Learn to Engage Life Using ACT

Discovery Mental Health

Acceptance and Commitment Therapy, or ACT, can help you to engage fully in your life. If you missed the introductory post on this approach to ACT you can find it here:


The Open and Centered posts, which make up 2 of 3 areas of the Hexaflex model, can be found here.





Welcome to the third part of the Hexaflex model. What you will learn:

  1. What being Engaged means in ACT
  2. Values
  3. Committed Action

Hexaflex Model

There are 6 key concepts in ACT and learning how to apply them promotes psychological flexibility. They are as follows:

act-processes Headsted UK. (n.d). The six processes of ACT [Graphic]. Retrieved from https://headsted.co.uk/static/img/act/act-processes.jpg ACT breaks these concepts down into 3 areas which are “Open,” “Centered,” and “Engaged.” Psychological distress originates from within these three areas.

P_20160514_164832_1_1 Wish this image was more pretty.  Taken from the book!


You have one shot at life…

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Mental Illness Stigma in the Media

Recently, the Huffington Post contained an article covering a speech by Presidential candidate Ben Carson, M.D.. Dr. Carson was asked if he believed Muslims who adhere to Sharia Law could participate in a Democratic society and its laws.

Dr. Carson answered, “Only if they are schizophrenic.”

This is not the first time Ben Carson, a well-known neurosurgeon, has used the term “schizophrenia” in a pejorative manner. On October 15, 2015, Dr. Carson was asked about America’s relationship with God and faith. He stated: “So if it’s in our founding documents, it’s in our pledges, in our courts and it’s on our money, but we’re not supposed to talk about it, what in the world is that? In medicine it’s called schizophrenia. And I, for one, am simply not willing to kick God to the curb.”

Actually, Dr. Carson, there is no term in medicine which provides a diagnostic term for separation of church and state. Or to address the experiences of one type of group and their ability to embrace another society’s government structure.

Because those are not, in the wildest stretch of the imagination, medical issues. Or psychological issues.

What is schizophrenia, then?

Schizophrenia is a serious disorder of the brain. According to the Diagnostic and Statistical Manual, schizophrenia is chronic, debilitating, and complex. Its diagnosis is also complex, and physicians, psychologists, and psychotherapists spend years learning about symptoms, their range of severity, and how to diagnose and treat this condition. For example, part of the diagnostic process involves assessing for positive, negative, and cognitive symptoms, as follows:

Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in others without the diagnosis. Symptoms include:

  • Hallucinations
  • Delusions
  • Thought disorders
  • Movement disorders

Negative symptoms: “Negative” symptoms are associated with the absence of the usual feelings, emotions, and behaviors. These include:

  • “Flat affect” (flattened tone, expression, emotion)
  • Decrease in feelings of pleasure life
  • Difficulty beginning and sustaining activities
  • Reduced speaking

Cognitive symptoms: Cognitive symptoms (memory, thinking, decision-making) can range from subtle to severe. these include:

  • Poor “executive functioning” (taking in information and using it to make appropriate decisions)
  • Trouble focusing, or paying attention
  • Problems with “working memory” (learning information but struggling to be able to use it)

Complex, indeed. No mental health practitioner arrives at a diagnosis of schizophrenia quickly or easily.

I don’t for a moment believe that Dr. Carson is actually diagnosing “Muslims” or “American society” with schizophrenia. However, Dr. Carson was known as one of the country’s top experts on the brain. Prior to becoming an M.D., Dr. Carson graduated from Yale with a degree in Psychology.  He knows what schizophrenia is, how it affects lives, and what it does to the brain. So why does he continue to use “schizophrenia” as a pejorative term in his speeches?

Stigma is a real issue with regard to mental illness. Even though millions of American live with some type of mental illness diagnosis, misinformation abounds. How often do you hear “I changed my mind…I’m so bipolar!” or I hate my job. My boss gives me PTSD.” Schizophrenia in particular, is greatly misunderstood. The term carries with it images of danger, potential violence, and rampant hallucinations. Those of us who dedicate our lives to the field of mental health work tirelessly to support our patients in living productive, happy lives, and to raise awareness of mental health.

Ben Carson is certainly not the only public figure to use terms related to mental illness as slurs. However, he is currently in the media spotlight. He has the ability to raise awareness, and as a physician – a brain expert – he certainly has the knowledge. Using a mental health diagnosis as a way to denigrate a person, a group, or a process is wrong. When done by a renowned neurosurgeon, it is unconscionable.

Dr. Carson, please join with us in pledging to stop the stigma of mental illness. An educated man, doctor, and author, you have a multitude of words at your fingertips. Please consider foregoing the “wallop” carried by a word like schizophrenia to fire up your audiences, and instead use a more thoughtful, accurate vocabulary. If you feel someone is being foolish, say so. If describing a dichotomy, call it that. If nothing else, mental health conditions cannot be used as blanket insults, not anymore. Please join us in raising awareness.


How can I help my child stop picking/pulling?

How Do I Get My Child to Stop Pulling or Picking?

(watch the video here: https://youtu.be/DH8qYh0H_v8 )

Those of us who treat Body Focused Repetitive Behaviors like trichotillomania or dermatillomania hear this question often from concerned parents. I will try to give some support in this video, and let me specify that this is geared toward kids who are teenagers and older. I think the advice is a bit different for younger kids, especially those age 5 and below. I work mainly with teens and adults with chronic hair pulling and skin picking, and I can tell you that even those who are adults have concerned parents who may feel at a loss for what to do. So let’s talk about some things that help, and some that are not so helpful.

I ask clients early in therapy what their goals are for treatment. If the client is a minor, we may start off with mom and/or dad in the room. Treating a BFRB for a teen is a family issue, and enlisting family members in treatment can help ensure success in many cases – at least that’s always my hope.

So here are some common questions that parents (and sometimes their kids) ask when going into therapy for a BFRB:

“Can you make my child stop picking or pulling?”

In talking about treatment goals with one family where a teen had trichotillomania, one mom said to me “I want you to make him want to stop.” Right away, we were in trouble. Sometimes through the course of therapy a person can become motivated to make positive changes, but there is no guarantee. It helps if there is already some motivation on the part of the person being treated, or at least a willingness to give it a try. Worst case scenario – we teach the tools needed to help stop picking or pulling, we offer lots of educational material and support resources, and we hope that when the child is ready, they will have what they need to be successful. That is still beneficial for all involved, in my opinion. But no therapist has a magic formula to make anyone want to stop a Body Focused Repetitive Behavior. We do have knowledge, training, experience, and lots of tools. But recovery requires a lot from the person who picks or pulls. There is homework, like keeping track of the behavior and maybe changing daily habits or the environment.

“Why does my child pull (or pick)?”

There are a wide variety of reasons people of any age engage in chronic skin picking or hair pulling. Some contributing factors can be anxiety, impulse control, attention deficit disorder, obsessive compulsive disorder, genetic predisposition, and sensory input issues like the Highly Sensitive Person personality trait. In some cases, there is nothing we can point to as a cause. This can be frustrating for parents – if your child is exposed to strep, and they get strep, chances are there is a standard treatment and they get better. BFRBs aren’t like that. They take time, patience, some detective work, commitment, and a flexible, open approach. We do spend some time looking at “why,” because there may be important guideposts there. For example, if the person who picks has a problem with anxiety, we not only provide tools to stop the BFRB, but we treat the anxiety. In many cases, where the “why” is less clear, we spend more time looking at the “how” – the sensory and environmental contributors to picking or pulling.

“How can I help?”

Talk to your child. Whether they are 14 or 35, they can tell you how they experience the urge to pick or pull. Listen to them. Ask them how you can help them – do they want to be reminded if you see them pulling? Do they want to join a support group, or see a therapist who is trained in treating BFBRs? Let them know you are a safe person to talk to. Read what you can about these behaviors.

I have to talk for a moment about what does not help. Unfortunately, these stories are not unusual. Seeing your child struggle with a BFRB is incredibly stressful for parents. You wonder if it is your fault, if other kids will make fun of them, or if the behavior will ever end. With teens especially, some have trich or dermatillomania and they are actually not bothered at all. But it is upsetting for parents all the same. The bottom line here is not to take that frustration out on your child. It breaks my heart when parents become so frustrated that they end up screaming at their child, telling them they will never quit, and basically taking out their anger at the behavior on the person. It happens more often than I would have believed when I started working with people with BFRBs. I have never once seen this work in helping to motivate someone to change. More often, it destroys their hope and their faith in themselves, whether they are 15 or 50. If you are feeling so upset that you are taking your anger out on your child, please consider talking to someone to help come to grips with your feelings. If you have a toddler who is learning to walk, you don’t yell at them or call them a failure every time they fall. You know they will get there, you show them compassion, you help maximize their chances of succeeding. That same approach is recommended with someone who picks or pulls.

“Can you recommend some resources?”

I have seen some absolutely awful advice on the internet, so if possible try to stick with people and websites where they actually have extensive knowledge and a track record of helping people. The gold standard in my opinion is the Trichotillomania Learning Center, and I will put a link to their website below. They have a wealth of information on both trichotillomania and dermatillomania, as well as lesser discussed BFRBs like thumb sucking and nail biting. Facebook has some great resources as well, such as the Canadian BFRB Support Network. I would be very wary of websites promising an instant cure, or that make you pay just to get a glimpse of their “advice.” Those of us who actually work with BFRBs tend to write, make videos, and talk to groups for free, just to help get the word out. The Trichotillomania Learning Center also has lists of support groups and qualified therapists in your area.

So, whatever their age, listen to your child, be someone safe to talk to, offer help and resources, and reach out for help yourself if your frustration reaches the boiling point. Your child is still your child, even with dermatillomania or trichotillomania. People with BFRBs can feel very isolated. Don’t let this behavior drive a wedge between you and your child. Join their team. Keep the dialogue going – your supportive presence can go a long way in your child’s recovery.

Resources in the video description box here:  https://youtu.be/DH8qYh0H_v8


Making Sense of Suicide

Many people are talking about suicide this week. We lost a beloved icon in Robin Williams, who ended his own life by suicide. For a number of reasons, it’s important to talk about this difficult topic. As we struggle to make sense of this death, we come up against confusing and painful questions – why did he do it? He always seemed so happy – what changed? Was it depression? Drugs? A diagnosis of Parkinson’s Disease? All of the above, or none of the above? We understand deaths from heart disease, or cancer. Suicide…? Not so much.

So we talk about suicide because it’s frightening and it doesn’t make sense. We want it to make sense. We look for reasons so that we can move on to closure. The truth is, suicide is something we may never truly understand. We can talk in generalities, such as the high numbers of people with untreated depression who take their own lives. Or the studies which have shown that people who attempt suicide and survive are glad they did. But generalities won’t help us understand what happened to Robin Williams, or to a friend or family member whom you have lost to suicide.

So. We do know for certain that losing someone you love to suicide is an excruciatingly experience. Let’s start there.

When someone takes their own life, we are left with all kinds of doubts and questions. Did I miss the signs? Could I have done more? Maybe it’s my fault. So not only is your world turned upside down by the loss of a friend or family member, you may be agonizing over these types of thoughts. The important thing to know is this: you did not cause the suicide. There are a number of support groups, including those that are online and free of charge, for suicide survivors. If you have lost a loved one to suicide, please reach out to others who know what it’s like. Grief, in any form, is difficult, but grief when there has been a suicide is very complicated. Take care of yourself and reach out.

One myth that exists about suicide is that the person who takes their own life is selfish or cowardly. I believe a couple of public figures actually made comments about Mr. Williams to that effect. These types of statements show ignorance and disrespect, and contribute to the stigma surrounding suicide and mental illness. Again, I am speaking in generalities, but typically the person who takes his or her own life is desperate to end emotional pain. They want the pain to stop, and for whatever reason, they cannot perceive of other solutions. To make judgmental statements about them after the fact is uninformed and cruel – to the deceased and their survivors.

Another myth about suicide centers on the assumption that if the deceased could have only been more resourceful or positive, they would still be with us. Quotes like “Suicide is a permanent solution to a temporary problem” make sense – unless you are suicidal. So what does help?

If you have someone in your life who is suicidal, here’s what may help. Listen to them. Let them talk. Don’t jump in with solutions right away. Take them seriously and let them talk as much as they need to. When you are talking to someone who is suicidal, offer encouragement, be gentle, and try your best not to be shocked or judgmental. Ask them what they need. Help them find a doctor or therapist if needed. If they are not in immediate danger, check back with them regularly to make sure they are all right. Remember, talking about suicide doesn’t cause suicide.

If you feel they are in immediate danger, or if they clearly have a plan, a timeline, and the means to kill themselves (such as a gun, or pills), call for help immediately. Call 911, or 1-800-SUICIDE, or 1-800-273-TALK. Those numbers and other resources will be in the description bar below. Write them down and save them. Don’t hesitate to contact professional help. A qualified mental health professional or physician can intervene and get the person the help they need.

Finally, I want to touch on one last piece of the Robin Williams story. After his death, news came out that Mr. Williams had recently been diagnosed with Parkinson’s Disease. A number of people reacted with comments like “Oh, now it makes more sense. He didn’t want to live that way. I understand better now.” I’m not sure it does make more sense now, actually. Maybe this diagnosis played a part in the suicide of Robin Williams, but maybe not. Either way, as devastating as it can be to receive a diagnosis of a serious medical condition, people can and do live productive, happy lives even with disease and disability. A diagnosis does not mean suicide suddenly makes sense.

Suicide never makes sense. There are always other choices and there is always hope. This may be impossible to see, for the person struggling with so much pain that they believe suicide is the only option. What can get them there is support and treatment for whatever is causing such pain. I have heard time and time again from people who didn’t die, even though they believed at one time it was their only option, that they are grateful to still be here.

If you are feeling suicidal, please pick up the phone and call for help. Allow someone to help you. Stick around, please.


Bipolar Disorder

Bipolar disorder, which is classified as a mood disorder. Bipolar disorder used to be called manic depression – it is most known for its mood swings, which can be of varying degrees – mild, moderate, all the way to severe. Moods can be up – like the highs of mania, or they can be down, like the lows of depression. The periods of these mood swings can be brief, as in hours, or as long as months in duration. I have read that the average time between episodes can be about 3 years.

So what is “mania”? Mania is the up side of the mood swing – it can mean the person feels high energy, very creative, very happy. It can also involve irritability, impulsive behaviors like acting out sexually, or going on spending or gambling sprees. It usually means the person feels little need for sleep. They may be hyperactive and notice that their thoughts and even their speech seems to be racing. Again, symptoms of mania can be mild, or they can be severe – anywhere along the spectrum.

Most of us are familiar with the depression side of the disorder. Depression can mean deep sadness, possibly out of proportion to life events. There may be a lack of energy, too much sleep, and no sense of joy in things that used to be pleasurable. The person may feel hopeless and worthless.

During episodes of mania or depression, the person may self medicate with drugs or alcohol to try to manage the symptoms. This doesn’t help, and usually makes it worse.

Bipolar disorder tends to be recurrent. What I mean is, it’s not just one episode then it’s over, or cured. In 90% of people who are diagnosed with bipolar disorder, there will be recurring mood swings of depression and/or mania.

The symptoms of both mania and depression can overwhelm the ability to deal with everyday life. The person’s ability to use reason and logic to manage their behaviors, relationships, personal safety, work, etc may be greatly impaired. One of the most challenging aspects of bipolar disorder is that the person may not recognize that they are in the midst of a manic or a depressive episode. They can go from euphoria to aggression to deep sadness and not be able to identify or verbalize what they are feeling.

All of this can make it difficult for loved ones to stay connected and offer support. It may take them a great deal of time to notice patterns of behavior that may indicate bipolar disorder in a friend or family member. And if they do notice, how do they express their concern in a way that the person can hear, in a non-threatening way? “Hey, I was just noticing that maybe you are bipolar – let’s go to the doctor and see,” probably will not get a favorable response. Bipolar disorder has such a stigma in our society, as does any mental health diagnosis. People misunderstand, they judge, they even make jokes about it. How many times have you heard someone say “Yeah, I changed my mind so many times I must be bipolar!” Ugh. The concept of having someone you care about dealing with bipolar disorder is complex enough for its own video, and that will be coming soon.

For now, let’s focus on the person who may possibly have bipolar disorder and how to get help. I’m going to cover three areas for your attention, to maximize the odds of the best results possible:

See a licensed mental health professional. You might start with a psychiatrist, or a therapist who has experience with bipolar disorder. Chances are, medications may be recommended to help manage your symptoms and help bring about more balance to your life. If you have concerns about this, by all means talk to your doctor and be an active participant in your treatment, but DO see a professional. Bipolar disorder is not something you just have to get tougher to recover from. There is plenty of self-help advice and I am going to mention some tips, but first – see a qualified professional to join your team. Be honest with them about your symptoms, about your family history (particularly if anyone else in your family has bipolar disorder), and about your lifestyle and behaviors. Help them give you the best care available.

Next, lifestyle changes. Here is the self-help stuff, and it’s pretty much common sense. Get enough sleep. Eat right. Exercise. Minimize stress. Take care of your physical health. If you are self-medicating with drugs or alcohol, stop – there is real help available, and drinking too much or other substance abuse is not real help.

Third, get support. Bipolar disorder affects your friends, family, and even co-workers. Talk to the people close to you and let them know what you need and how they can help you. Join a support group, or go to see a counselor for talk therapy. Read the many books available about bipolar disorder. You are not alone.

 Bipolar disorder can disrupt virtually every area of your life if left untreated. Reach out for support, develop a treatment plan with a qualified professional, and take good care of yourself. The majority of patients with bipolar disorder do find relief by following these steps. The very nature of bipolar disorder can convince you that either you don’t need treatment, or that it wouldn’t work anyway. Talk to those around you, and see what a doctor or therapist says. Look at it this way. If you were diabetic, you could suffer with the roller coaster of your blood sugar going way up then way down, but you would probably see a doctor, get medications, and adjust your lifestyle to maximize your overall health. Bipolar disorder is no different. There are resources available to help you live your life the way you want to.


Video of this blog article can be found here: http://youtu.be/UTb4QSWAEas


Inner Critic Doll

Building Ebenezers

Inner Critic Doll Sometimes you get a nudge from the universe. And sometimes that message comes in the form of a cute, squishy doll.

The past few weeks, I have been wrestling with my Inner Critic. I used to think of the Inner Critic in terms of something that got in the way of my writing by stifling my creativity. But creativity is more than just producing a story or a painting or a song. I’ve always believed that – or at least said I believed that – but I lately I have been developing a deeper appreciation of how living life and moving through the world is a creative act. And how my Inner Critic effects the way I do that every day.

I think of my Inner Critic as the part of me that is working overtime to keep me “safe.” And not in a good way. It’s almost like the…

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