The Amygdala Answer: How understanding the origin of your anxiety will lead to the best solution

We usually assume all anxiety has a similar biological process, but anxiety can come from two different places in the brain. 

The Cortex

If anxiety is caused by our thoughts, it originates in the cortex. For example, if you are preparing for a big presentation and you start to think about all the things that could go wrong, you will likely begin to feel anxious about it. Those thoughts come from the cortex, which activates the amygdala, and then the amygdala responds by releasing an anxious response in the body.

The Amygdala

However, when anxious feelings come on suddenly before we are cognitively aware of the cause, that anxiety originates in the amygdala (without the cortex being involved). This type of response is the body’s way of protecting itself from perceived danger when there is no time to wait for our thoughts to recognize there is a problem. For example, if you heard a car horn just before being in a car accident, your amygdala might have learned to associate the sound of a horn with danger. If this happens, the amygdala will initiate an immediate anxiety response every time it hears a car horn. Only after the body has responded in this way will your thoughts catch up to apply reason and determine if the horn is a sign of danger or not. The amygdala has activated a response aimed at protecting the body, without you having cognitive awareness until after it happens. 

Responding to Amygdala Anxiety

Knowing what area of the brain is causing our anxiety is the key to understanding how to best address it. If our anxiety is coming directly from the amygdala, then the cortex (and conscious thought), are not involved. So, it would not be effective to try to use our thoughts to change this type of response. With amygdala-based anxiety, the best thing we can do is work on exposure. Finding ways to expose ourselves to the trigger that causes this type of anxiety will over time teach our bodies that the situation is safe. The amygdala learns from experience, so the more we experience a perceived threat without a negative outcome, the less likely it will continue to cause an anxiety response.

Responding to Cortex Anxiety

With cortex-based anxiety, the most effective approaches address our thoughts directly. Cognitive restructuring refers to the process of identifying thoughts that cause anxiety and replacing them with helpful thoughts. Thanks to neuroplasticity, each time we do this we are creating new pathways in the brain that will help to prevent an anxious response in the future. Different problematic thought patterns contribute to anxiety, such as expecting the worst, jumping to conclusions, judging yourself unfairly, making ‘should’ statements, and perfectionism. Using these thought patterns as a guide, you can identify specific thoughts you have that lead to anxiety, and then develop coping thoughts to replace the unhelpful thoughts. For example, if you frequently think ‘I need to do this without making any mistakes’ (perfectionism) it might lead to feeling anxiety about completing the task, and possibly prevent you from doing it. A more helpful coping thought to use in its place could be ‘I am learning, it is safe for me to make mistakes.’

Anxiety is a complex issue, and this is a very brief overview of how understanding where it originates in the brain can help inform the proper intervention. These processes would best be navigated with the help of a mental health professional trained in the treatment of anxiety. 

–Laura Gross, LMSW

Laura Gross is a Clinical Therapist with Marsh Psychology Group

You can contact her at:

(248)860-2024

lgross@marshpsychologygroup.com

Pittman, Catherine M., and Elizabeth M. Karle. Rewire Your Anxious Brain: How to Use the Neuroscience of Fear to End Anxiety, Panic, & Worry. Echo Point Books & Media, 2019. 

An Introduction to Dialectical Behavior Therapy: 1. Mindfulness

Dialectical Behavior Therapy (DBT) is an evidenced-based type of psychotherapy developed to help individuals manage emotions and symptoms of mental illness. It includes four different modules that will be explained in a series starting with Mindfulness in this article.

Mindfulness has become a buzz word in recent years, and for good reason. Being mindful is increasingly challenging as our lives become more focused on technology, and most of us are running on auto-pilot to manage our packed schedules. Mindfulness is simply paying attention to the present without judgment, being aware of what is happening in your mind, in your body, and in your surroundings. It is easy enough to see how detached we can become from the present when we think of an activity like driving. Do you have full awareness of your actions every time you use your blinker or look in the mirror? Something we tend to do so often becomes automatic, to the point we might not even fully remember getting from one point to another!

While this lack of awareness has become the norm, it can cause problems with our mental health. When we go through the motions without checking in with ourselves to notice how we are feeling and responding to things, we become ungrounded and detached from ourselves and our experiences.

Learning to become more mindful in our everyday lives is a process that takes time, but even starting with small practices can help. Mindfulness is the foundation for being able to improve our emotional experience and mental health.

DBT teaches the following ideas for mindfulness:

Here are some ways to build mindfulness skills:

If you feel you need more guidance to incorporate mindfulness skills and improve your mental health, a licensed mental health professional can help.

-Laura Gross, LMSW

Marsh Psychology Group

248-860-2024

Linehan, M. M. (2014). DBT Skills Training Handouts and Worksheets. New York: Guildford Press

It is incredibly common to struggle with the process of setting and accomplishing goals.  And due to this difficult process, many of us end up feeling defeated or as if we have some sort of character flaw.  This way of thinking can not only keep us from practicing goal setting but can have negative impacts on our overall self-esteem.  The process of setting and accomplishing goals is a vital component to our overall mental health and emotional wellbeing; therefore, it is extremely important that we do not abandon the practice of goal setting and goal accomplishment.

Below are some tips to assist you in successfully setting and accomplishing your goals:

1. Keep your goals simple and specific.  Many of us set goals that are simply too large and/or not clearly defined.  This can lead us to feel overwhelmed and/or inadequate if we do not accomplish our goal, when in reality the goal as we defined it was just not feasible. Examples include the following:

2. Make sure your goals are realistic. Identify potential barriers to accomplishing your identified goals and modify your goals accordingly.  For example, if you set a goal to go to sleep each night at 10 pm but you have a favorite show conflicting with that time, consider altering your chosen bedtime for that evening, or recording the show to watch it at a time not conflicting with your chosen bedtime.

3. Identify and challenge “all-or-nothing” thinking. “All-or-nothing” thinking is a pattern of thinking in “extremes” or “absolutes.”  When we apply this inaccurate and often-negative method of thinking to goal setting, we can become very easily frustrated or feel as if we have failed.  It is therefore vital that we are able to identify and challenge “all-or-nothing” thinking as it applies to goal setting and completion.  The following is an example of “all-or-nothing” thinking in relation to goal setting and completion:

4. Set up cues or prompts to remind you of your goal and/or to assist in making your goal more attainable. An example of this would be keeping a pair of walking shoes near your door if your goal is to begin an outdoor walking regimen.

1. Be mindful of your self-talk.  It is not easy to develop a new habit.  It is not easy to set goals and accomplish them.  Be kind to yourself.  Remind yourself that this is a new process, and it is completely normal to struggle when we are learning something new.  If you find it hard to be compassionate with yourself, think of what you might say to a close friend or even to a child who is learning a new skill and/or attempting to develop a new habit.

1. Provide yourself with positive reinforcement for accomplishing your goals.  As stated above, this is not an easy process.  Reward yourself for setting and accomplishing a goal.  This is a way to show yourself encouragement and compassion, and it is also a technique to make habits you are trying to develop more likely to continue.

If you are finding any of the concepts and/or techniques described in this blog particularly difficult, it may be helpful to seek the guidance of a mental health professional.

-Sierra Shapiro, MS, LPC

When Spring Comes and Depression Stays

Oftentimes, people struggling with depression look forward to springtime and the hope that warmer weather and longer days will bring some relief to their symptoms.  Unfortunately, that is not always the case and hopelessness can set in.  This year especially, with the pandemic seeming to be never-ending, people are dealing with the loss of the ability to find pleasure in activities.

The number of people experiencing burnout, stress, and depression has increased as the pandemic continues.  During long periods of unpredictability, like what has been happening over the past 13 months, it can be easy to become lethargic and lose any kind of pleasure in what would normally feel good to us.  And the hobbies that may have been taken up time in the beginning of the pandemic, may have lost their luster.  People are losing motivation to do much of anything.

Connection with other continues to be extremely important during this time.  As the weather warms, it provides us the opportunity to meet up with people safely outside.  But if that is not an option for you, reach out through video chat or phone calls.  Let people know you are struggling so they can support you.

Other options include spending time in nature, connecting to a spiritual practice, or exercise.  When not much seems to be working, be patient with yourself and remember this too shall pass.  And of course, seek out professional help and support when you need to.  Working with a mental health professional can help you to begin to climb out of your depressive mood.

-Julie Lublin, MA

Julie Lublin, MA, PLC is a staff psychotherapist at Marsh Psychology Group.  She can be reached at jlublin@marshpsychologygroup.com or 248-860-2024.

Resilience

With the pandemic continuing into 2021, stress levels are at an all time high.  Most people have been challenged in unimaginable ways.  Whether it be isolation and loneliness from sheltering in place, loss of income, or even loss of a loved one due to Covid 19, we ,as a nation, have been pushed to the limits.  

However in times of stress, one’s resilience comes to the forefront.  In focusing on self care and self exploration , it is the rule rather than exception, that struggles, anxiety, grief, and trauma can provide an opportunity for growth.  To be clear, this is not to dismiss pain,anguish, and struggle. Rather, we can use these difficulties as a springboard for growth.

What is Resilience?

Resilience is defined as the capacity to respond to pressures and tragedies quickly, adaptively and effectively(Graham,2013). It is our ability to both “go with the flow” and learn from our difficult experience, resulting, in time, a better understanding of self, increased confidence, and functioning.  But it begs the question, why are some folks more resilient than others, and can resilience be taught?

The truth is some folks are more resilient than others.  Some of this stems from a having a strong support system and a healthy development prior to the difficult event.  That being said, even the most resilient person will struggle with traumatic event, like a pandemic.  So if even the most resilient struggles, is it possible to learn to be  more resilient? The answer is yes.

Neurons that Fire Together, Wire Together

Neuroplasticity is the brain’s ability to form new pathways and grow. Studies on neuroplasticity(Siegel,2007)repeatedly show the brain’s ability to re-wire, grow and change in response to new experiences, both joyful and traumatic.  This means that when we are faced with a new challenge, our brains are primed to learn new ways to cope.  Similarly, when we try new healthful ways  of coping in the face of struggle, our brains are ready to develop new pathways, becoming stronger and more resilient. Further, the window of opportunity for  increasing resilience does not have an expiration date.  The brain continues to create neural pathways throughout our lives.  

Ways to Increase Emotional Resilience

Practice daily self care: good nutrition, sleep, and exercise increases our general sense of well being and provides a sense of stability in the face of negative events.

Journaling: Writing about your struggles allows increased self reflection and emotional attunement.  This creates new understandings of our inner voice and increases resilience.  Focus on what things are particularly challenging as well as the ways you cope.  Thinking  about what lessons may be learned,  and how you would like to be different, stimulates the brain.

Mindfulness:  Become aware and curious about your thoughts and feelings in response to challenge.  Focus simply on noticing rather than judging.  This is a powerful data collector for our brains, providing new material to link/ wire for growth.

Practice Self-compassion: cut yourself a break when shame/guilt/self deprecating thoughts come up.  This practice is a very powerful fuel for resilience.

Psychotherapy: Psychotherapy can be a powerful catalyst for resilience.  New insights, coping techniques, and emotional attunement help fuel resilience.  In some instances of trauma or enduring depression/anxiety, working with a trained psychotherapist is needed to create new coping skills and insights.  Having a mental health professional serve as shepherd, witness, and support while working through intense trauma and emotional strife is a powerful tool for change.

Resilience is a constant and enduring quality that we all can cultivate.  Here’s to finding our strongest inner selves.

Be well,

Dr. Marsh

Pamela Warner Marsh, Psy.D., is a licensed clinical psychologist at Marsh Psychology Group.  Contact her at 248-860-2024 or pmarsh@marshpsychologygroup.com

Resources and Citations:

https://www.apa.org/topics/resilience

https://www.mayoclinic.org/tests-procedures/resilience-training/in-depth/resilience/art-20046311

Graham, Linda. Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being. New World Library, 2013.

Siegel, Daniel (2007). The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (Illustrated ed.). W. W. Norton & Company.

What to Expect in Your First Psychotherapy Session

Although seeking help for mental health struggles is becoming more accepted and de-stigmatised, even the most accepting people may wonder what exactly to expect in the first meeting with a therapist. In general, here are 3 things every first psychotherapy session should include:

• A discussion of what you would like to change:  This discussion usually begins with the question: what made you reach out for help? For some it might be a specific event, like a fight with a family member , a panic attack, or break up with a significant other.  For others, counseling may be something they have been contemplating for a while.  Often folks call in after one too many days of  battling their depression or anxiety.  It is likely that your therapist will spend some time exploring how the presenting issue developed and any other key stressors in your life.

•  Taking your mental health temperature: Your therapist should also spend some time assessing how you are functioning in your daily life , given the problems you presented. They will likely ask about:     Sleep, eating/appetite, attention/concentration,  exercise habits, current coping skills, support system, caffeine intake, alcohol intake, recreational drug use, family history of mental illness, current medications.

•   An assessment of their understanding of your issues and how they might help you. You should leave the session with an idea of what the therapist thinks is causing your current struggles and how they propose to help.  This assessment may vary depending on how the therapist practices and conceptualized treatment.  Some therapists may focus on exploring your thought patterns and irrational beliefs.  Some might focus on your emotional experiences and ways to understand and control your feelings.  Others might look at your relationship patterns and how this fuels difficulties.  Another therapist might propose to improve your coping skill through teaching stress management techniques.  Most modern therapists will use a combination of these interventions.  What is most important, is that you leave the office with an idea of how the therapist can help you.                                                             

I hope this helps demystify the first session. Here are some links to further explore starting psychotherapy and  different types of treatment :

https://www.npr.org/2019/12/11/787058888/how-to-start-therapy

https://www.apa.org/topics/psychotherapy/approaches

https://www.goodtherapy.org/learn-about-therapy/types

Be well,

Dr. Marsh

Pamela Warner Marsh, Psy.D. is a fully licensed clinical psychologist and Director of Marsh Psychology Group.  She can be reached at pmarsh@marshpsychologygroup.com or 248-860-2024