I read these stats in an email from National Council for Behavioral Health today. Pretty eye-opening. More of us need to be aware of these systemic differences in health outcomes for Americans.

Click on the links to see the research.

• LGBT (lesbian, gay, bisexual, transgender) youth are two to three times more likely to attempt suicide than their heterosexual counterparts.
• More than two-thirds of Southeast Asian refugees receiving mental health care were diagnosed with PTSD associated with trauma experienced before and after immigration to the U.S.
• People of color are overrepresented in prisons and jails. Additionally, blacks account for 37 percent of drug arrests but only 14 percent of people who regularly use drugs.
• Native Americans experienced a 236 percent increase in deaths from heroin overdose between 2010 and 2014.

​

Bright and early a few days ago, I had the fantastic opportunity to teach a workshop about yoga to counselors from across our state at the Texas Counseling Association annual conference in Dallas. It was a great time! I shared a presentation, then led the group through a yoga practice so they could experience it for themselves. We ended our morning circling up for discussion.

In the session, we talked about the ancient roots and philosophy of yoga, the different types of yoga classes found in many communities today, and how specific approaches have been developed to use yoga for trauma recovery and mental health. You can learn more about all of these ideas in the complete Powerpoint presentation.

Here are a few key slides that may be very helpful when considering starting a yoga practice. First, a description of some of the terms used to describe types of classes.​

Then some findings of researchers. There's a lot of data that points to the benefits of yoga.

But yoga is not to be used without caution. Here's my advice for choosing the right yoga class:

1. ​Know what type of class you are best suited for, and seek that out. Know the class descriptions above and search for those in your community. If you can't find a class, try yogaglo.com for online streaming.
2. If you are a trauma survivor, be especially selective about your yoga class. Choose a class that is "trauma-sensitive" if you are just beginning to process your traumatic experiences. Know that some teachers provide "physical assists" or adjustments that involve them touching you. If you do not want to be touched, communicate that to your teacher prior to class.
3. Hot yoga (100 degrees +) can be counter-productive if you are overwhelmed by heat or have medical conditions. You should have an established practice of good hydration before you attend hot yoga classes. As an alternative, many vinyasa classes offer a warm room (85 degrees +).
4. Look for teachers that offer modifications of difficult poses and encourage acceptance of your body as it is today.
   

What to know before you go:

1. ​Yoga is usually practiced barefoot.
2. It's best to practice on a mostly empty stomach. You will be more comfortable with heat, vigorous sequencing, or twisting if you haven't just eaten a meal.
3. Some studios will have mats to borrow, or you can bring your own. For sweaty classes, a towel placed over your mat keeps you from slipping. You can use a towel from home, or there are special ones made to go on top of yoga mats.
4. Most studios have a place for your belongings outside of the yoga room. They are usually secured by the teacher locking the outside door before class begins.
5. Studios have differing policies about talking inside the yoga room. Some observe silence and others welcome chatting before class.​

​Here's to finding the best yoga experience to reap the benefits of this ancient practice!

Here are some of those symptoms to look for when regular drinkers quit drinking, ranging from less to more intense.
​

• Tremors and shakiness
• Eating and sleep disturbance
• Anxiety
• Sweats
• Elevated temperature
• Hallucination and agitation, ranging in severity
• Change in pulse rate, racing in severe cases
• Seizures and/or convulsions
• Delirium, disconnection from reality

​These symptoms appear anywhere from 6 to 72 hours after the last drink, and can last up to 1-5 days based on the level of  physical and emotional dependence. Medically supervised detoxification is absolutely required in severe cases, and there are many local facilities in Dallas that facilitate safe withdrawal. Contact us or check out our Commuity Resources page to find support for alcohol detoxification.  

In the book How to Change Your Drinking by Kenneth Anderson, ​he recommends three ways to prevent alcohol withdrawal.
​

1. Don't drink every day. Have at least a few days of abstinence each week.
2. If you are drinking every day, don't drink more than four. Here's a link to learn how to count your drinks.
3. Don't mix alcohol with anti-anxiety medications like Xanax and Klonopin. 

Reaching out for counseling and support when alcohol becomes a problem can be a powerful step in the road to recovery. It is one of the most dangerous substances to stop using because of the profound physical effects on the body.

by Kambria Kennedy-Dominguez

It's an unseasonably cool day in August today and it seems fall may be coming! I had the wonderful opportunity this summer to take time away from work with my family, rejuvenate and recharge from what's been a very busy past year at Flourish. I am grateful to each and every client that has walked through my door keeping my practice thriving. My sincere hope is that work we've done together in the counseling room allows lives to flourish, self-understanding to deepen, and relationships to strengthen. So much beauty is created through sharing, and in that vein, I'm sharing some images that I've captured thanks to a new photography hobby, a great camera, and our beautiful earth. Some of these images were captured far away and some right here in Dallas.

Noticing beautiful objects, creatures, plants, landscapes, and people in our environment certainly impacts my health and wellness. I hope we are all able to find beauty around us, whether we are in a distant place or right outside our front door.

Have you ever wondered whether you or a loved one has post traumatic stress disorder? While an assessment by a trained mental health professional or doctor is required to diagnose any mental health condition, I'd like to share a few tools that can help you sort out your own experiences and learn more.

First, the Life Events Checklist. Look through the below document and answer the questions. Have you ever had any of these stressful or traumatic life events occur to you, witness them happen to someone else, or learn about them happening to a loved one?

If you've had one or more of these stressful life events occur to you, witnessed it, or learned about it happening to someone close to you, then move on to the following questions. The next questionnaire, called the PCL-9, is designed to help you and your therapist understand 1) whether you have symptoms of post traumatic stress disorder and 2) the severity of these symptoms. 

If you scored 28 or higher on the PCL-9, take these questionnaires to a therapist as soon as you can. If you didn't score that high, but are still concerned about your experience of a stressful life event, talking to a therapist can help you sort out and further assess what you are experiencing.

Please know these questionnaires alone are not meant to diagnose PTSD. However, the way you answered them can help a mental health professional provide an accurate diagnosis and treatment options. The good news is that PTSD is treatable and mental health counseling is often a critical part of treatment. 

Contact us at Flourish if you want to learn more about how we work with trauma to help those with PTSD live a meaningful and rich life, despite the history of stressful life events. 

Let's give anxiety some consideration today. You've likely experienced it over and over. You may have heard about certain types of anxiety like phobias and panic attacks, or diagnoses like Generalized Anxiety Disorder or Panic Disorder. There are lots of levels and experiences of anxiety, and sometimes even different definitions of anxiety from person to person. Anxiety is essentially worrying, feeling afraid, overthinking, and sometime panicking.

The common thread is that anxiety exists and is real for all of us, because it stems from an innate human emotion...Fear.

The DSM 5 (the manual we look at to classify symptoms and diagnose) draws a distinction between fear and anxiety like this:

 The autonomic nervous system, referenced above, pays a particularly important role in anxiety, and has two distinct parts. It revs us up (courtesy of the sympathetic system), then stabilizes us (thanks to the parasympathetic system), when there is a perceived threat in our environment. Imagine a bear chasing you...your heart rate increases, breathing rate increases, blood flows to limbs, pupils dilate, digestion slows, muscles tense. Sometimes tunnel vision and hearing loss occur, as well as relaxation of the bladder and colon. This very physical response to danger has a purpose. Muscles tense to ready themselves for action, blood flows to limbs to enable us to move quickly away from danger. Then, the nervous system slows and reverses this response once danger has passed, initiating relaxation. Our breathing and heart rate slow down, our muscles relax, our body comes back to homeostasis.

Both humans and animals alike experience this stress response cycle. Animals and humans differ, however, in the ability to reason, classify, predict, and analyze. We humans can thank our bigger brains and cerebral cortex for that. An animal might encounter that same bear, have a fight or flight response, be able to escape from danger, then quickly stabilize and move on. The cerebral nature of our human brains don't allow us to move on in the same way. We would likely have persistent fear or worry after an episode like that. We may feel afraid of bears, the place it happened, what we did right before it happened, that we may not protect ourselves from it happening again, or that it will happen to someone else. You can see how the human mind's ability to analyze gets us in a pickle here. 

We can get stuck with our fear in the "on" position, even in response to more innocuous stimuli like work or school demands, relationships, financial issues, health concerns, parenting, and other aspects of daily life. Our reasoning and predicting minds create future scenarios to worry about, and sometimes with good reason. If you lost a job in the past because you were late, you may be well served to worry about being late in the future. So in this way, anxiety is a helpful and useful tool that reminds us to pay attention to something specific like not being late to work. However, as we know, anxiety can become problematic when it immobilizes us in everyday life, keeps us from making decisions, disengages us in things we'd like to do, or impedes relationships.

Here's how I describe the anxiety continuum. Remember, fear and anxiety are related to paying attention to our environments and paying attention is a good thing.

​It may be helpful to outline the different types of anxiety disorders listed in the DSM 5.

• ​Generalized Anxiety Disorder. This is a general worry that underlies experience and gets in the way of daily functioning. It may be hard to pinpoint exactly what you are worried about, or it may seem like you're worried about everything. You may feel tense quite a lot and find your mind racing, jumping to conclusions, and thinking of the worst case scenarios. 
  • ​Fear is is generalized to everything.
• Social Anxiety Disorder. This is anxiety specific to social situations. You may worry about what others are thinking of you, that you'll embarrass yourself, that others will reject you, and avoid social situations in which you are likely to have to interact. 
  • ​Fear is about social interaction.
• Specific phobia. This is anxiety specific to a particular object, activity, or situation. Common phobias are of heights, flying, insects, blood, animals. You may feel intense immediate anxiety when seeing or thinking about your phobia, and actively avoid it.
  • Fear is related to something very specific.
• Panic Disorder. This occurs when panic attacks perpetuate themselves through anticipation of another attack. Panic attacks can occur with other anxiety disorders, depression, post traumatic stress disorder, and many other mental health conditions. Panic attacks are episodes of terror that occur for no apparent reason, in which one may feel shaky, sweaty, racing or irregular heartbeat, difficulty breathing, the sensation of choking, chills or hot flushes, and/or nausea. (Remember the fear response to the bear described above...a panic attack is almost just like that, minus the actual danger). Most panic attacks involve a fear of passing out, fear of going crazy, and/or fear of dying. Merely having a panic attack doesn't warrant a Panic Disorder diagnosis, however.  Panic Disorder emerges when the anticipation of more attacks and the avoidance of places or situations that may cause another attack interferes with everyday life. 
  • Fear is of having another panic attack. 
• Agoraphobia. This occurs when there is a persistent fear of public places or situations, including using public transportation, being in either open or enclosed spaces, standing in line or being in a crowd, or being outside of home alone.  Usually thoughts accompanying this fear are "I can't get out of here" or "no one will help me."
  • Fear of a particular situation, usually in public. 
• Substance or Medication Induced Anxiety Disorder. This occurs when anxiety is attributable to the effects of a specific drug, legal or illegal. 
  • Fear occurs as a side effect of a drug.

The body's natural ability to balance itself in response to stress is powerful. Just knowing that the nervous system is able to balance chronic anxiety is the first step. Then, learning and practicing tools that enhance our body's natural ability to balance, will help us move beyond fear and anxiety that might be crippling us. 

In counseling, there are many approaches to working with anxiety. I've found three approaches most helpful:

1. awareness of the breath
2. mindful meditation
3. awareness of habitual, unrealistic or unhelpful thought patterns.

For more information on how we incorporate these approaches into therapy, please contact us! We are happy to help you learn more about how counseling can work to manage fear and anxiety.

Mental health is worth spending time on, just like going to the doctor when you're feeling under the weather. If you're feeling overwhelmed, anxious, sad, angry, hopeless, sleepless, distracted, panicked, these are symptoms, just like a runny nose or a cough, that deserve attention from a professional. This month of April is about spreading the word that mental health support is readily available, and can be easily accessed. Check out Megan and Kambria's bios here to get to know us and see if we may be a good fit for you, and read all about the counseling process here. 

Also, here's a great article about how to make the most of your counseling experience. 

Be well. Breathe easy. Make use of a counselor.

This will be a great opportunity for the general public to learn about mental health and addiction. You must register to attend, but the cost is free.  Hope to see you there!

.Psychosis involves one or both of the following:

• Hallucinations. Hallucinations occur when you hear, see, or otherwise sense something that is not actually present. Auditory hallucinations occur when something is repeatedly heard that others do not hear, most commonly voices. Voices can be loud or quiet, aggressive or gentle, sudden or predictable.  Visual hallucinations involve seeing something that others do not see. These experiences may include seeing shadows, people, animals, or other figures. Less frequently, other types of hallucinations occur. These include tactile (feeling something on the skin or inside the body that isn't there), gustatory (tasting something foreign or inexplicable), or olfactory (smelling something with no known cause). 
• Delusions. Delusions are fixed, false beliefs to which you hold strongly and which interfere with your normal cognitive functioning. Examples could be believing that you are being followed, or that your phone is tapped. These are examples of persecutory delusions. They can be accompanied by hallucations, such as seeing someone following you or hearing someone tampering with your phone. Other types of delusions also exist. Delusions of grandeur involve believing you are special and different from others, have been chosen to perform special tasks, or are being given special sorts of information. Delusions of guilt or sin involve beliefs that you are unforgivable and/or should be punished.  Erotomanic delusions involve beliefs about others being in love with you. Delusions of reference involve placing unusual significance on specific objects, people, or events in your environment. 

Psychosis is not a mental health diagnosis, but rather a set of symptoms that accompany a diagnosis. Schizophrenia, schizophreniform disorder, and brief psychotic disorder are three diagnoses distinguished only by the duration of time symptoms have been present. They each include either hallucinations or delusions, may include disorganized speech and/or behavior, and may include what's called "negative symptoms" which manifest as lack of emotional or behavioral expression. Negative symptoms include decreased interest in activities, decreased speech, decreased social interaction, or decreased ability to experience pleasure.  Schizoaffective disorder involves the symptoms of schizophrenia listed above, with an accompanying mood disruption like depression or mania.  Delusional disorder involves delusional thinking without the symptoms listed above that indicate schizophrenia-related disorder. Depression and bipolar disorder in their most severe forms can include psychosis as well. 

Psychosis can be induced by substance use, and usually pass once intoxication passes. Most notably, methamphetamine, hallucinogens (particularly synthetics like K-2), and stimulants like cocaine can induce symptoms that look like psychosis. Acute alcohol withdrawal can also produce psychotic-like symptoms, and should be treated immediately.  

Some medical conditions may also induce psychosis. The most notable conditions in which this may occur are endocrine and metabolic disorders, autoimmune disorders like lupus, and temporal lobe epilepsy. 

Stay tuned for another post on treatments available for disorders that include psychosis. In the meantime, here is a helpful page from the National Institute of Mental Health on schizophrenia.

By Kambria Kennedy-Dominguez

Getting Sober

What "sobering up" means to you depends on your situation. Sometimes it means decreasing the frequency or quantity of use. Called "harm reduction" in treatment terms, many people naturally do this when they notice a problem with drugs and alcohol but are unsure of its severity. For example, if you find that you binge drink (more than 4 drinks at a time for women and more than 5 for men) when you're out with friends at bars, you might decide to ask your friends to meet you at a movie instead of a bar. Shifting the environment in which problematic behaviors occur is a way to reduce harm. Likewise, you may try to limit the amount you are drinking or using, or you may make deals with yourself not to use at certain times of day or in certain places. All of these methods of control are common once a problematic pattern is recognized. Whether these methods of control work or not depends on your individual circumstances. Here's a guideline for the safe consumption of alcohol, by the way. Great graphic from the CDC. 

Harm reduction is controversial, because many treatment professionals and many of those in recovery believe complete abstinence is the only way to sobriety. They might say that attempting to reduce harm only keeps you in the dangerous cycle of addiction, as you try to negotiate the problem away. There are reasonable arguments in favor of abstinence as the best strategy and it does indeed seem to work best for many. Taking a harm reduction versus abstinence approach is a very personal decision, one that I help clients make based on their own experiences.

Depending on the severity of the addiction and on the substances or substance combinations being used, withdrawal may with abstinence. Withdrawal symptoms range from mild to severe and vary depending on the drug. The process of withdrawal under medical supervision is called detoxification, and is the safest way to discontinue use of a drug when withdrawal is present, particularly with alcohol, opiates (heroin or prescription pain killers) and anti-anxiety drugs (like Xanax and Klonopin). After detox, many continue to residential treatment for 30 days or more, and some choose to move into sober living environments after residential care. These are each options along the way to sobriety, and most everyone's journey looks different depending on what they need. 

Once a more sober life is established, you have entered "recovery." Below is the three part plan that I use with counseling clients to help sustain recovery.

Using coping skills that work

A critical part of therapy for anyone, whether addiction is present or not, is learning to identify and use coping skills that work. What do you do when you feel stressed out at the end of a busy day? What do you do when you fight with your spouse? What do you do when you come up short on your monthly bills? What do you do when your boss yells at you? These are just some examples of possible triggers (see above) that may lead to cravings to use if there are not more adaptive coping skills in place. Some examples of coping skills are exercise, art, reading, talking to trusted friends, 12 step groups like AA, support groups, meditation, spending time with pets, making music, listening to music, walking, drinking tea, taking a warm bath, having a massage, giving yourself a massage, learning a new skill, taking up a new hobby....the list is limitless really. The question to ask yourself is how can I soothe myself in a way that doesn't create harm? 

Recovery is possible and it's happening for many people every single day. There are a ton of resources available to help and lots of evidence that positive change is within reach. If you are struggling with addiction or wanting to know more, please don't hesitate to reach out.