Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey. 

Utilizing The Transtheoretical Model or ‘Stages of Change’ to Better Understand Your Addiction

By Concentric Counselor Charles Weiss, LCPC

If the dopaminergic receptors in my brain didn’t make me feel so good when stimulated and weren’t so intertwined as well as interwoven with my serotonin levels and that my GABA receptors didn’t inhibit my nerve transmission leading to my brain activity level to be depressed, I would have never used in the first place.  Do people who suffer from addictions really think like this?  Do they really understand the intricacies on how drugs affect the brain and other physiological aspects of their bodies?  If they had that insight or answers, would they still want to get high, continue rationalizing the reasons in which they use or actually seek out help?

For the change process of the individual to be effective and impactful, it is helpful to better understand how certain drugs affect the brain.  Different drugs when taken affect different aspects of our brain functioning.  For example, alcohol is a depressant, which slows down or depresses our Central Nervous System, which helps reduce anxiety and inhibit relaxation in our body.  It slows down brain activity through binding with GABA receptors to help with minimizing racing thoughts, rapid breathing and quick pulse.  Substances like opioids and stimulants, that target the pleasure center in our brain, which involves the Dopamine neurotransmitter, provide us with that “feel good response” that makes it more difficult for people who are addicted to want to quit.  Let’s not forget the cannabinoid receptors that are naturally occurring neurotransmitters that our brain produces, which Tetrahydrocannabinol (THC) and cannabidiol latches onto.  When this occurs, we often experience a more euphoric feeling and our sensory perceptions are often enhanced, which also increases the level of dopamine that is being produced in our brain.  This list is just to name a few of the more widely used substances individuals can become addicted too. 

Substances have the propensity to be both psychologically and physiologically addicting, meaning either the body and/or our mind needs the drug to avoid potential withdrawal.  Not everyone who tries a substance for the first time will become instantly addicted, however, it can increase their risk of them wanting to try it again because of how it made them feel. 

It is not just the neurochemistry in the brain that makes a person struggling with addiction want to use, but the stages of the change they are in can have an impact and effect into the chronicity of their use.  Prochaska and DiClemente postulated a Transtheoretical Model or what many might know as the “Stages of Changes” that people can experience when it comes to their understanding their addiction and their willingness to cease it. 

This model has 5 stages that an addict can experience, with a sixth called Relapse, which I will discuss later, that indicate the individual’s willingness of wanting to continue or cease the use of the substance(s). This model can also apply to a wide range of other behavioral challenges that individuals are having an arduous time in overcoming, not such substance use, abuse, or dependence. 

Stage 1- Precontemplation

Pre-contemplation is when an individual doesn’t think they have a problem with the drug and/or substance they are using and aren’t willing to change their behavior.  Oftentimes these individuals are in denial that their addiction is a problem, they have not connected the experience of the negative consequences of their addiction or understand the severity of their addiction at this time.  They are currently enjoying and appreciating the positive and pleasurable effected of their addiction, the “high” and positive aspects of the substance they are using due to neurotransmitters that substance targets to cause this affect.  It often isn’t until the individual begins to experience more of the negative aspects of the substance (i.e.: withdrawals, negative consequences from their addiction), will the individual begin to consider they might have a problem and move from pre-contemplation to the contemplation stage.

Stage 2 - Contemplation   

Contemplation stage typically occurs when individuals have the self-talk about the challenges and struggles in wanting to make a behavior change, yet are unable to pull the trigger at this stage and follow through with their thoughts of wanting to change or cut down their use.  Individuals are typically open to listening to advice on how they can change their behavior, to gain a bit more insight into their addiction, understanding the consequences of their addiction, but have not established and/or developed a specific plan on how they would like to change their behavior.  Utilizing a non-judgmental attitude and motivational approaches to encourage change, such as beginning to teach individuals a harm reduction approach, can help propel the individual towards the preparation stage of change.

Stage 3 – Preparation

During this stage of change, individuals are starting to become more committed into wanting to change their behavior and develop plans on how they can begin minimizing the frequency and occurrence in which they are using substances.  Individuals start to gain more insight into the impact and effects the substances have on their level of functioning and the dysregulation of neurochemistry in their brain through collecting and gathering resources either provided to them or investigating these resources for themselves.  They become more cognizant of their triggers and begin learning more effective strategies to minimize the occurrence of them as well as seeking out and developing healthier support systems to aide in their recovery.  Individuals begin to gain more insight into the consequences their addiction is having on their level of functioning.

Stage 4 – Action

As the insight and introspection into their addiction becomes more “front and center”, individuals are able to begin developing plans to implement to aide in their recovery.  Now all the preparation that was exerted and exhibited in the previous stage can be put into motion.  As stressful as this stage can be, it is the best time when interventions such as seeking out a Certified Drug and Alcohol Counselor (CADC), licensed therapist or going to a substance abuse or detox center can be most impactful and continue to move as well as guide the individual towards their recovery.  With a trained and licensed professional, appropriate and realistic goals can be established to be addressed gradually as well as developing more adaptive over maladaptive coping skills that are taught to help move the individual towards the maintenance stage.

Stage 5 & 6 – Maintenance/Relapse

After the strenuous time it takes into in acknowledging, accepting and putting into motion plans that become action, maintenance follows.  This is time in which the individual is able to maintain sobriety for at least 6 months of implementing everything they have learned in treatment and progress on the goals they have developed for themselves.  During this time, individuals might begin to feel complacent or feel like there is some plateau they have reached with their progress, that defaulting into their maladaptive habits might be inevitable.  However, with the continual commitment and support to their recovery, maintenance can be an obtainable long-term goal. 

Part of any recovery can be relapse, although not everyone experiences relapse(s).  When an individual relapses, they don’t necessary default back to Stage 1 - Precontemplation.  If the individual is committed and with ongoing positive support they have created for themselves, they might only fall back a stage to Action and/or potentially Preparation Stage.  It unfortunately might take an individual several relapses before they are fully committed to the change process.  The goal is never to give up and continuing reinforcing yourself of your commitment of wanting to make the behavior change in being able to abstain from one’s substance of choice, such as alcohol or illicit substances.

If you or a loved one is struggling with any addiction, please seek out professional help. There are countless resources available that can help and aide you in your recovery.  Change doesn’t happen overnight, but understanding as well as acknowledging that you might have a problem is the first step in your journey to change and living a healthier and more fulfilling lifestyle.  This Transtheoretical Model or Stages of Change by Prochaska and DiClemente might not be applicable to everyone, but it can be applied broadly to anyone who is willing and wanting make the necessary change to improve their overall lifestyle and to be a better you. 

The Value of Vulnerability

By Concentric Counselor Christian Younginer, LPC, NCC

Life XXXV by Emily Dickinson

I CAN wade grief,

Whole pools of it,—

I ’m used to that.

But the least push of joy

Breaks up my feet,         5

And I tip—drunken.

Let no pebble smile,

’T was the new liquor,—

That was all!  

Power is only pain,         10

Stranded, through discipline,

Till weights will hang.

Give balm to giants,

And they ’ll wilt, like men.

Give Himmaleh,—         15

They ’ll carry him!

Emily Dickinson’s word choice in the first line sticks with me- she can “wade” grief. She can trudge through the thick, tarry mire of sadness, pain, loss, and sorrow. It really feels like that, doesn’t it? This viscous bog of grief, she’s “used to that”. It’s familiar for her. But joy is foreign. 

Although she can bear the pain of life, let life surprise her with joy and she will stumble, drunkenly. This voices a common human experience: Let something test our resolve, and we will meet that challenge. But let us be vulnerable, and we will dissolve.

It is easier to harden, than to soften. Give comfort and love to giants, and they will “wilt” into ordinary men, but ask them to carry mountains (‘Himmaleh’ is the archaic form of ‘the Himalayas’), and they will offer up themselves.

This brings us to the question of this post: How does a person allow themselves to be vulnerable, without wilting? How do they remain resilient when life gets hard, without hardening themselves?

What is vulnerability?

The insightful Brené Brown defines vulnerability as both “the birthplace of love, belonging, joy, courage, empathy and creativity”, but also as “uncertainty, risk and emotional exposure” (Daring Greatly). So, our options are: recoil at the latter and tell ourselves we don’t need the former OR accept the latter because we accept that we need the former.

There were times in my life where I clung to the idea that ‘ I don’t need others’- to avoid feeling exposed. That idea eventually spoiled, and I was faced with the reality that I DO need others. While I was aware of the fact, I had not yet accepted it. It was not until I accepted that I need others that my journey towards understanding vulnerability began.

Being vulnerable feels like the difference between writing in the 3rd person and 1st person. It is keeping others at a distance, to avoid the pain of feeling exposed- of not being accepted. If you notice, I switched from using “they” and “them” to “I” and “we”. As I wrote, I noticed feeling exposed, but I also noticed feeling satisfied with my self-awareness and honesty. That is, I felt joy in sharing this part of myself so that it might be of help to someone. It is this ‘trade-off’ that I believe Brené Brown is describing. If we can be ok with feeling a little exposed, we can receive wonderful gifts of acceptance, approval, validation, and love.

The Alternative.

In my pursuit of understanding vulnerability, I came to a choice. Would I rather feel uncomfortable or alone? My choice to embrace vulnerability and accept the possible “emotional exposure”, speaks to not only my desire for connection with others, but to the horror of the alternative: feeling alone. Jumping from a burning building does not mean that jumping is not scary, rather the alternative is too horrifying to consider.

Resilience.

What I am suggesting almost seems oxymoronic: Become vulnerable to become stronger. Invulnerability is not a superpower. Unless Superman exists and no one told me. Rather, accepting that we need others is the true superpower. One powerful result of letting ourselves connect is resilience. That is, if we temper ourselves in the furnace of vulnerability, we become stronger than we were. This is possible due to what Brené Brown references as the gifts of vulnerability: love, belonging, joy, courage, and empathy. Having these in our arsenal make us stronger humans, less prone to burnout and emotional distress.

Let us learn to enjoy the intoxicating effects of joy and not let it cause us to stumble. Carry the mountain if asked, because you are strong enough to shoulder it. But also do not wilt at receiving comfort or help. If we accept that we not only need others for support, but also that they have gifts to offer us, we become stronger. More resilient to carry the mountains when we need to and more courageous to be vulnerable when we just can’t carry anything else. It is the courage and strength to say: “ I’m not ok right now. But I will be.”

Asking for Help - Not Waving but Drowning

By Concentric Counselor Christian Younginer, LPC, NCC

Not Waving but Drowning

By STEVIE SMITH

Nobody heard him, the dead man,   

But still he lay moaning:

I was much further out than you thought   

And not waving but drowning.

Poor chap, he always loved larking

And now he’s dead

It must have been too cold for him his heart gave way,   

They said.

Oh, no no no, it was too cold always   

(Still the dead one lay moaning)   

I was much too far out all my life   

And not waving but drowning.

I believe this poem verbalizes well a common societal pressure. That is, the need to be happy externally, even if drowning internally. As we go through our day, met with multiple “How’s it going?”, we invariably are trained to answer “fine” or “great”, without the slightest thought. The question we’re left with is: how would anyone know I’m drowning, when I always give them a friendly wave?

Asking for help can be deceptively difficult. Frequently I hear from clients that asking for help shows weakness, or is shameful, or too vulnerable. So, we strengthen our resolve, buckle down, and soldier on at the expense of our wellness and happiness. We become run down, exhausted, and deflated. Imagine a balloon trying to remain the same size, while its air slowly leaks. We receive messages from our families of origin, our employers, and consumer culture that tell us to harden. But the harder we get, the more brittle we become. Rather than naming our need for help, we’re now drowning with work, emotions, schedules, and isolation. 

Ultimately, this issue of asking for help comes down to a person’s struggle with taking care of themselves. Wellness, self-care, asking for help, boundary setting, etc all live in the same neighborhood: taking care of the self. A former supervisor of mine offered this metaphor:

You board an airplane, take your seat, and the flight attendant begins the safety protocols speech. They get to the section on the oxygen mask. They say, ‘please secure your own mask before attempting to assist anyone else.”

Why is that? Well, you can’t help anyone if you’re dead. The same concept applies here, albeit with less grim consequences. How can we expect to function, let alone help others, when we run ourselves ragged?

To return to the topic at hand, one way of taking care of the self is asking for help. Seeking therapy is a form of this. I often name the courage it takes for a client to find a therapist. As we know, it’s hard to find help for ourselves- especially for our mental health. As if the unfortunate stigma isn’t enough, busy schedules and work demands can get in the way. If therapy is two steps too far for you, there are smaller ways to open ourselves to the help of others.

We don’t have to instantly open up and adopt this idea. Rather we can take smaller steps that feel safer. For example, if we have created a default answer of “fine” when asked “how are you?” by random people, then that may have filtered into closer relationships. Those relationships where it may feel safer saying “Actually, I’m struggling.” So, what if we remove the automatic ‘fine’ from our vocabulary? Rather, when asked by a close friend or family member, “how are you?”, we take that question for what it is: an out-stretched hand to a drowning person.

 I think it is unfair to view this poem as an indictment of those who misread the author’s anguish. Rather, I believe it is a call to stop waving when we’re drowning. To let those looking out for our safety, save us. Only from this place of moaning, cold death does the author finally feel safe saying she was much too far out all of her life. If only we, the onlookers, knew this we could’ve helped.

 It is ok to feel you’re too far out. It is ok to feel like you’re drowning. There are those who want to help us, but only if we let them. When we don’t ask for help, we deny our friends and family the gift of being able to help someone they love.

The Role of Anxiety in Living an Authentic Life

By Concentric Counselor Christian Younginer, LPC, NCC

To be brief, anxiety can suck. The persistent worry of imagined scenarios can plague the mind and exhaust the body. It can manifest as brief periods of pronounced worry, a baseline worry for all things, and even panic attacks. But I would like to offer a perspective that may be overlooked in coping with anxiety. That is, can my anxiety teach me something?

Specifically, can my anxiety teach me how to live an authentic, meaningful life? This question shapes Existential Therapy. At its broadest, existential therapy is the endeavor of understanding one’s existence in a therapeutic setting. This is done via an honest exploration of one’s freedom, choice, responsibility, meaning, and inevitable death. Existential psychotherapist Irvin Yalom conceptualizes much of anxiety as death-anxiety (Existential Psychotherapy, p.189). That is, persistent anxiety can be explained as an underlying worry about a life without meaning in the face of approaching death. Death is what allows life to have meaning. If there were no end, then for what should we live? The finiteness of life can motivate, intimidate, and terrify. However, it is this anxiety that can be the canary in the mine of our life.

As we work, study, sleep, parent, eat, play, drive, and journey through life, meaning and purpose can slip through the cracks. Anxiety can creep in, seeming to have no definable impetus. Often enough the death of a loved one, or a diagnostic medical scare can bring perspective -- wherein we confront our death. But one does not need to wait for such a moment to ask these questions, such as “Why am I here?”, “What does it mean to exist?”, and “What is my purpose?”.

Anxiety can be that canary that alerts us of an inauthentic life. It warns of the finiteness of life, and the importance of living a life with meaning. This often manifests as a vague sensation of “running out of time”. Without meaning, one can find life pointless or trite. The finiteness of life no longer motivates, it terrifies. But if we listen to what our anxiety is telling us, perhaps we can redirect our lives towards meaning.

How does one do this?

An example from philosophy may be of use. In Frederick Nietzsche’s The Gay Science, Nietzsche offers the reader an aphorism he titles ‘The Heaviest Burden’. He proceeds to ask the reader: if a demon were to order that you must live this life in eternal recurrence, every moment, detail, pain, and triumph- would you thank him or curse him? (The Gay Science, Aphorism #341). So, do I live my life in such a way that were I to re-live this life on repeat, I would praise the demon with gratitude for the opportunity? Or would this prospect bring about the abysmal dread of re-living a meaningless life? It is this precise idea where anxiety comes into play. Am I experiencing the anxiety and dread of a life not worth re-living?

It is this question that can help steer us towards meaning. Do I live in such a way that were I to re-live this life on repeat, would I be in joyful contentment or in abysmal dread? This is a tough question with which to be confronted. However, we can use this question as a beginning: the moment one begins to ask “does my life have meaning?”. Rather than be frozen by the possible dread this question instills, one can frame this as the moment in which a new life begins. As always, Confucius said it best, “ We have two lives, and the second begins when we realize we only have one.”

Determining WHAT is meaningful is a personal journey that can take time to uncover. But knowing thyself was important to Plato for a reason. It is this existential journey of a human confronted with death, through anxiety, uncovering that which gives their life meaning.

To conclude, yes, anxiety does suck. But as we work to cope with it, let us ask -- What is this anxiety trying to teach me?  Anxiety very well may lead us away from the existential dread of an unexamined life, and instead towards finding a meaningful life worthy of repeating.

Adolescents, Teens, Depression & The Warning Signs

By Concentric Counselor Katie Ho, LPC, NCC

At a time in life when the only thing certain is constant change, recognizing and being aware of depression during adolescence can be a challenging feat without the knowledge of warning signs and risk factors. Mental health and the seriousness of depression continue to be topics of conversation following the headlines of national news and tragedies - but an equally, if not more urgent conversation is the one that needs to be started at home. The pressures of adolescence and impact of today’s culture of social media appearances and limited interpersonal connection only reinforce the need for education and awareness on depression. Parents and caregivers can provide their support and intervention through having the skills and knowledge to address their young person’s greatest mental health needs.

The answer to why we should talk about depression with teenagers is becoming more clear as the topic continues to be normalized, de-stigmatized and commonplace in the discussion of healthy emotional development; but the answer of how is where the light could shine a little brighter. How do you initiate a conversation around feelings, emotions and concerns of your child or loved one’s changes in mood and psychological health? How do you create a safe environment that fosters and promotes honest, sometimes uncomfortable dialogue about profound sadness or even thoughts of self-harm or suicide? Many of those answers involve one important action: listening.

In order to fully understand and be prepared for a conversation around your young person’s mental health, it’s vital to know the warning signs and symptoms involved with depression during adolescence. These characteristics can be different than how they typically manifest in adults, and can oftentimes be mislabeled as expected changes during a new phase of life. It’s important to distinguish between depression and normal sadness. Depression can consume their day-to-day life; interfering with the ability to work, eat, sleep, study and have joy. It can involve feelings of helplessness, hopelessness and worthlessness with little to no relief.

Here are some signs and symptoms of adolescent depression:

● While some individuals may appear sad - many and most appear irritable (unrelenting)
● Negative view of self and/or the world and future
● Withdrawal from family and friends (isolation)
● Anger/Rage
● Overreaction to criticism
● Excessive sleeping
● Significant change in appetite
● Increased reckless or impulsive behaviors
● Substance use or acting out in an attempt to avoid feelings
● Violence
● Running away

If you suspect your teenager is struggling with depression or begins showing signs of concerning behavior, finding the time, the patience and the space is the first step in creating an environment for an honest discussion.

❖ Remember the value in listening over lecturing: initiating a conversation about emotional pain or hardships means being willing to hear their truth without judgment or criticism.
❖ With unconditional love will need to come unconditional support; let them know you’re committed to helping them fully and in a way that respects their experience, choice and voice.
❖ Be gentle, but persistent - if your teenager claims nothing is wrong, but is otherwise unable to explain the concerning observations and behaviors, trust your intuition and consider options for getting them to open up. The most important goal is to get them talking - whether it’s to you or to a reputable third party, give them the resources and options to share with someone they can trust.
❖ Validate their feelings - always. Try to avoid talking them out of their feelings or giving them an alternative perspective in which to view their experience. Acknowledging and communicating that you believe and hear them will foster trust and empathy. In combating adolescent depression, it can be effective to take a holistic approach - making their physical health as much of a priority as their social and emotional health. Encourage movement!

Physical activity can be incorporated in a number of ways, whether it’s a sports team, individual activity, dance class, walking the dog or riding their bike - all movement is good movement! Healthy, balanced eating and limited screen time are essential requirements for anyone’s lifestyle, but particularly those in adolescence. These items can also be partnered with the important aspect of positive interactions with family or loved ones. Sharing a meal or spending quality time can help that young person feel connected and valued.

Should the need for professional help and intervention be determined, be sure to involve your teen in those decisions. Respect their thoughts and opinions, and talk openly about their options for treatment. It may be a struggle for them to feel connected or comfortable talking with a professional, and collaborating with them on identifying someone who could meet their needs may help to bridge that gap. Depression and recovery can feel scary to both parent and child, but having open conversations with clear understandings of love, validation and support can make helping them more manageable so that they can live their most meaningful life.

Men, Loneliness, and the Substance Substitute

By Concentric Counselor Myron Nelson, LCPC

We know it is true when we take stock of our lives, although it is easier to simply ignore. We do not have the same number of friends that we used to. We definitely do not have the same number of close friends, friends we could call in an emergency. Whether it is technology taking up more of our time, a culture that promotes handling problems on your own, or some other reason, it is clear we do not connect in the same way.

Due to factors that will be explored in this blog post, half of the population is more vulnerable to the Great Friend Migration. Men, myself included, are bombarded with societal forces that encourage segregation. We are instructed to cope with problems silently, internally. Isolate yourself or be shamed. We are taught to detest emotions, push them down or aside but do not let them grow. Best to not spend time with other people if we are in an emotional state.

Consequently, our problems grow bigger, the stress becomes heavier, and the emotions continue to build up until we are neck deep. Keeping quiet and keeping it to ourselves, we fall deeper into our own thoughts. Expecting that other people do not want to be burdened with our issues. We drift apart from friends because we do not know how our problems could possibly fit into their lives.

What’s next? We turn to something that can help. Something that makes us feel better, it’s reliable, it’s dependable, it does not judge us, and it does not share our secrets. Alcohol and other drugs can become a refuge for emotional pain. They can buffer feelings of anxiety or depression and temporarily give us the mask we want to keep the facade going.

Alcohol and drugs can slowly become something we depend on but that dependency is dangerous. What starts as a solution to the problem becomes its own problem. Substances attempt to fill the void that other people used to, but they will never be enough. Substances can never talk back to us and make us feel cared for and understood. They cannot debate options with us and challenge us to be better. Substances offer complacency but relationships give us acceptance and growth. It takes courage and a leap of faith to connect with another man and share your problems but it is truest the solution.

The irony is, that we all want to lean on each other but are scared to lean first. It is society’s expectation about men and men’s expectations about society that propel this problem into an epidemic. When we let our predictions go and venture into reality, it’s clear that other men feel the same way we do and we can meet each other with compassion and caring.

Men are not inherently isolating and society is not inherently cold. Expect that other people feel the way you feel. Expect that as a man you will experience things that other men experience. Expect that others want to know about your struggles because they want to be able to lean on you too.

If you find yourself experiencing The Great Friend Migration, convincing yourself that filling your loneliness with substances is better than the alternative - opening up, reaching out, and relying on a male friend, I encourage you to stand up to your shame, choose connection, and lean it to a friend.