mental health

Generalized anxiety: the Energizer Bunny of the brain

What is generalized anxiety? Generalized anxiety is a little bit different than most other anxiety experiences. Typically, anxiety is linked to particular items such as a traumatic event, panic attacks, obsessive thoughts, or even particular critters (I’m snake phobic). Generalized anxiety is anxiety about EVERYTHING! Hopefully the name it away, but generalized anxiety is the experience of constant, excessive, uncontrollable worry about pretty much everything in your life. These worries can range from worried about being on time to a meeting, saying the right thing on a first date, the health and safety of your loved ones, or even something as small as taking the right road to work. Now, we live in a society that tells us that worry is normal and that everyone has it….this is both true and untrue. Worry is a natural experience as is the subsequent anxiety we experience. However, for many individuals their level of worry is above and beyond the average level. When you can’t stop the worry, when your brain doesn’t let you sleep at night because it is consumed with worry thoughts, when you can’t concentrate, when you believe you will get fired because you made a small slip up during your presentation, when you call your partner 15 times in 4.5 minutes because you think they died on the way to the grocery store; this is the worry that is likely eating your life.

I’m noticing this level of worry come into my office more lately, which has me thinking about what various factors might increase someone’s worry from average to clinical levels. Increased demands at work might be the cause. Increased stress from our current political climate might play a role. Constant comparison between yourself and others might make you reflect on your life and believe things that ordinarily you might not. Generalized worry is constant and often feels very out of your control. It’s as if your mind is on a hamster wheel that is being run by the Energizer Bunny, it never stops. This type of worry can really take a toll on your body, mind, and life. You might notice yourself feeling more agitated throughout the day, irritable at your kids or partner, your shoulders and jaw may feel tense all the time, you might even feel like you’re going crazy.

Generalized worry is a really common experience, but it is one of those experiences that people often don’t talk about. Nearly 15 million people in the United States alone experience clinical levels of generalized worry and that is a low estimate! Generalized anxiety can start at any time in your life and can continue throughout your life. But it doesn’t always decrease your ability to live into your life. For some people who experience generalized anxiety, it’s actually motivating because if you’re anxious about getting tasks done you might actually finish them weeks in advance (I am one of these people). Orrrrrr you might notice yourself procrastinating assignments or tasks because the anxiety makes you believe that if you can’t do it perfect there’s no point to do it. General anxiety is chronic, but often untreated for many people. Worry is totally normal for many of us, but there comes a point when the worry doesn’t stop, where you can’t focus, where you feel exhausted, where you don’t enjoy your life anymore because of how much you worry. Fear not though! There is hope imbedded deep within that worry. Cognitive Behavioral treatments for generalized anxiety have been shown to be highly effective for reducing the frequency, intensity, and duration of worry-based thoughts (and this is without medications too!). There is life without all consuming anxiety and worry. There is a way to overcome that Energizer Bunny in your mind. For more information about generalized anxiety and treatments, please contact my office via phone or email. You can get your life back, let’s find your spark as we extinguish the flame of worry!

Psychological Recovery Following Mass Shootings

On October 1, 2017 in Las Vegas, NV we saw the largest mass shooting in modern US history. On June 12, 2016 in Orlando, FL we saw the largest mass shooting in modern US history. On December 14, 2012 in Newtown, CT we saw the second largest mass shooting in modern US history. On April 16, 2007 in Blacksburg, VA we saw the largest mass shooting in modern US history. The list goes on and on and on. In recent years, we have seen a surge of mass shootings and violence in the US and at the center of every shooting is one question, “why?” Today, I don’t care about the why. Why’s that you may ask? Well, as a Las Vegas resident my primary question at this point is “now what?”

Mass shootings and violence are not natural disasters. They don’t exist naturally in our world; they are created, molded, groomed, and lashed out into the world. Some of the worst types of violence are those perpetrated onto others from our fellow human being. This is what leads me to ask “now what?” Las Vegas, like many other cities and towns after such violence, is still in the early recovery phase. Like any other break, the wound needs to be covered before it can heal. Our first responders, police officers, emergency services personnel, nurses, doctors, and Red Cross volunteers are taking care of those open wounds even as they hemorrhage themselves. The psychology of mass murders is an interesting topic, but not my speciality. No, instead, I’m more interested in the psychology of mass murder survivors.

What does it mean to recover from mass violence? How do you know when you are “better?” How do you live with the new scars in your mind? The best way to start answering these questions starts with the responses. Trauma and stress responses are normal. Your body is reacting to danger, whether you were there at the shooting, know someone who was there, watch it on the news, or work with those who both survived and died. Our hearts race, our minds race, our breathing can change, we start looking up at windows of tall buildings, we don’t go where there are crowds, we begin to fear. There is no right or wrong way to respond to threat especially the surprise threat of mass shootings. In war, you are deployed. You know you are going into a war zone. You don’t know what is going to happen, but you prepare for the “what ifs” that come with that situation. Mass shootings are the unplanned warzone. You are not prepared to face them. You are not trained to control your breathing. You are not armed. You are not expecting them. This is what makes them so devastating to so many people; the unknown.

Now, here we are. After the sounds have stopped, the blood donated, the wounds packed and wrapped, we exist in a world unsure of what to do next. Some people may think “I need therapy now” or “I have to talk to someone.” As a psychologist, I am here to tell you that these instincts are natural, but slightly premature. Crisis counseling is not trauma processing. What that means is that the immediate needs after a mass shooting are specifically designed at ensuring stability. Making sure someone has proper medical care, housing, food, finances, and is alive. Crisis counseling allows you to have a safe, supported space to get these basic needs met; this is your survival mode. You may talk with someone, cry with them, shake in their arms, as you think about what happened. All of this is normal. Whatever needs you have right now are our priority. Survival mode is temporary, but temporary is subjective. Some people will feel somewhat better days after an event, for others it may take months. There is no right way to process trauma. You may notice changes in your eating patterns, you may be more cautious on your way to work, your sleep might be interrupted, you may notice yourself feeling jumpy or on edge; all of these are normal responses and, for most, they go away. Having trauma responses immediately after trauma is not pathological, it’s entirely normal.

Experiencing a trauma does not mean you are guaranteed to have residual effects. Nearly 80% of individuals experience at least one trauma in their lives, but the rate of chronic trauma responses is less than 15%. Why is that? What makes someone able to survive trauma and still be ok? Resiliency. Human beings are amazingly resilient. We have go through hell and come out kicking on the other end. We are resilient with support; knowing that how you feel is normal, that is it likely temporary, and that while this experience may change you, it does not define you. There is the old cliché that “time heals all wounds,” which I think is accurate to some degree, but I’ll extend it to “time heals all wounds, but they leave a scar.” Your scars are your battle wounds, they are your reminder that you are strong, that you are able, that you can make it through trauma, and be ok in the end. You are not alone, you are not broken, you are not crazy, and you can get better.

Can you cure PTSD?

This is a question I hear from patients on a near constant basis and one I ponder on a regular basis both personally and professionally. What does it mean to cure PTSD? Does it mean you can sleep again? Does it mean you don’t remember what happened to you? Does it mean you can smile again? The notion of a “cure” for any mental health condition is still an extremely controversial topic in the field. While there are some mental health conditions we know are not “curable” by the textbook definition of a cure such as Schizophrenia, Bipolar Disorder, or Autism, that does not mean your life is over. Think about it this way. Is there a cure for Diabetes? Is there a cure for cancer? Is there a cure for a broken leg? The standard answer is “ yes,” but when you think about these conditions, the “cure” is more about treatment not necessarily just getting rid of the disorder. With cancer, you can go into remission, but that doesn’t mean it’s cured because it can come back. With diabetes, you can manage it with insulin and still live a full life. PTSD is the same way. When I think about “curing” PTSD, I think about it just like “curing” cancer; an individual goes through treatment, their symptoms subside, and they are able to function again. Does that mean it will always be like that? No, of course not, there are no guarantees with any treatment medical or psychological. But you can have your life back in a way that you likely didn’t think possible.

Now, I recognize how Pollyanna that perspective may sound to many, but from experience with my patients and copious amounts of research done my individuals far smarter than I am, it is something I wholeheartedly believe to be true. I have seen people with PTSD symptoms for decades go through treatment and come out the other side happier, healthier, calmer, more rested, and able to live again. Their trauma wasn’t gone though, trauma never goes away, it’s the symptoms that we are trying to treat. PTSD is made up of 4 symptom clusters: re-experiencing, avoidance, negative mood and thought changes, and hyperarousal. I spent a whole lot of time getting to know these symptoms in textbook form before I got to see them in the real world and let me tell you, the textbook has nothing on the real world manifestation of this life-destroying disorder. PTSD eats away at someone, it infects their entire existence, it makes them want to die, but for most, they keep on fighting. Suicidal thoughts with PTSD are so very common as is drinking, other substance abuse, sexual difficulties, medical problems, and a whole host of other life changers, but just as Princess Leia says in Rogue One, “hope” is the answer. Hope means there is at least the smallest glimmer that things will change. Never underestimate the motivating power of hope even if it’s just to prove someone wrong. PTSD can be cured, symptoms can go down, your life can be yours again. No, your trauma will never go away, but that does not mean you cannot get better.

Treatment for PTSD sucks. I’ll be the first one in the office telling you that from meeting #1. Having to uncover your deepest, darkest, more horrid experience to a near complete stranger is an experience that inherently makes your body tense and pucker with anticipation, but that’s honestly my job. It is the job of a trauma psychologist to be your go to person, the person who sits with you while you tell every gory, bloody, scary, horrifying, disgusting detail of this horrible time in your life, and who will never recoil from a single word. Treatment means uncovering the wound, cleaning out the infection, and stitching you up. It also means going through the rehabilitation and tending to the scar. See, trauma is a scar while PTSD is the hemorrhaging bullet wound. Like any wound, you have to stop the bleeding before you put it in a cast. Your life will never be the same after a trauma, that’s the very nature of trauma, but it does not mean your life ends after the trauma. Hope exists, treatment exists, you can exist again. To learn more about PTSD, treatment, or recovery from trauma, feel free to email or call my office. There is life after trauma, there is you after trauma.

The Quarter-Life Crisis

Your 20s suck. The reason they suck is because it is a very vague time point in your life where you’re not really a child anymore, but you’re also still not really an adult either. We use the term “young adult” to define individuals typically between 18-25 years-old, but then anyone older than 25 is just an adult until they reach the age of “older adult,” which is usually 65+. But are 26 year olds really adults? By legal definitions, yes of course they are. When you are 18 years-old you typically graduate high school, make a big life decision (i.e., go to college, go to work, go into the military, etc.), and then are expected to act like an adult. One of my favorite phrases that truly highlights my concern with this issue is from a Tumblr account I wish I remembered so I could cite, but it goes a little something like this: you expect college freshman to make a decision about their whole career yet 3 months ago they had to raise their hand for permission to pee. It doesn’t make sense.

In your 20s and 30s, you are constantly bombarded with messages about who you are, what your life should look like, how successful you should be, what house you have, what relationship you are in, what school you should go to, and on and on and on. These pressures can come from any source whether it be family pressure, the media, friends, and internal ideas about what your life should look like. The quarter-life crisis is a term I use often with my patients who are frequently described as “millennials” to highlight how these pressures can severely impact their functioning and drastically alter the way they think, feel, and act. Common signs of a quarter-life crisis are feeling lost, lonely, confused, scared, and anxious about your life. These are above and beyond typical anxieties about life, but rather exemplify a pattern of chronic self-doubt, anxiety, avoidance, and low self-esteem. But does this description really seem limited to millennials? Not really. This pattern of experience has been found in all generations just at different severity levels and if you’ve ever seen any John Hughes movie than you’ve probably seen signs of this phenomenon. The quarter-life crisis is not limited to any particular generation, yet individuals who are actively going through it have received some pretty negative messages about their self-worth based on the label.

According to Erik Erikson, a well-known psychologist in the field of development, life is defined in accordance with particular stages. He defined life as comprising 8 stages from infancy to adulthood each with particular psychosocial crises that result in either a positive or negative outcome for personality development. Let’s go over his stages quickly:

Now, I will be the first to admit that I am not a developmental psychologist and that I have not done nearly as much research as Erikson on these stages, but I can’t help but think that Stages 5 & 6 might be more interconnected than they appear. This is what brings us to the topic of a quarter-life crisis. During this stage in your life, you’re defining not only who you are as a person now, but who you want to be as a person in the future. To say that you’ll know at 18 exactly who you want to be at 40 isn’t realistic largely in part because your brain has not developed the executive functioning skills to make those kind of decisions, hence, the quarter-life crisis.

When you’re in your early/mid-20s to early/mid-30s your brain has finally finished cooking from a biological standpoint. You are better equipped to think clearly, logically, and long-term, but what also comes is the fundamental human anxieties of life. Who are you? Who do you want to be? Why aren’t you there yet? The quarter-life crisis highlights a near universal experience of individuals in this developmental stage of life that may require more exploration than Erickson provided. In a way, the anxieties caused during this stage of your life are similar to those of Stage 8; questioning your life and defining accomplishment. Ask yourself some of these questions:

·         Who defines who you are as a person?

·         What do you want in your life? What don’t you want?

·         Do you feel worried about the future?

·         Do you think there’s something wrong with you because you’re not
           married, have babies, a mortgage, a career, that perfect car, or whatever
           other symbol of “adulthood” you think you should have?

·         Do you feel like a failure?

·         Are you scared of who you will become?

·         Do you feel alone?

These questions are important to start asking yourself because these are some of the real questions that will help you define yourself not just now, but in the future. Screw what the media, society, or even your friends tell you about your life. What do you want? Who do you want to be when you grow up? The comparison of your “behind the scenes” to someone’s “highlight reel” can really alter your perceptions of yourself.

I’m not writing this just from a professional lense, but a personal one. I look around at people in my cohort and I see what they have accomplished. I compare myself constantly to individuals who have been in my field longer and ask “why am I not there yet?” I have discussions about anxieties, worth, love, and purpose with my friends, colleagues, and clients on a near constant basis. I went through my own quarter-life crisis and kinda feel like it’s still there a bit, but it is these times that make us human. We question our own existence, we question our worth, we question what makes us happy, and we seek answers even after we have them. You are not weird because you don’t know what you want to be when you grow up. You are not abnormal because you still don’t know if you want children. You are not broken because you feel alone. You’re not behind the curve because you’re still in school. You are human and your humanity is what makes you amazing, anxieties and all!

I shall now leave you with one of my favorite pictures that, again from Tumblr, shows the struggle. If you'd like to discuss this matter further, feel free to email me at or via phone at (702) 587-1573.

Men, Sex, and Anxiety

One of my favorite topics to talk about is anxiety. Another is sex. As someone who has spent a large portion of her career examining gender variables, these topics tend to overlap when talking about men and sexual performance. Anxiety does not discriminate based on any variable and for many individuals, when anxiety hits sex starts to plummet. Sex is an innate part of humanity, without it, the species could not continue. But as we have progressed as a species, so have our difficulties. Men who have difficulty functioning sexually are stigmatized, humiliated, and frequently report feeling inadequate. But what role does anxiety have on sex for men? Let’s dive in shall we!

According to Masters and Johnson, sexual response occurs on a particular cycle:

When we discuss sexual functioning issues in men, we are talking about something not working somewhere in this cycle. Now, different sexual problems happen at different points. For example, the most commonly known sexual difficulty in men is erectile disorder (aka erectile dysfunction). This is the inability to obtain and/or maintain an erection for the desired length of time. For most, they think that it is an organic issue that can be treated with a pill such as Viagra or Cialis. However, for more individuals than you may think, the cause of ED is not organic. Psychological effects can be a major cause of sexual issues, particularly in men. One of the major areas I am going to focus on here is anxiety.

Anxiety can look differently for different people, but ultimately it is a sense of arousal (not sexual) where your body cannot turn off it ingrained flight, fight, or freeze response. Your body is preparing you for something bad whether it be anxiety related to intrusive memories of combat, fear of going over bridges, shaking from a fear of panic, stress related to obsessive thoughts; anxiety makes your body turn on and not in the fun way. When your body is anxious, it is often difficult to focus and this includes sexual focusing. When a man is anxious he may notice his erection not emerging or deflating quicker than he’d like . He may be able to “keep it up,” but not be able to have an orgasm. For some, the anxiety makes their system go into overload and they may orgasm extremely quickly.

So why does anxiety cause these problems and why is it that once they start to happen more often, it’s harder to fix them? The penis is very sensitive, both literally and figuratively. Anxiety can make a man even more sensitive to everything around him both internally and externally. A major area of concern I see in practice is the impact of Posttraumatic Stress Disorder or PTSD on erections. While not often discussed, it has been found that individuals with PTSD are at significantly increased risk of having sexual problems. Why you may ask? One major area is the body. When someone is going through a trauma, their entire body system is activated. They are more sensitive to sights, sounds, smells, tastes, and physical sensations, so when they are trying to make sense of what is happening, their brain is creating a pairing that tells it “when X body system happens, Y bad thing will happen so be prepared.” Ready for this: when your body is sexually aroused, the exact same physiological system being activated is the one that was activated during trauma that created that pairing. So, when your body “turns on” for sex, it’s also “turning on” for trauma. No wonder someone with trauma has difficulty functioning sexually! Their body is preparing for another horrible thing to happen even though the actual situation is one of pleasure. The pairing effect often results in increased fear and anxiety, intrusive thoughts about the trauma, disconnection from the situation, and physical touching difficulties to name just a few. This is only one example of how anxiety can cause difficulties in someone’s sex life, but for men especially, there is another layer to the anxiety.

Societal pressures about sexual performance and expectations in men are staggering, but not often discussed. Men are typically told that being a man means certain things and one of those things is having a functional penis. There are horrible messages given to men that if they don’t have sex that makes them weird, a freak, broken, not a man, and so many other completely wrong labels. Not being able to have sex, masturbate, or feel aroused with anxiety is completely normal, but it is also one of the things that makes someone feel not just anxious, but depressed. If a major area of your identity is your ability to functioning sexually and that goes away, what does it say about you? For many men with anxiety and sexual problems, it does not just go away. If anything, the longer you wait to treat the anxiety, the harder (pardon the pun) treating the sexual problem is as well.

Anxiety is a tricky thing to treat by yourself as are sexual problems, but what we know about treatment is that treating one can impact the other. Finding a provider who can address these interconnected issues is key in your overall recovery. If you would like to know more about how to treat anxiety and sexual problems in men, feel free to give me a call at 702-587-1573 or an email at Having anxiety does not make you a freak, having sexual problems does not make you any less of a man, and seeking out treatment does not mean you are weak.