Therapy zone 

October 4, 2023

Things you should ask and do if someone is suicidal:

Are you thinking of hurting yourself (committing suicide)?
How long have you been thinking about suicide (frequency, intensity, duration)?
Do you have a plan? Get specific information if there is a plan.
Do you have the means to carry out the plan (accessibility of a weapon, pills, drugs, etc.)?
Have you attempted suicide in the past?
Has someone in your family committed suicide?
Is there anything or anyone to stop you (religious beliefs, children left behind, pets, etc.)?
Depending on the responses:
o Setup a suicide prevention plan
o Provide the person with emergency/crisis numbers 1-800-273-TALK (8255)
o Explore what resources are available, e.g. family support, friends, etc.

o Develop a plan to deal with potential weapons, medications, drugs, etc.

o Increase frequency of your check-ins
o Assess the need for getting the person assessed for medications
o Assess the need to contact the “crisis team” or "emergency team"

o Assist the person hospitalized if necessary

September 14, 2020

With children back in school, it’s important for parents to help build up their self-esteem. Self-esteem, is how we identify the feeling that everything is going to be okay. How parents foster failures and successes is eventually how that translates into self-esteem.
Low self-esteem can lead to depression and anxiety, difficulty maintaining relationships and inability to try anything new because of a fear of failure.
This is how you can help your child to build self-esteem:
-Give them household chores appropriate for their age.
-Praise your child when they do something right.
-Allow them to fail occasionally, this reinforces that it’s not the end of the world.
-Love for your child is unconditional regardless of their failures or if they make bad decisions.

August 8, 2020

Suicide is a major public health concern and among the leading causes of death in the United States. 
Suicide is death caused by self-directed injurious behavior with intent to die as a result of the behavior.
A suicide attempt is non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. A suicide attempt might not result in injury.
Suicidal ideation refers to thinking about, considering, or planning suicide.
According to the CDC, in 2017: Suicide was the 10th leading cause of death overall in the United States, claiming the lives of over 47,000 people. Suicide was the 2nd leading cause of death among individuals between the ages of 10 and 34, and the 4th leading cause of death among individuals between the ages of 35 and 54, 8th leading cause of death among individuals between the ages of 55 and 64.
History of Trauma and Adverse Childhood Experiences (Emotional, Sexual, or Physical Abuse), Past history of Suicide attempt, Mental Health Conditions, Substance Use.
Talking or writing about suicide, Access to lethal means (weapon, medication, poison, suffocation,..), Feeling hopeless or burden on others, Concrete Plan and Means to execute plan, Saying Goodbye to friends and family members, Fluctuation in Weight and/or Insomnia, and Recent Diagnosis for Terminal condition.
ASK: Are you thinking of killing yourself?
If the answer is YES immediately call 911 or Crisis Line: 24/7 National Suicide Prevention Lifeline 1-800-273-TALK (8255)
En Español: 1-888-628-9454

June 15, 2020

If You Wake Up With Anxiety

When you first wake up your defenses are down and you are more vulnerable to an attack of negative thought which, if not properly managed, could lead to anxiety.
Anxiety originates in the brain amygdala, a section that regulates emotions. Amygdala registers danger, and when it identifies a threat, it mobilizes the body into “fight or flight” mode to help us combat the danger (fight) or run to safety (flight). Then heart starts pounding, blood flows to extremities, and thinking skills may become impaired. Amygdala can’t distinguish between an immediate danger like having a gun pointed at you and perceived danger like knowing the world is full of forces that threaten your safety, it activates the same physiological responses either way.

So waking up and immediately worrying about your day, or other chronic stressors in your life, can jolt your amygdala into “fight or flight,” and that, in turn, leads to anxiety.
Morning anxiety is also sometimes caused by certain medical conditions, like asthma, heart disease, and diabetes. Lack of quality sleep can also exacerbate morning anxiety, and for some people, too much caffeine could contribute.

-Deep Breath: put your hand on your stomach and inhale deeply for 4 seconds, watching your stomach and chest rise. Hold your breath for 7 seconds; then slowly exhale for 8 seconds.

-Leave your phone in another room at night and rely on a digital alarm clock instead.

-In the front page of phone, have some apps that help you with mindfulness or meditation or breathing.

-Meditate in the morning.

-Set your intentions for the day, starting off with some sort of clarity is really important.

-Make a list of all the tasks that actually have to get done today.

-Ground yourself back in the present moment like running your fingers along the teeth of your house keys, hold an ice cube, or stretch your limbs one by one. You can also spend a couple minutes taking stock of your surroundings, focusing intensely on what you hear, smell, see, and feel around you, he adds.

-Give positive affirmations to yourself like “I'm going to have a good day no matter what,” “I deserve compassion,” or “My anxiety is justified.

​-Writing your thoughts can promote self-awareness and shift your mind from being a victim of your thoughts to being an observer of your thoughts.

​-Go for a 20 minute walk, run, or bike ride. This will help calm your amygdala and could give you a quick boost of feel-good endorphins.

-Distinguish between stressors that you’re able to change like getting out of a toxic relationship versus what’s out of your hands like worrying about whether or not you’ll get fired at work can help you focus your efforts on resolving the former and relieve yourself of any stress associated with the latter.

-Seek resources whether in your community or on the internet can be really helpful because it helps you connect to something that is relatable.

April 27, 2020

Managing COVID-19 concerns for people with OCD

-Manage anxiety about future and decision makings:
Give yourself permission to not constantly check the internet or ask others’ opinions to try to figure out which way the situation will go. Frequent checking and reassurance-seeking can cause more anxiety for those with OCD without an increase in useful information. you can observe how a friend or family member without OCD is making decisions and try to follow their lead. 
-Reduce compulsive news watching:
For instance, only check news once a day for a maximum of 5 minutes, or watch the evening news once a week, or decide not to check news at all.
-Follow valid recommendations for health like hand-washing:
Many people with OCD are in treatment to reduce compulsive washing rituals; however, because of the COVID-19 crisis, it’s important that they give themselves permission to follow current guidelines being recommended by WHO or CDC but not more than that.
-Practice self-compassion:
Remember that it’s normal to be anxious about the coronavirus. COVID-19 is making many people fearful, including people who don’t have OCD. It’s not your fault and do what you can to keep your compulsions in check without trying to be perfect. 
-Remember people are resilient:
Remember that you have skills to manage uncertainty and anxiety as a result of OCD. Your fear is real and meaningful, and that the OCD may act up more than normal right now. You will handle it!

April 10, 2020​

Celebrating Holidays/Passover/Easter/Ramadan during COVID-19 quarantine:
The senses of fear, anxiety, loss and being away from extended family have nobody in a celebratory mood. 
Traditions and rituals are powerful ways to manage extreme emotions and stress. Holiday rituals in particular help to give our children and us a sense of purpose and belonging. As we navigate through a pandemic, celebrating holidays with our kids grounds them in us as family which is important and gives them cause for gratitude in an otherwise uncertain future.
For all families even those who may not celebrate holidays this is an opportunity to talk to kids about racial and cultural differences. Research shows children notice differences and form biases at a surprisingly young age. By 3 months of age, a child begins to show a preference for faces of their own racial group. Yet, only 10% of American parents talk to their kids about racial and cultural differences. So go ahead honor the Passover Seder virtually with family and friends, get creative about celebrating the Easer egg hunt at home, and observe Ramadan prayers with appropriate social distancing. And in the process, we may also consider teaching how special it is to celebrate many diverse holidays.

April 5, 2020

Turning to alcohol, marijuana, or other substances to help ease feelings of stress and loneliness during the COVID-19 outbreak could do more harm than good.
I am seeing more people using alcohol as a way to cope with the anxiety and stress and uncertainty to numb out. While numbing is a human response to what’s going on right now, it’s not the best way of managing stress.
Alcohol is both physically and mentally a depressant, so those already prone to sadness or depression may find those feelings worsened by drinking.
Alcohol can actually increase anxiety, because it interferes with the ability to get quality sleep at night. Without quality sleep, not only you will have weakened immune system but also it can be hard for you to manage stress the next day. It’s also important to know that per WHO drinking alcohol does not protect you against COVID-19.
Marijuana and other inhaled substances including cigarettes and e-cigarettes or vaping devices can also be dangerous because of the stress they place on the pulmonary system.
Replace alcohol and other substances intake with more effective coping skills: physical tasks like exercise, cooking or dancing, or cognitive tasks, such as puzzles, crosswords or reading, or sensory tasks, such as spa-like baths with candles.

March 25, 2020

If you experience these feelings or behaviors for a few days in a row, and you are not able to carry out daily responsibilities because of the changes, please seek professional help. Common signs of distress:
-Difficulty with concentration
-Difficulty with sleep and/or experiencing nightmares
-Changes in appetite, eating habits and/or energy level
-Feelings of numbness, anxiety, or fear
-Anger or short temper
-Headaches, body aches, stomach and digestion problems, skin rashes
-Increased use of alcohol or drugs

March 19, 2020

Health care providers, doctors, nurses, and medical team leaders:
1- Managing your stress and keeping your psychological wellbeing during this time is as important as managing your physical health.
2- Keep in mind: it is quite normal to be feeling anxious in the current situation. Stress and the feelings of anxiety do not mean that you are weak or you cannot do your job.
3- Take care of your basic needs and use your coping strategies: rest between shifts, eat adequate and healthy food, exercise, and stay in contact with your family and friends.
4- Avoid using unhelpful coping strategies such as smoking, drinking alcohol or using drugs.
5- Some health care providers may unfortunately experience avoidance by their family or community members due to the fear. Staying connected with your loved ones even virtually is one way to maintain contact.
5- Turn to your colleagues, your manager or other trusted persons for social support; remember that your colleagues may be having similar experiences.
6- If you are in charge remember that keeping your team protected from stress means that they will have a better capacity to fulfill their roles.
7- Ensure accurate information updates are provided to your staff. Rotate team members from high-stress to lower-stress duties. Partner inexperienced staff with their more experienced coworkers. Encourage and allow work breaks. Allow flexible schedules for those who are directly impacted or have a family member impacted by a stressful situation.

March 16, 2020

How to talk with children and adolescents about Corona Virus?
- Provide accurate and age appropriate facts. Adults should understand the facts before talking to children and be prepared to provide accurate information in a comprehensible way. It can be said that "most children do not get sick with the virus".
-Talk to children to help reduce their anxiety. We can tell the child: "When you feel anxious, talk to us about it".
-Tell them adults are trying to protect children. Assure them that even changing conditions such as school closures are just for the sake of their protection and is temporary. 
- Have proper health habits. For adults, modeling the right habits like constant hand washing is the best way to teach children to wash their hands with soap and water after playing outdoors or before eating, not touching nose or mouth and have no physical contact with friends.
- Explain to them that they may need to be away from their grandparents for the health of their grandparents. Tell them, this is temporary.
-If a child falls ill, remind him or her that doctors and nurses know what to do. Parents can remind children that the medical staff has passed training on the disease and they know how to take care of the children. Tell them they will recover soon with rest and hygiene. 

March 13, 2020

​The psychology behind #Coronavirus panic buy:
-People resort to extremes when they hear conflicting messages about the risk it poses and how seriously they should prepare for it.
-Some are reacting to the lack of a clear direction from officials to promise them that everyone will be taken care of. Then they are left to guess at the probability of needing the extra supplies, sooner rather than later.
-People see images of panic buyers, assume there's a reason to panic and buy up supplies, too.
-It's natural to want to overprepare.
-It allows some to feel a sense of control to what seems like a helpless situation. 

March 10, 2020

Over the past week, our Amygdalas which is the fear centers of our brain have been in overdrive. As #Coronavirus and anxiety spread, The level of pandemic fear circulating through our news and social media is concerning. On one of the worst days for Coronavirus in China on February 10, 2020, 108 people died. But on a given day, globally:
* 26,283 people die of cancer;
* 49,041 people die of cardiovascular diseases;
* 4,383 people die of diabetes;
* 2,191 lives are taken on average by suicide;
* 2,740 people die by mosquitoes;
* Humans kill an average of 1,287 fellow people, every single day.
These figures are not to suggest we should live without precaution, but knowing the numbers helps limit our fear of the unknown, and battle our Amygdalas against irrationality.

March 7, 2020

With age, immune systems weaken, leaving the elderly at an especially higher risk of developing serious complications from a respiratory illness. 
Having stress worsens their immunity. 
Elderly should be heard, soothed, accompanied by and attended to. 
Advise them to avoid watching, reading or listening to news that cause them to feel distressed and anxious; seek information mainly to take practical steps to prepare for plans to be safe.

March 5, 2020

I am seeing many patients suffering from rising anxiety and panic related to COVID-19 scare. Please do these to stay psychologically healthy during outbreak: 
1-Recognize that your anxiety is normal, but resist inflaming it. 
2-Limit your Corona virus news consumption. Stick to a few trusted sources of information. 
3-Remind yourself that you're doing the best you can in this situation. 
4-Viral infections are less traumatic to those who get more than 8 hours of sleep. Lack of sleep disrupts the normal production of white blood cells, a crucial component of the body’s immune system. 
5-Daily exercise can help promote feelings of well-being and boost your immunity. 
6-Stress can weaken immune system. Do: yoga, meditation, massages, hobbies.