therapy

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.

Things You Didn’t Learn in Sex Ed - Ladies

Okey dokey ladies, let’s get down to business (and yes, half of you are now singing the song from Mulan, you’re welcome btw). One of my major pet peeves is that the majority of individuals in the United States are not provided comprehensive sex education. What sex education should include is information not only about biology, reproduction, and STDs, but information about sexual pleasure, functioning, natural body quirks, social pressures, boundary setting, and so much more. Instead, you either get nothing or abstinence-only which is fraught with inaccuracies.

I have worked with a number of teens and young adult women who report feeling alone in regards to their bodies, who don’t feel like they are normal because they don’t know what is “normal” and what isn’t. Some of the information I provide here may not apply to your individual experience and that’s ok! Everybody is different and that’s the real message of sex education. Your body is unique, your quirks are unique, and you are fantastic no matter what society may tell you about your body, sexual orientation, gender orientation, or whatever label they try to stick onto you. Here are just some basic things I think you should know about your body that you probably didn’t learn in school. This will most likely not be the only time I address this topic, but this is a good start.

1.       You are hairy. Hair will be everywhere. It’s up to you to decide how you want to deal with it, but the reality is, it’s everywhere and it just keeps on growing. There will be times where you have to pluck hair from your chin, your breasts, your belly button, or pretty much anywhere. You do NOT have to groom just because someone wants you to UNLESS that person is you. Be prepared, hair is coming.

2.       Related to hair, should you decide that you want to give shaving a try, please, please, please be careful around your labia. Nothing is worse than shaving around your vagina and taking a slice out of your labia.

3.       Also, speaking of the labia (a diagram has been included below for those who may not know what a labia is) be very careful not to pinch it when putting in or taking out a tampon if you have long nails. One of the major nail trends happening right now is stiletto nails and there is nothing worse than pinching your labia with sharp pointy fingernails. 

4.       Another thing no one tells you about is that weird sensation in your vagina after you’ve been on a bike for a while. Just like any other area of your body that has blood flowing through it, your vagina can fall asleep, and if you’ve ever had that tingling sensation in your foot when it starts to wake up, just imagine how odd that feels in your vagina. Again, completely normal.

5.       Your bladder is small. That’s it. Whenever you get slack from a guy for having to pee all the time, just remind whoever made the smartass comment that your organ is smaller than theirs, just like their brain compared to yours.

6.       Sometimes things can get stuck up there. Yes, this is a thing that happens and no, I’m not talking about a magic trick of losing things in your vagina. I’m talking about situations where your pelvic muscles may have tightened and something that was inserted may have gotten stuck momentarily. Examples of this include diaphragms, tampons, nuva rings, diva cups, small vibrators, and condoms. You can use your pelvic muscles to try to push the items out, but sometimes you’re gonna have to go fishing to get the item out. Just be careful of nails!

7.       Your vagina talks. Again, not a magic trick, although you probably could make it a magic trick. Your vagina is a hollow entry and sometimes air goes into it. During times of vaginal penetration where air is being forced in and out of the vagina it’s going to make sounds.  IT’S NORMAL!!!

8.       For those women who are engaging in vaginal sex with men where there is ejaculation into your vagina, something no one has probably told you is that you will leak. Yes, there will be leakage after the big O inside of you for a little while after even if you use your kegel muscles to push the fluid out. Word of advice, do not wear super adorable undies the day immediately after ejaculation, they will be leaked on.

9.       Do not get seminal fluid in your eye. I had someone describe it to me as one of the worst burning sensations they experienced, which ultimately lead to an eye infection. A major trend in pornography now is a “facial,” which has transcended to real life sex practices. Unfortunately, this significantly increases your chances of a bullseye (literally), which is no bueno.

10.   Your body is truly amazing! You don’t learn in sex education that your body is truly sensational. It can have multiple orgasms, hike mountains, traverse oceans, create human beings; it can do anything. There is no right or wrong way to have a female body, there is only your way.

If you would like more information about anything I discussed in this post, feel free to reach out to me via email at jnspsychology@gmail.com. I hope you took something from this even if it was just a giggle or two.

Top 5 Tips for Titillating Sex

Sex is a vital aspect of human relations, but oftentimes it is the first thing that goes down the drain when life gets in the way. Growing that flame takes time, effort, and can get messy. Here are some of my favorite tips for titillating sex!

1.      Touch-a touch-a touch-a more! Physical touch is such a critical aspect of intimate relationships, but often people think the only way to turn someone on during sexual activity is through genital touch. Nooooooot so much. Increase your touch with your partner in both sexual and non-sexual ways. Touch their neck lightly with your fingers while you caress the small of their back. Spend time massaging their thighs as you both undress. Tease them with small kisses on various parts of their body. Foreplay is not designed for any one gender or any one way; touch is the piece that gets both genders ready and raring to go. Spend at least 15 minutes touching one another in nonsexual ways while slowly incorporating sexual touch into the equation. This tool is not just great for increasing intimacy, but is also helpful if there is any anxiety about performance. Touch should feel good, foreplay should feel good, sex should feel good; if it does not, time to make some changes

2.      Masturbate! Yes, I said it! One of the most basic skills to learn when trying to improve your sex life with a partner is to improve your sex life with yourself. Masturbation is a completely natural experience because it’s all about pleasure. We have decades of studies that show fetuses in the womb “masturbating” and anyone who has ever been around toddlers knows sometimes it’s near impossible to get their hands out of their pants. Masturbation is pleasure seeking, it feels good, it only takes yourself, and it’s entirely safe. So when you want to have a better sex life, masturbate more because it will give you the opportunity to know what works for you. There is a lot of stigma associated with masturbation, that it’s somehow gross, taboo, or sinful, which can severely impact your views about sexual pleasure. Masturbation not only gets you comfortable with sexual pleasure, but it introduces your body to you in a different way; it is a completely sexual act, while sex with a partner often has intimacy connected to it. When you masturbate, you’re learning how to make yourself happy and that is crucial when you add another person into the equation later.

3.      Read about sex! Watching porn and reading about sex are two entirely different entities, but they both serve a similar function, which is exposure. Pornography is a great tool for gaining exposure to sex, but just like war movies aren’t a great representation of the military, porn isn’t the best representation of real sex. Books are a bit different because oftentimes their function is to educate; porn is meant to be entertaining not educative. Learning about pleasure, biology, safety, different techniques, ways to talk about sex, all of it will really open up not just your mind, but also open up a new aspect of sexual pleasure. Here are some stellar books I’d really recommend reading to give you a place to start:

  •  She Comes First: The Thinking Man's Guide to Pleasuring a Woman by Dr.  
     Ian Kerner
  •  Passionista: The Empowered Woman's Guide to Pleasuring a Man by Dr.
     Ian Kerner
  •  Guide To Getting It On by Dr. Paul Joannides (I love this one!)
  •  Reclaiming Desire: 4 Keys to Finding Your Lost Libido by Drs. Andrew
     Goldstein and Marianne Brandon
  •  Reclaiming Your Sexual Self by Dr. Kathryn Hall
  •  Sexual Pleasure by Dr. Barbara Keesling
  •  The Heart and Soul of Sex by Dr. Gina Ogden
  •  Sexual Healing: The Complete Guide to Overcoming Common Sexual
     Problems by Dr. Barbara Keesling
  •  Wanting Sex Again: How to Rediscover Your Desire and Heal a Sexless
     Marriage by Dr. Laurie Watson
  •  The Return of Desire: A Guide to Rediscovering Your Sexual Passion by Dr.
     Gina Ogden
  •  Intimacy & Desire: Awaken the Passion in Your Relationship by Dr. David
     Schnarch
  •  Come as You Are: The Surprising New Science that Will Transform Your
     Sex Life by Dr. Emily Nagoski

4.      Dirty talk! Ok, you don’t necessarily need to talk dirty, but communication is extremely important. Talking about sex doesn’t only happen before sex starts, it needs to be something that happens throughout the experience. A major factor to help make this tip more palatable (pardon the pun) is to get used to saying some words that you may not say all too often. What do you want your vagina to be called during sex? How do you want to refer to your penis and testicles? Are there some words that would really turn you off if your partner said it? What words turn you on? Do you want to use humor during sex? Figure out how you want to use language during sex, practice it a little. Start slow, use one or two words here, test the waters when you tell your partner to lick your clit softer or that you like it when they caress your balls. It’s likely going to feel a little strange at first, but communication about what you like not only leads to improved pleasure on your part, but also to increased feeling of satisfaction on your partner.

5.      Mix it up…..a lot! Variety is one of the most requested things I hear when working with individuals who want to improve their sex lives. Being in a rut with sex can really discourage someone or even make sex seem like a chore. Trying new things doesn’t mean you need to bring out the whips and chains just yet, but it does mean that new experiences could be had. Try sex in a different room of the house, in the shower, different positions (that won’t hurt your back), costumes and roleplaying, or even adding in new ways to creating tension with restraints. There is no right or wrong way to spice things up, it really is about figuring out what works and what kind of things you’d like to try. This is where communication with partners comes into play. If you want to try being strapped to the bed, you probably need to tell your partner first and discuss their reactions to this. If you want to try a different position talk about it! Communication about sex, variety, and sharing fantasies not only increases sexual intimacy, but can improve emotional intimacy between partners because sharing sexual content is vulnerable to do. Be honest with yourself, your interests, your boundaries, and be willing to hear, share, and indulge in your partner’s as well. Now, off to sex all of you!