBT) is considered to be a top form of treatment for anxiety disorders, and that includes OCD too.

4. The Goal of Treatment Helps You Learn the Tools to Manage Your Symptoms

Throughout your therapy sessions, you’ll continue to learn strategies and tools for managing the cycles of intrusive thoughts and compulsions.

Does your OCD need treatment? Read this blog: Does OCD Need Treatment?

5. Treatment Isn’t Completed Overnight

Often, when teens start treatment for OCD, one of their first questions is “how long does treatment take?” The short answer is: as long as is necessary for any given individual. Managing symptoms is an individualized process and can be impacted by your teen’s willingness to participate in therapy, the presence of any comorbidities, and how severe your teen’s symptoms are.

Understandably, long-term OCD can take a heavy toll on your teen’s quality of life.  It may have been a long time since your teen socialized comfortably, held a summer job, or felt at ease doing daily chores. Some teens have never done these things without the obstacle of OCD.

6. Know the Signs of Relapse in Teens with OCD

As with many disorders, your teen may go for long periods with his or her symptoms well managed, but a relapse can knock them off track. Relapses are not uncommon with OCD.

Here at NextStep, our therapists know that the best way to deal with a relapse is to get ahead of it. We discuss relapse in our sessions and help you engage in as many relapse prevention strategies as possible.

That being said, if you or your teen notice any signs of a relapse, don’t hesitate to reach out. The quicker you seek help, the quicker you can get back on track.

7. OCD Can Be Managed

The most important fact to remember is that OCD can be managed. As with any anxiety disorder, lifestyle modifications help support mental wellness. This includes getting enough sleep, following a proper diet and exercise routine, engaging in positive social relationships, and engaging in hobbies or productive work of some type.

At NextStep2MentalHealth, we know how profoundly OCD can impact all aspects of your teen’s life, and if your teen is struggling now, you don’t have to wait until it gets worse before reaching out for help. Our compassionate, non-judgmental team offers a variety of OCD treatments, including medication and therapy.

If you have concerns about OCD, schedule an appointment at our Louisville, Kentucky office. Request an appointment online.

Does My Teen Have OCD?

8 Early Warning Signs of Postpartum Depression

Just like there are many different types of anxiety, there are also different types of depression. Postpartum depression is a type of depression that affects new mothers, and it can start anywhere from a few days to a year after the birth of a baby.

May 2 – 8 is Maternal Mental Health Awareness Week, so now is the perfect time to raise awareness of postpartum depression.

What Is Postpartum Depression?

Due to the immense shift in hormones (and the dramatic change in sleep schedules), baby blues are common for most new mothers. Approximately 80% of new moms have baby blues. Baby blues are characterized by crying, feelings of overwhelm, and sadness. However, baby blues typically dissipate a few days (or up to two weeks) after childbirth.

Postpartum depression is more severe than baby blues and doesn’t ease up as time progresses.

Watch the video below to learn more about the differences between baby blues and postpartum depression.

8 Signs of Postpartum Depression

Other signs of postpartum depression include:

1. Your baby blues aren’t going away
2. Feeling disconnected from your baby (or partner)
3. Intrusive thoughts, such as checking repeatedly on your baby
4. Intense crying
5. Overwhelming feelings of anxiety
6. Sadness
7. Changes in eating or sleeping habits
8. Thoughts of self-harm

If you notice any of these symptoms, don’t hesitate to reach out for help. Asking for help doesn’t mean that you’re not a good mother. Asking for help is one of the best things you can do for yourself and for your baby. Postpartum depression, and other maternal health disorders, aren’t a reflection of your mothering abilities.

Getting Help with Baby Blues and Postpartum Depression

Taking care of yourself is essential when you’ve just had a baby. Your body needs rest, hydration, and good nutrition. Although the first few weeks can be an adjustment, you can find help in many ways including asking a partner to watch the baby while you practice self-care, shower, eat, and rest. You can consider hiring a cleaning service for a few weeks to assist with household chores while you recover.

That being said, friends and family can help mitigate some of the feelings of overwhelm if you have baby blues, but if you have postpartum depression, you may also benefit from therapy and/or antidepressants. Here at NextStep2MentalHealth, our team is experienced at treating co-occurring disorders, and if you’re also struggling with postpartum anxiety, we can help.

Additional resources:

• BLOG: Overcoming the Negative Self-Talk Cycles of Depression
• BLOG: 11 Ways to Help a Loved One with Depression
• BLOG: 32 Ways to Help a Loved One with Depression (When They Don’t Want to Talk about It)
• Maternal Mental Health Leadership Alliance
• Postpartum Support International

National Suicide Prevention Hotline at 1-800-273-TALK (8255).

If you are looking for a trusted and experienced mental health doctor or therapist, contact us today to get started exploring your multidisciplinary postpartum depression and postpartum anxiety treatment options. 

6 Tips for Dealing with Return-to-Work Anxiety

In addition to remembering your favorite elements of working in an office, make new traditions to tame return-to-work anxiety. Even little things, like buying a new lunch bag or making new habits (like listening to a fun podcast on the way to work) can help make your transition easier.

9 Surprising Ways Anxiety Shows Up in Kids

Anxiety in kids is like an iceberg: what you see is often just a fragment of what’s beneath the surface, and that’s especially true for children. While many parents might associate anxiety with intense worry (because that’s part of it), the reality is that anxiety can cause many different behavioral issues and feelings in children.

Below, we’ll take a look at nine surprising ways that anxiety can show up in kids.

1. Trouble Falling Asleep and Staying Asleep

Anxiety and sleep problems are connected in a vicious circle. Anxiety can contribute to sleep problems, and sleep problems can make anxiety worse.  Difficulty falling asleep and/or staying asleep is a classic sign of anxiety in kids. For children with anxiety, an anxious train of thought can keep your little one awake long after bedtime. Some kids even have anxiety about waking up late, missing their alarm or school bus, feeling tired in the morning, or other school-related events.

Tip: Always practice good sleep hygiene and consider using warm-colored lights around bedtime.

2. Anger and Irritability

Anxiety in children happens when there is:

• A perceived threat (e.g., a school project or an upcoming date)
• An underestimation of coping skills (e.g., “I will never pass this math test.”).  

The combination of perceived threats and underestimating coping skills leads to feelings of helplessness, and in many cases, helplessness leads to frustration, which leads to anger.

Interestingly, both anger and anxiety are activated in your amygdala. Your amygdala is the “threat center” of your brain. If your child’s brain perceives a threat (even if it’s overestimated), his or her amygdala activates the flight-or-fight response. This creates a flood of hormones designed to make you stronger and faster. While this helps us flee or fight against threats, it creates issues when the anxiety is chronic. The flight-or-fight response creates rapid heart rate, rapid breathing, and can make you feel on edge.

It’s possible that remaining in this state for a prolonged time can lead to irritability, agitation, and anger. 

3. Defiance

A child with anxiety often feels like his or her life is out of their control. This can lead to your child trying to regain control in any way that he or she can. For example, this could explain a sudden outburst over a red jacket instead of the blue jacket.

4. Chandeliering

Chandeliering is “pushing the hurt down until one day it’s all unleashed at once in a fit of rage (shooting that person up to the chandelier). [Brené Brown]

Sometimes children try to hide anxious feelings, especially if they don’t know how to talk about it. Chandeliering happens when a child has a seemingly out-of-nowhere tantrum or outburst. It may seem out of place, but in reality, the child has been hiding anxious feelings until they all bubbled up over the top.

5. Lack of Focus

Inability to focus is often linked with ADHD, but ADHD isn’t the only mental health condition that can contribute to difficulty focusing. Children with anxiety can also struggle to focus both at home and at school.

6. Avoidance

“I don’t want to go.” Has your child ever said he or she didn’t want to go to school? Or maybe they suddenly don’t want to attend a sporting event? Avoidance can be another sign of anxiety. Avoidance can create bigger problems though. For example, if your child is trying to avoid schoolwork, the continual procrastination can create more trouble when all of the homework builds up. This can lead to even more anxiety about the sheer amount of catchup work.

7. Overplanning

Overplanning can show up as questions. For example, if your child is invited to a birthday party, he may plan what gift to bring, but he may also ask:

• Who else will be there?
• What will they do when they are at the party?
• What time will you be back to pick up him?
• What food will be served?

Overplanning is a coping mechanism to help ease anxiety, and it’s a way that your child tries to find control.

8. Negativity

Anxiety can create negative thoughts, including:

• I can’t do this
• I’ll never pass my history test
• I’m too shy to do this
• I’m not good enough for this

9. Change in Eating Habits

Is your child suddenly nibbling at their food? Anxiety can cause physical symptoms, such as upset stomach, headaches, etc. This can make your child lose his normal appetite.

Treating Anxiety in Kids

Anxiety disorders can be treated, and the right treatments can restore your child’s quality of life. Common treatments for pediatric anxiety include talk therapy, play therapy, counseling for the family, and in some cases, medication. 

NextStep2MentalHealth provides pediatric mental health care, and our multidisciplinary team is dedicated to helping parents and their children with their mental health needs. Call us for an appointment or simply use our online scheduling tool.

Does Your Child Have Separation Anxiety?

5 New Year’s Resolutions for 2022

Getting ready to celebrate the New Year? Are you making any New Year’s resolutions this year? New Year’s Resolutions don’t have to be out-of-reach goals. In fact, New Year’s Resolutions are the perfect opportunity to create some mental health goals for the upcoming year.

New Year’s Resolutions that Support Mental Wellness

Here are a few more goal-oriented resolutions that support mental health:

1. Add More Physical Activity to Each Day

Exercise is good for your body and your mind. It helps you sleep better at night (which is also good for your mental health), but it also reduces symptoms of anxiety and depression, according to recent studies.

Exercise — especially aerobic exercise — boosts your mood, reduces stress, reduces social withdrawal, and boosts your self-esteem. Examples of aerobic exercise include running, jogging, dancing, walking, hiking, swimming, and playing tennis.

Exercise-related goals don’t have to be intense workout regimens. You can sneak exercise into your day in many ways:

• Walking your dog an extra loop around the neighborhood
• Going to the local rec center and walking around the track while listening to podcasts
• Swimming with friends at a local YMCA

2. Practice Good Sleep Hygiene

It’s far too easy to stay up late watching another episode of your favorite show, but research shows that getting a reasonable amount of sleep each night can have many positive effects on your mental wellness.

Sleep hygiene tips include:

• Going to bed at the same time every night
• Avoid blue lights for 1-2 hours before bed (What’s a blue light? Find out here: Do Warm Lights Help You Sleep Better?)
• Sleep in a cool, dark room
• Spend some time in the sunshine each day as this helps reset your circadian rhythm

3. Pick Up a New Hobby

Hobbies — like knitting, reading, gardening, fishing — are good for your mental health, according to the Australian Government Health Department.  You don’t have to be a pro to reap the rewards of a hobby. Just participating in a hobby can boost your self-confidence, promote feelings of relaxation, reduce stress levels, and improve your overall happiness.

Need a few ideas? Here are some common hobbies:

• Sports and exercise
• Fishing
• Gardening (indoor plants count too!)
• Music
• Drawing and painting
• Crafting, including knitting and crocheting
• Baking
• Reading
• Journaling

4. Spend Time in the Great Outdoors

Spending time in nature can also support your mental health. Just 20 minutes spent outside can make a big difference, according to the experts at Harvard.

Looking for activities to do outside? Check out this article to get a few ideas.

5. Seek Help When You Need It

This is perhaps the best resolution of all! Even with all of these resolutions, you might need a little extra support this year, and that’s okay! The best thing you can do for your mental health is to ask for help if you need it. As a multidisciplinary practice, we can support a variety of mental health conditions with therapy, medication, lifestyle changes, coaching, and more here at NextStep2MentalHealth. Our team of psychiatrists and therapist are here to help adults, teens, and children.

We’re just a call or click away. Call 502-339-2442 or send us a message to request more information.

What Is Generalized Anxiety Disorder (GAD)?

Generalized anxiety disorder or GAD is a condition wherein a person displays an excessive, uncontrollable, and sometimes irrational worry about every day…