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Do you have that pesky voice in your head constantly shutting you down? Maybe you hear it say, “be a man”; “just do better”; “suck it up and deal”; “talking about your feelings makes you weak”; or “dude, no one wants to hear about your problems, just push through”. Seems familiar? 

You are not alone. Men across multiple cultures to include the United States of America are constantly told to bottle up their emotions and not talk about their feelings because vulnerability is seen as weakness. This is not only a cultural norm, but something that families instill in young boys growing up, in professional career settings, and in interpersonal relationships throughout our lives. But it’s all bullshit. If you want to know the truth, allowing yourself the space and strength to be vulnerable and discuss what you are going through makes you a man with courage; the courage to help yourself when you need to in a healthy way. 

The defining stereotyped image of whats makes someone a “man” includes expectations to use aggression (verbal and/or physical)  to solve their problems, suppressing emotions and never talking about their problems, isolating themselves and withdrawing (“because no one wants to hear your problems”), expected to be effortlessly attractive and/or in shape, value sexual conquests over emotional intimacy, homophobia, and be tough/intimidate others to get their way and/or defend themselves. 

Because our culture tells us that men should just sit down and shut up about their vulnerabilities, this often leads to self-destructive means of coping in men. Whether that be alcohol and/or substance misuse or abuse; or sabotaging personal and/or professional relationships with terrible communication skills and next to no problem solving abilities.

According to Benita N. Chatmon, PhD, MSN, RN, CNE, “Depression and suicide are ranked as a leading cause of death among men. Six million men are affected by depression in the United States every single year. Men (79% of 38,364) die by suicide at a rate four times higher than women (Mental Health America [MHA], 2020). They also die due to alcohol-related causes at 62,000 in comparison to women at 26,000. Men are also two to three times more likely to misuse drugs than women (Center for Behavioral Health Statistics and Quality, 2017). These statistics are troubling because they reinforce the notion that males are less likely to seek help and more likely than women to turn to dangerous, unhealthy behaviors.” (

So, how can we help challenge the negative stereotypes men are expected to live up to? How do we break the stigma so that men can achieve the felt safety in asking for help from others, whether that be trusted loved ones or professionals?

First, it is essential to normalize the idea of seeking mental health treatment. When we have a medical condition like Diabetes or Hypertension, there’s no shame in going to the doctor and/or dietitian for guidance and/or medication management. So, why should there be shame in seeking out help for issues like Depression, Anxiety, or Trauma? I feel that the reason this happens all too often is that we can’t just look inside the brain anytime we want to see what’s going on from a chemical or physiological standpoint. So, because we can’t physically see and/or measure exactly whats going on or why we feel the way we do, it becomes stigmatized as “a figment of our imagination” or “over-exaggerating”. This is beyond infuriating because mental health concerns are just as legitimate and can potentially become just as, if not more devastating than some medical conditions. 

In my career, I’ve seen lives destroyed by Post Traumatic Stress Disorder, Psychosis, Depression, and Anxiety. Although such conditions don’t always lead to debilitation and/or significant decrease in functioning, they sometimes do and this is pathologized by cultural norms in America, especially for men. As noted above, men are expected to sit down and shut up, and not talk about their feelings because…”who cares, just deal and push through”.

In addition to normalizing the idea of seeking help, it is also important to be able to talk with trusted loved ones about what you are going through. Also, find ways to educate yourself about your mental health issues, maybe even do your homework about what condition you’ve been diagnosed with and what to expect in therapy. A wonderful resource for learning more general information about mental health diagnoses and treatments is National Alliance on Mental Illness (NAMI). Please see the link for their main website listed here. Talk with your mental health provider openly about your diagnosis, what to expect in treatment, and any negative feelings that come with attending therapy. Your therapist is there to help. Try to use the time and calm space in therapy sessions to explore the negative stigmas around men seeking mental health care and how this has affected you and your relationships to yourself, others, and the world. This helps the therapist understand your world and your experience so that they can provide the appropriate tools to help. It is also beneficial to outreach others who are having the same or similar experiences as you; this can build compassion for others and feeling more understood and grounded in knowing that you are not alone. 

Men, just know that we all have baggage and you are not broken. You deserve to have the felt safety of seeking mental health care and addressing the concerns you have in a productive and healthy way. 

Jackie Martinez, LMSW (NY), LCSW (NC)

According to a study conducted by the insurance company Lemonade, 7 out of 10 American households have at least one pet. Pets are considered beneficial for mental health, providing companionship, emotional support, and entertainment. Furthermore, as is stated by the National Institutes of Health, pets are also found to improve human health by decreasing cortisol levels, lowering blood pressure, and improving mood.

If you are reading this article, chances are you are grieving the death or absence of a beloved pet, or you have learned your pet is terminal. Maybe there is something else going on. If not, you may be doing research to help someone who is going through such experiences. Whatever your reason for being here right now, I think we can all agree the key importance of pets in our lives cannot be dismissed.

We have all heard (or made) the statement, “that animal got me through a dark, bad time in my life.” I vividly recall my dachshund, Sierra, who I adopted only a few months after the death of my mother. While I knew she could not replace my mother, her unconditional love did help to fill the heavy void within my heart. As a dog with special needs (she was born with microphthalmia, which affected her vision) and me as a human broken by despair, we helped each other. Indeed, Sierra was my best friend.

Sadly, Sierra is no longer here, but I will never forget the bond we shared.

A child holding a dog

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The therapist/writer, Valerie, with Sierra.

When we consider the comfort, joy, and support given to us by pets, it makes sense why losing them can be devastating to our psyches. For some of us, our pets are closer to us than our own family members and friends – and indeed, they are our family members, repairing the wounds we suffered from others. Pets can offer the connection we need to remind ourselves we are loved. Simply think of the last time your dog ran to greet you as you came through the front door or your cat snuggled and purred on your lap.

Grieving a pet after euthanasia (being “put down”)

For some people, one of the most painful, difficult decisions they will ever need to make is to allow their beloved pet to be euthanized or “put down.” Euthanasia is frequently the merciful decision if the animal’s prognosis is poor. However, the realization of knowing you made a critical decision regarding your pet’s health and life can result in guilt, thus intensifying the grief process. You may swarm yourself with the “what-if” thoughts, such as, “should I have got a second opinion from another veterinarian?” or “is it at all possible the veterinarian was wrong and more could’ve been done?” or “did my cat even really want to die despite her being so sick?”

Unlike humans, who can help prepare for their demise through completing advanced directives, pets are incapable of making their own decisions. Thus, it is not surprising that devoted pet owners may feel complex emotions about if they did the right thing.

Grieving a pet due to an accident

A few years ago, I scheduled for my cats to be spayed. Since this was a routine procedure and my cats were seemingly healthy, I had expected nothing catastrophic to happen. Instead, I figured my cats would be fine, and that I was doing the right thing by helping control the excessive cat overpopulation. Luna recovered well. Tragically, though, my lovely dilute calico Maine Coon mix, Starla, died from the anesthesia. Post-mortem, the veterinarian discovered she had a hereditary form of hypertrophic cardiomyopathy, which is relatively common in the breed. I was devastated, shocked, and angry. I never thought trying to be a responsible pet owner would result in my cat’s untimely death.

In time, I realized Starla likely would’ve died young regardless due to her underlying condition. But in that tsunami of grief, it was difficult for me to think clearly. Rather, I thought there was an injustice.

Like my experience, some pet owners have complicated grief due to an accident that killed their pet. Whether this be a health-related issue like my Starla, or perhaps a beloved dog getting out and run over by a car, or a cat running away, such an unexpected event can complicate the grief process. They may also experience guilt or think they have failed their companion.

Starla as a young kitten, a few months before the veterinary procedure.

Grieving a pet due to surrender/rehoming and other such reasons

A final form of grief over a pet is not due to death at all, but rather in instances that an owner needs to make the difficult decision to rehome their pet. This can be for a myriad of reasons. Perhaps their animal is aggressive and thus unsafe around the children. Maybe someone in the home is ill, requiring much care, and stretching resources thin for the caregiver. Or perhaps the pet owner is experiencing unforeseen circumstances, such as job loss, eviction, or other life-changing events. The person could have become disabled and realized they do not have the ability to care for something dependent on them. Whatever the reason, the person has made the decision to give up their pet.

This type of grief presents its own challenges. Like the other two types, there is guilt, but it can be even more severe because it can be coupled with a sense of betrayal. Furthermore, such owners are also stigmatized by others, such as animal shelters’ social media pages that can portray them to have no justified excuse whatsoever to surrender their animal. This type of loss often is faced in secrecy because the owner is afraid to admit the reason behind what happened, aware they may be shunned for the violation of a social norm.

Whatever the reason for the pet loss, it is loss. It hurts. And it can hurt just like any other loss. Grief is not only for the death or absence of people.

The following are ways to help cope with the loss.

1. Recognize your grief is valid.

As a grief therapist, I can assure you it is normal to be distraught after the loss of a pet. There have been moments when my clients have confessed that they feel more heartbroken over losing their pet versus significant people in their lives. Some express feeling embarrassed or ashamed, saying things like, “the truth is, I’m sadder about my dog dying than my grandfather, but I know I’m supposed to be sadder about my grandfather.” In response, I challenge them to consider that unlike their grandfather, they lived with their dog. Their dog was never callous toward them, never judgmental, only a loving friend. And thus, of course it makes sense they would feel more grief for their dog.

For some people, pet loss can be the most difficult loss they have ever experienced. It is important for us to normalize this type of grief.

2. Understand that grief presents differently for everyone

Grief will manifest itself differently depending on the individual. In a family who lost their pet, one person may be angry. Another could be crying nonstop. Still another may seem indifferent. One person may say “she was just a cat” and think about getting another cat right away, while someone else may exclaim, “she was more than ‘just’ a cat; she was my friend, and no, I don’t want another cat!”

All people will progress through their grief journeys at their own pace, facing difficult obstacles and emotions. It is also not a linear process; instead, grief can “go backward” or be experienced more like a web or set of highs and lows. These experiences are normal.

To be of support to someone grieving their pet, simply validate their emotions. Let them know it is okay to feel the way they do.

Remember, too, that other pets in the household can grieve. When Starla died, Luna wandered aimlessly around the home for days to look for her. She seemed to finally realize Starla was not coming home. Since then, I added other cats to the family. Luna tolerates them, but she has never shown the bond with them she had with Starla.

3. Join a support group

Some individuals do not want or need a support group. For those who would like to feel less alone or are having a hard time coping because they feel their loss is misunderstood, they can benefit from peer support. They can find solace in communicating with others who are going through the same thing. There are many support groups on social media platforms such as Facebook specifically for pet loss.

4. Talk with a therapist

Yes, it is okay (and encouraged!) to reach out to a therapist to help grieve the loss of a pet and to learn coping skills for effectively managing that loss. As a grief therapist myself who has had my many heavy cries for losing a beloved pet, I will never judge you for talking about this issue to me. And it’s not just me – there’re many therapists out there who would love to work with you through this issue, offering compassion, empathy, and loving support. You are not “weird” for grieving.

5. Honor your pet through memorials and rituals

For some people, a healthy way to express their grief is to honor their pet through memorials and rituals. Some veterinarians will send a grieving owner a sympathy card along with mold of the animal’s paw print. Meanwhile, some owners may choose to keep their dog’s collar or their cat’s favorite toy. Other owners may find comfort in reading the poem called The Rainbow Bridge, which suggests pets go to a special place in heaven accessible by crossing a rainbow-colored bridge.

Some people may find comfort in burying their animal in their backyard, while others may choose to do so at a pet cemetery. Others may do neither, choosing to keep the cremains, and others may not want any objects to serve as reminders. Again, there is no right or wrong decision here – all that matters is what will help you.

Valerie Smith, LMSW, CFTG

In our hectic daily lives the quality and quantity of our sleep is often overlooked. And this is due to a myriad of reasons including children, work, stress, and interpersonal issues, to name a few. For many, this is even the case in the face of regular reminders about how sleep is connected to our mental health on the news and social media. 

So, what exactly does happens when we close our eyes? And how can we improve the quality of the rest we are able to get?

Benefits of Sleep

I’d venture to guess that everyone has, at one point or another, not gotten enough rest and felt irritable or had trouble concentrating. And this universal experience is really indicative of the larger impact that rest has on our lives. Sleep is a biological function that impacts our hormones, immune system, and metabolism. Likewise, sleep impacts us neurologically in regard to our mood, cognition, and attention. And the list goes on for both as research and science around sleep improves.

In regards to mental health, we know that many diagnoses, like depression, anxiety, and PTSD have symptoms that relate to sleep disturbances. For instance, studies show people who are suffering from depression may find it hard to fall asleep. Some people with anxiety may report similar issues with insomnia, if they find themselves worrying while in bed. PTSD can be associated with anxiety and nightmares that impact the quality and quantity of sleep hours. Likewise, studies have shown that symptoms of mania and psychosis can emerge due to sleep deprivation. 

This is all to say, getting an appropriate amount of shut-eye, without interruption, on a regular basis, may be significantly helpful in deterring the onset of mental health symptoms. 

Improving my Sleep

So, the science is there, but it doesn’t change the fact that life happens. What can we do?

  1. Set up a routine. Try to be consistent in going to sleep, in the same place, at the same time each night. Likewise, try to wake up at the same time each morning.
    1. Try to get between 7 and 9 hours of sleep each night.
  2. Make sure your environment is comfortable.
    1. Set the thermostat to a comfortable setting, shut the lights off, turn off noise so it’s quiet.
  3. Electronic screens have been shown to negatively impact our sleep because of the blue light that they emit, so give yourself 30 minutes of screen-free time before trying to sleep. 
  4. Avoid caffeine, alcohol, or large meals before bed.
  5. Exercise during the day.
  6. Try not to drink a lot of fluid before bed.

Using a Professional

These are just some general tips to help improve your routine. In some cases, medication or medical intervention, like a CPAP machine, may be necessary. Be sure to visit your primary care doctor on a regular basis to inform them of concerns regarding your sleep. For example, if you wake up in the middle of night, struggle falling asleep, or if someone is concerned about your breathing while you’re sleeping.
As previously mentioned, sleep disturbances can be a consequence of a mental health diagnosis. If you feel you are overwhelmed, struggling with your mental health, or just need someone to talk to, you can reach a qualified clinician at Suffolk Family Therapy and schedule an intake appointment at your earliest convenience. To do so, call 631-503-1539 or visit our website.

Nicholas Costa, Social Work Intern with Hunter College

Have you ever felt like when you try to explain something out loud, the pieces aren’t all coming together like you thought…but when you write things out, it makes so much sense?! Or maybe you’ve noticed that fiercely scribbling out your upsetting feelings on paper to get it out of your head brings such a huge sense of relief, just to vent out the intensity for a second. Lots of people experience this relief and sense of calm with the powerful tool of journaling. It is a great  way to organize our thoughts a bit better and use writing to cope with our feelings. 

The many benefits of  journaling to address our thoughts and feelings  include the relief that follows laying out our thoughts on paper; tracking our emotions, triggers, and physical symptoms related to our thinking patterns; figuring out and processing what is helpful or not in our coping;  and thinking at our writing pace so that we can slow any racing thoughts so they are more manageable. 

Journaling is an amazing tool to help us learn more about ourselves that we didn’t realize. We often feel that we know ourselves well enough and don’t need writing to figure it out. However, if we try journaling, we may find that it increases our insights into ourselves and how our thinking influences our feelings, behavior, and overall functioning in our lives. Sometimes, people find that journals with prompting questions and/or tasks help guide them in a positive direction in their journaling practice. Some ways to do this could be with Cognitive Behavioral Therapy (CBT) thought challenging, practicing gratitude exercises; mindfulness exercises; creating task/goals lists-breaking down large goals into smaller and more manageable ones; or tracking physical symptoms related to our emotional experience. Journaling not only helps with self reflection, but it boosts our sense of self efficacy, and shows us that we can take some control back in our lives. 

Over time, I have seen that journaling using prompts based in Cognitive Behavioral Therapy have been especially effective as it gives a new perspective on how to view and analyze different situations that are upsetting to us. Some prompts you may notice are helping us to highlight the negative thought and situation that may have contributed to it, thinking about whether this is emotions based or reality based thinking, finding new ways to view the situation and/or thinking about what we might tell a loved one if they were faced with similar thinking and/or circumstances. This method helps to reduce or even extinguish upsetting thoughts and/or feelings so that they don’t rule our existence. 

It is recommended to journal with the guidance of a professional if you feel like your journaling often takes you to a dark place, whether that be becoming more stuck in thoughts related to depression, anxiety, or trauma without any relief or benefit to journaling. I say this because some people may ruminate over the negative thoughts recorded and this is not useful. Some ways to manage this could be writing out the negative thoughts and then throwing out the page, burning it, or shredding it, whatever fits with how you feel. Avoid journaling about trauma independent of a professional. The reason I say this is because recording traumatic events and/or issues related to the trauma(s) can ultimately increase distressing thoughts and feelings, leading to potential decompensation in our emotional regulation and functioning. 

There are many structured journals with amazing prompts that can be found online that I highly recommend. One is called “Worry for Nothing: A Discreet, Guided Anxiety Journal | Journal with Prompt to Calm Anxiety & Improve Mental Health | Promotes Stress Relief & Self Care”. See link for additional information (  Using such a tool with the guidance of your therapist can help increase your own insights and help your therapist understand you better as a person and how they can help solidify your emotional coping artillery.

In closing, journaling can be utilized as an incredibly effective tool to help us identify and manage our thoughts and emotions. I prefer the journals with specific prompting questions to guide me along in my wellness journey; but of course, everyone has a different preference and that is okay. As long as you are taking note of your negative thoughts and feelings to help shift them to a more positive and empowering place, this is the true benefit of journaling and its power.

Jackie Martinez, LMSW (NY), LCSW (NC)

For years, the acronym ‘OCD’ has been widely misused by people to describe their organizational skills or how neat they keep all of their belongings. To be technical, Obsessive Compulsive Disorder (OCD) should be defined as the presence of obsessions as well as compulsions. Obsessions being characterized by “recurrent & persistent thoughts, urges, or images that are experienced as intrusive or unwanted..” and compulsions being characterized by “repetitive behaviors or mental acts that that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly,” (APA, 2022). What I hope to voice is that OCD is not something that is a personality trait, it is a mental health disorder as it states in its name. 

History of OCD

It is actually believed that OCD can be dated back to the 14th century. Researchers believe that some religious depictions and works depicted signs of OCD-like behaviors. Of course, the term OCD was not around during this time and it was referenced as scrupulosity (a term to reference fear of sins and compulsions to be devoted). During the 19th century, a time when psychology as well as medical advances were being made, French psychologists attempted to understand what they came to know as compulsions and obsessions by separating them into different categories. These conditions include that of phobias, panic disorders, as well as manic behaviors. 

What we have come to know now within the world of psychology, is that there really is no particular cause for OCD. There are current theories that state that biological, environmental, as well as learned behaviors can trigger the onset of OCD behaviors. However, what we do know is that those who have OCD have a larger sense of responsibility to tend to their intrusive thoughts as well as may misinterpret these intrusive thoughts. This sense of responsibility and repetitive behaviors lead to the obsessive thoughts regarding the stressor, leading the individual to engage in compulsive behaviors to rid themselves of the intrusive thoughts. 

OCD Breakdown

Obsessive-compulsive and related disorders is now its own section within the DSM. OCD used to be categorized as an anxiety disorder, however with the recent DSM-V edition it has been separated into its own section for obsessive-compulsive and related disorders. There are several disorders that fall under this category: Obsessive Compulsive Disorder, Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, Substance/Medication Induced OCD, Excoriation Disorder, as well as Other/Unspecified Obsessive-Compulsive disorders. 

Body Dysmorphic Disorder occurs when an individual has a preoccupation with perceived flaws or defects in their appearance. Any part of the body can be the area of concern for the individual; even if these flaws are not observable to anyone else. Because of the obsession over these perceived flaws, the individual likely will engage in compulsive behaviors in order to keep themselves in check.

Hoarding Disorder is probably one that you may know well due to TV shows like Hoarding: Buried Alive, I came to know it because of my grandparents. My grandparents were excessive hoarders, with their house being filled with countless knick-knacks, books, clothes, and even hundreds of mason jars. After my grandparents passed, it was up to my family to clean out their house and that was a project! After, most likely, 10 full dumpsters and a week of work we were able to clean out the house that they once lived in. Hoarding is the characteristic that an individual has a hard time letting go of items, regardless of their perceived and actual value. The difficulty that comes with letting go and releasing these items is the aesthetic and/or sentimental value that the item may have. Even though my grandparents were victims of hoarding, we were able to donate many things from the house we were able to salvage. 

Trichotillomania is a disorder where the individual compulsively pulls hair out from any part of the body. The distress that can be experienced by those with a hair-pulling disorder is one that can be described as shame, embarrassment, or even just feeling as though they have lost control. Hair-pulling may bring one gratification and satisfaction with each pull of a hair. Whereas, excoriation is the picking of the skin. Individuals who actively pick at their skin throughout the day, may experience similar emotions and feelings; feeling embarrassed, ashamed, as well as loss of control. The preoccupation with the intrusive thoughts of wanting to pick at your skin, or the struggle to fight the urge to not pick off a healing scab can leads to the compulsive behavior of removing that part of their skin. 

Still think that OCD is just a cliche personality trait?

OCD Treatment Methods

There are ways to live with symptoms falling under the umbrella of obsessive-compulsive related disorders. A common modality that is used is Cognitive Behavioral Therapy, which is oftentimes used for many mental health concerns in therapy today. For a brief explanation of CBT, it essentially involves regular talk therapy about problems causing distress in the here and now. One of the key targets for CBT are intrusive thoughts, which we can also call OCD obsessive thoughts and need to act on compulsions as intrusive thoughts. Unfortunately, intrusive thoughts are something that cannot be completely eliminated because intrusive thoughts are simply unwanted or distressing thoughts, urges, or impulses.

Additionally, there is an approach termed Exposure & Response Prevention that is specifically geared towards challenging one’s fears, obsessions, and compulsions. The idea of ERP is not to scare the individual, but to allow the individual to confront their fears in a comfortable setting that does not cause further distress. A major part of ERP is for the individual to be confronting these fears, but minus the act of the compulsions to “make it right.” Similar to regular talk therapy, with ERP the initial targets are small and are ones that don’t cause too much distress. This is because it is easier to challenge minute fears and be able to comprehend your ability to overcome them when first starting out.

OCD & ERP Example

Let’s say that your fear is that everything around you is covered in germs and you are fearful that these germs will cause you to become infected or die. Here is an example of what can be done to challenge and confront these fears over the course of treatment. Also notice that these steps are broken down into simple achievable steps, as to not be pushing the fear too far.

  1. Touch stair railing in a public place
  2. Use both hands to open doors to public buildings
  3. Touch toilet seat at home, without washing hands afterwards
  4. Be around an animal of some sort 
  5. Use a public toilet
  6. Showing physical signs of affection with loved ones (spouse, children, parents, etc.)
  7. Use a fitting room at a store to try on new clothes

With each step being broken down and with each step gradually working up the fear ladder, an individual can become confident with facing their fears. However, it should also be stated that the person seeking treatment determines their hierarchy of fears and what they feel comfortable confronting and in what order.

OCD can be a debilitating illness, although it doesn’t have to stay that way. OCD is not making sure your desk is organized, or your kitchen is always clean. It’s more so about what these obsessions and compulsions do to you and how they impact you. Also, OCD is not the only disorder that comes with this family sized pack of obsessions and compulsions. If you feel like you’re struggling with any of these, there is a way to regain control. Obsessions and compulsions will not write your life story.

Conor Ohland, MHC-LP

Moral injury has been defined as, “In traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations” (United States Department of Veteran Affairs). 

Essentially, moral injury can occur when someone either engages in or witnesses an event and/or action that goes against their own personal values, ethics, and beliefs. There are two types of acts that can lead to moral injury; acts of commission and acts of omission. Acts of commission refer to actions people take that go against their own morals and/or belief systems. While acts of omission highlight when someone intentionally does not take action on something that leads to an adverse event that goes against their own morals and ethics. 

To clarify, an example of an act of commission may be that a military member kills civilians in the midst of performing combat related duties. An act of omission might be a physician not taking someone off of life support despite patient suffering due to the patient’s family making the decision to keep the patient on life support. 

So why are we talking about this?

Well, oftentimes we tend to associate the term “moral injury” with military personnel and military related tasks/traumas. However, moral injury extends to multiple life experiences in addition to the military experience. For example, those who are in the healthcare and/or mental health care field, first responders, survivors of crime, and survivors of intimate partner violence may also deal with the negative thoughts, feelings, and even potential decrease in functioning related to traumas associated with moral injury.  

What types of situations can lead to moral injury?

While we can take an educated guess that engaging in and/or bearing witness to a violent war event is traumatic and will create moral injury in most of us, there are other scenarios in the civilian world that can also inflict moral injury.

For example, during the height of the COVID-19 pandemic, healthcare workers across the world were stretched incredibly thin; working longer hours, having to isolate from their families for extended periods, seeing a high volume of patients, and not always being able to help dying patients see their loved ones one last time before they left this world. The unimaginable stress of working in healthcare at the height of the pandemic led to unavoidable moral injury on various fronts, given there was so much out of our control and so many difficult decisions had to be made. There are even people who blame themselves for others’ deaths after unintentionally and/or unknowingly exposing people to the disease, healthcare workers or not.

Then, there are those who are survivors of violent and/or sexual crimes that often suffer with depression, anxiety, social isolation, grief, and resentment towards themselves, others, and the world based on their own traumatic experiences and moral injuries sustained. They might blame themselves for what happened to them, whether that be rape, sex trafficking, or assault. They may know their assailant and still have love and/or affection for them, which creates an internal storm of emotions and confusion.

People who suffer with moral injury often deal with bouts of depression, shame, anger, disgust, distrust, and self loathing. Such feelings can compound with clinical depression, anxiety, or even post traumatic stress disorder that makes moving forward in our lives that much harder. Maybe we notice ourselves to “shut ourselves off” to others, the world, and ourselves…we just can’t trust anything or anyone anymore which creates negative bias that impacts how we live our lives. We feel more isolated because we feel shameful or disgusted by what happened, so we disengage which ultimately fuels the anxiety, anger, sadness, poor sleep, helplessness, and hopelessness that may come with moral injury. 

So, what do we do to heal?

Much like any emotional wound, it is important to be able to have the felt safety to talk about our moral injury without being judged. Simple, right? No! Dealing with the dissonance that comes with moral injury is hard enough for the sufferer, but it is discouraging when we think about telling a trusted loved one with fear of being met with “well, why didn’t you just do this?” or “Oh, I would have handled that way differently” or “You could’ve just said no”. Sometimes we may be met with such responses; or, sometimes we may have unconditional love and nonjudgmental support. But we can’t know until we put ourselves out there as a first step in healing. Again, I acknowledge that this is far from easy.

Research also points to forgiveness and self compassion as means of coping and healing from moral injury. How is that done? Well, therapists can help you talk about the event(s) leading to your moral injury followed by discussion of negative beliefs you hold about yourself, others, and/or the world as a result. From there, your therapist can help you find ways to accept the reality of the occurrence and forgive yourself to release the hold of self hatred and condemnation. Your therapist can teach skills to reinforce self compassion, such as learning self empathy and acceptance to lift the burden as well. This work is nowhere near easy, but with time and dedication, the wounds of moral injury can be healed so that you can live your life again.

– Jackie Martinez, LMSW (NY), LCSW (NC)

Ah, the new year. We all think it – “new year, new me!”. We can be so eager to identify one or more resolutions. We always say, “this year is going to be different,” and we start off with a strong motivation until that dreaded crash about three weeks into January.

Some of the most popular resolutions include: exercising more, losing weight, getting organized, living life to the fullest or feeling happy, mastering a new hobby, budgeting, quitting smoking, traveling more, and spending more time with friends and family. While these are all admirable goals in and of themselves, the problem is that they are broad, vague, and unrealistic. For instance, exactly how does one plan to lose weight? Is it realistic to commit to going to the gym every day while having a strict low-carb diet? No. How does someone plan to budget? Does this mean paying for only necessities, and if so, what defines a necessity? Is it fair to say no to a night out with friends because that could break the goal?

The most important factor in making and keeping a resolution is to be realistic, balanced, and fair. No, someone will not lose three dress sizes in one month. No, they will not go to the gym every day. Yes, they will give in to temptation — they will eat that Boston cream donut in the break room at work. Yes, they will end up buying something “on impulse” simply because they want it.

Now let’s change the “they” in the above paragraphs to “I.” Go back and read the paragraphs again. Reflect on what these sentences mean to you, if anything, when in the first-person.

Do they sound realistic, balanced, and fair? No.

In other words… Be nice to yourself. You are not a failure for a slip-up. You’re human, with your ups and downs, just like everyone else. Imperfection is okay. No one – absolutely no one – is motivated 100% of the time. Even Olympians struggle to maintain motivation. If you’d like additional resources of New Years Resolutions, click here.

Motivation Operates in Cycles

It is normal to experience the highs and lows of motivation. Instead of thinking, “why can’t I be motivated all of the time?” consider that some motivation is far better than none. That episode of motivation, no matter how fleeting it may seem, can still help you achieve your goals. Embrace it.

I used to struggle with not being able to uphold my motivation for long periods. I became frustrated at myself when I was doing something unproductive. Then I realized that the “something unproductive” was the very thing I needed to do to help recharge my emotional battery – to get me to feel inspired to get back on track with my goal.

Motivation operates in cycles, designed with peaks and troughs. It is not linear. Once you can begin to picture those highs and lows of motivation, moving away from the mentality that it is a straight-line to success, you work toward achievement of your goal (or you can at least readjust the goal to be a realistic one!).

The Phases of Motivation

The New Year before my wedding in October, much like so many other brides, I made it one of my resolutions to look a certain way for my wedding. I was determined to lose some of that weight I gained from too many snacks during all-nighters writing papers in graduate school.

I wanted to be reasonable with myself. I knew there was no way I was going to fit into a certain dress size, but I did know I could at least buy a dress in my real size and get it brought in if I lost weight. So, I did that.

I also downloaded Noom, a weight loss app with skills from cognitive behavior therapy (CBT). Daily, Noom drops short tips and suggestions to aid someone as they work toward weight loss. Early in the program, they introduced me to the Motivation Model, which changed my mindset. I began to be much more patient, loving, and kindhearted toward myself, addressing those nagging negative beliefs that were chewing away at me.

Let us use an example. Say you want to save 10% of your paycheck going forward. This is an illustration of what your motivation will look like throughout the journey:

No photo description available.
Photo credit: Noom’s Facebook page.

As you can see, the Motivation Model has peaks and troughs; it is not straight nor linear.

The following names of each phase come from the model by Noom. However, keep in mind it applies to all reasons for motivation, not only weight loss. It is a universal model, and I am certain there are other products that have the same model but simply with different names.

Phase 1: The Hype

This is the most exciting phase. This is the phase where you think, “I got this! I am going to achieve these resolutions!” and jump in with a complete, undeniable motivation. This is where you can feel caught in the momentum, determined that their first time saving 10% of your paycheck will be the norm going forward.

This is where you will experience the honeymoon – when motivation is at its most extreme. This is when we have that unstoppable, almost grandiose sense of motivation. We are in a blissful ignorance. We think we need to feel that motivated all the time.

Phase 2: The Plummet

This is the painful, dreaded crash that happens after the honeymoon. This is the part of the cycle where people have a bump in the road, thinking they are a failure, and may fall into an old habit. This is the part where we feel extremely judgmental toward ourselves, thinking we will never be able to get back on track with our resolutions.

This is the part where you did not save 10% of your paycheck. You had a draining day. The boss was hard on you, you got in an argument with your spouse, your child had a temper tantrum. To cope, you went online-shopping and bought some things you wanted but did not need.

You may think the following:
“This sucks. This is way harder than I thought it’d be.”
“Maybe I can’t do this.”

This is all normal! This is okay! It is all part of the journey. Simply acknowledge you had a slip up and continue along.

Trough 1: The Lapse

This is the most difficult part. This is where you will feel at your lowest in your progress with your resolutions. This is where you are most likely to give up, state you will never get better, give in to those negative core beliefs, and just go back to how you used to be.

“This is way harder than I thought it’d be” degenerates into “this is impossible.”
“Maybe I can’t do this” becomes “I won’t do this. I give up.”

This is the time when clients tell their therapists they have given up on their resolutions and goals. They are convinced things cannot get better.

But this phase can and will pass. Just believe in yourself!

To get through this phase, do something. Do something that will help you feel one step closer to your resolutions and goals, even if it is very minimal. If this feels like too much, use a visualization meditation to imagine you have achieved your goal. Visualization can be a powerful psychological trick to boost confidence.

Also, have some gratitude for The Lapse. Sure, it does not feel good being there, but it is not a crisis. It is an opportunity to be introspective, to dive into yourself to figure out what is effective for you when you are not doing well, so you can prepare to do better in the future. It is the time for wisdom.

It gets better.

Phase 3: The Slips and Surges

Phase 3 is the steadier phase, where going at a rabbit’s pace slows down to that of a turtle. You know the saying, “slow and steady wins the race.” In this phase, the highs and lows are easier to tackle. The highs are no longer mountainous like the honeymoon, and the lows are no longer like a great ravine. You will still feel those highs and lows, and yes, they are permanent. But that is exactly to be expected. It is normal.

You will have some days that are better than others. Perhaps one day, your boss says you did an amazing job leading the team project. Maybe that ongoing argument with your spouse is turning more so into manageable disagreements. Maybe your child is learning to use coping skills rather than have meltdowns.

There will be the bad days too, of course. You’re late for work because you got a flat tire – and it is the same day as an important business meeting. Maybe you get a phone call from your child’s teacher because he is having problems in math. Perhaps after weeks of you and your spouse working hard on effective communication, an argument happens again.

This is how motivation operates. It reflects the highs and lows of life – all the good and the bad, the celebrations and the tribulations, the gains and losses.

Once you accept that the slips and surges will happen, you can be mindful. You can think to yourself:

“Today I really will only spend my money on what I need.”
“Honestly, today really was a hard day. It’s okay if I indulge a little bit. But tomorrow I will be back on track.”

And it will also allow you to be more freeing and forgiving toward yourself… “You know, it really is okay if I go out with my friends on Fridays. It’s not going to ruin my goal if I let myself have some fun. If anything, it will probably motivate me to continue my journey.”


1. Our motivation operates in cycles. We will have highs and lows.
2. Be fair to yourself. Be mindful; reflect on what you can learn during the highs and lows. Know they will all pass.
3. When in a low, do one small thing rather than nothing at all.

– Valerie Smith, LMSW, CFTG

So…taking the first step to engage in mental health therapy can be jarring enough, especially when experiencing suicidal thoughts. If you have already taken this step, you should be so proud of yourself because this is a difficult step to take! 

Sometimes when we are seeking therapy, we have more on our minds than the day to day stressors and/or desire to vent to a neutral source. Sometimes, we are dealing with suicidal thinking, whether we realize it or not. And this can be quite frightening for some, while it feels fairly normal for others. So as a therapist, when I hear someone say something that may indicate suicidality, it is essential for me to take a closer look at what’s happening. 

Also, side note…if anyone in your life makes what you feel may be a suicidal statement, please make sure that you are asking questions, supporting them, and/or getting them connected to the appropriate professionals. Whether it is yourself suffering with suicidal thinking or a loved one, it is best to call the suicide hotline at 988 (press 1 for veterans) and/or call 911 or get to your nearest emergency room in the event that you or a loved one feels unsafe regarding suicidal thinking. Click here for additional resources.

Different Types of Suicidal Thoughts

I want to clarify the different types of suicidal thoughts that can happen for people so we all have a better understanding of varied experiences with suicidal thinking. 

Passive Suicidality

First, there is passive suicidal thinking. This type of thought is passive in nature, hence the name. When people have thoughts like this, such statements and/or questions may run across their mind like, “Maybe it would be better for everyone if I weren’t here”; “I wish I were dead”, “I want to die”, “why am I here?” or “I wish I could go to sleep and not wake up”. When people are dealing with passive suicidal thoughts, this tends to mean that there is no plan or intent to harm or kill themselves in place. In therapy, if we as clinicians have determined that you are safe at the time that passive suicidality is discussed, then we discuss creating a safety plan together and talk about safety contacts (trusted people and/or emergency contact) in case one no longer feel safe and they feel they cannot safely utilize their safety plan.  

What’s a safety plan? 

A safety plan is a tool that is created in a therapy session with one’s therapist for the purpose of having it at their disposal when suicidal thoughts creep back up. A safety plan will prompt one to list out triggers that contribute to suicidal thinking, plan, and/or intent; ways one can remain safe independently (go on a walk, read a book, spend time with a pet); who the trusted people in their lives are and who can be called by client for distraction (not discussing the problem) or for help (discussing the problem); listing out places that bring one a sense of peace and/or distraction, where they can go when feeling upset and/or overwhelmed; listing out emergency contact in safety plan (who can a therapist call in the event thatthere are concerns for safety and client is not reachable); listing out Suicide Crisis Line Phone Number- 988 (press 1 for veterans); list out 911 on safety plan; and list out nearest emergency room closest to client’s home where they may go in the event of a suicidal crisis/emergency.

Active Suicidality

Another kind of suicidal thinking is referred to as active suicidal thinking. With this comes thoughts of not only wanting to die and/or “not be here” anymore, but this has escalated to the point of the sufferer wishing to take their own lives, having formulated a plan and/or has intent to harm or kill themselves. For example, someone may tell you that they are feeling depressed, worthless, and life is no longer worth living. They then go on to say that they are ready to exit this world and plan to jump off of a bridge that very night. When something like this is said, immediate action should be taken. By immediate action, I mean calling the Suicuide Crisis Line and/or 911 or bringing your loved one to the emergency room. There is no tip toeing around this. If someone with active suicidal thinking has a plan and/or intent to harm or kill themselves, they need immediate safety and stabilization. No ifs, ands, or buts about it. They may be upset with you for calling the crisis line, the police, and/or taking them to the emergency room, but this is for their own safety and well being. 

Why take action?

Often times, those who survive suicide attempts are grateful they did and are more motivated to start a new chapter in their lives. Suicide is a permanent solution to a temporary problem. Suicidal thoughts are treatable! Therapy can help those who suffer with suicidal thinking to learn healthy coping skills,learn to reframe negative thinking and find news ways to navigate their lives in a way that feels worth while and meaningful.  

The Bottom Line

If you tell your therapist that you are suicidal, much more questioning needs to occur first before anything else. So you may get a slew of questions that seem redundant, but they are necessary to have the best grasp on what your clinical and safety needs are at that time. Oftentimes, we as therapists are able to formulate safety plans together and check in on this together regularly. However, there are some times when we need to call 911 and/or get you to an emergency room. Sometimes, this may result in a psychiatric inpatient hospitalization in order to keep you safe and have another treatment team in the hospital evaluate your safety and needs. This is all done in the name of safety and genuine care for our clients. We’d rather you be upset with us and get help than not be here tomorrow. 

The concept of psychiatric hospitalizations seems scary to some people, especially if you have never been hospitalized this way before. As someone who used to work in inpatient psychiatric hospitals, I can confidently confirm that the first goal at intake is discharge. Inpatient treatment teams seek to quickly stabilize and get patients out of the hospital safely with plans in place in the community to prevent future hospitalizations. 

We as therapists are here to support you no matter what. We just ask because it can save a life. Please see our emergency resources page if you are struggling with suicidal thinking.

Jackie Martinez, LMSW

I’m a therapist who is transparent about seeking therapy for myself, and who believes both teletherapy and therapy is helpful for almost all people, regardless of the circumstances. Throughout my years, I have undergone my own therapy for different reasons, from wanting support for the trauma I experienced, to learning how to gain the self-esteem needed for me to break free from domestic violence, for simple advice about navigating through transitions, as well as for a means to cope as a caregiver for two parents who both were terminal. Sometimes, too, it felt cathartic just to be able to “vent” to a nonjudgmental, compassionate individual.

Unfortunately, as I’m sure you’ve noticed, it isn’t easy to get a therapist! I’ve had to leave voicemails, emails, and private messages for many local therapists – quite a few who never got back to me, and most who said, “sorry, I’d love to help you but I’m full” without any advice about who I could go to instead. Alternatively, for the therapists who did respond, there were issues with the commute (I require public transportation due to a neurodevelopmental disability) or with timing. For part of my treatment saga, I was also in graduate school and working a full-time job on top of balancing a mandatory field placement, which made it seemingly impossible to fit in self-care for myself.

Talk about irony! I remember it so vividly. I was a social work student learning how to be a therapist, employed at a community mental health agency while also interning at a private practice. I made the time to be there for my clients at the expense of ignoring my own needs. I desperately wanted a therapist of my own, but with the transportation issue, an unforgiving schedule, and the lack of available therapists in the area, how could I?

Then the pandemic happened. The world shut down. Overnight, I had to change meeting with clients face-to-face to going online. I will admit I came with a bias. Years before, during orientation for my social work undergraduate program, a rather old-fashioned professor rambled about why online therapy is a “threat” to the field. Mainly it was that she assumed HIPAA could not be honored or that the relationship was not as “real and organic.” However, now after being exclusively a remote-based therapist since the pandemic to the present, I must admit I respectfully disagree with her. Some of my most intimate, heart-to-heart conversations have been over a video screen. I have shared in my client’s sorrows, hopes, fears, joys, celebrations, and hardships. And I have seen glimpses into the very environment where they spend most of their time – their homes. There is something so powerful, insightful, and raw about seeing one’s home which cannot be captured through the spoken word while in a therapy office. It is truly a privilege to be trusted with seeing the private spaces of my clients, and in turn they get to see mine. Furthermore, teletherapy allows for me to work with anyone if their primary residence is New York State, going far beyond the borders of Suffolk County. This means the people who choose me as their therapist do so because they want to work with me, not because of just location. This arrangement has allowed me to blossom as a specialist in turn, having clients who all fit into my niches (grief/bereavement, complex trauma or C-PTSD, caregiving stress, and/or people with debilitating disease).

Thanks to teletherapy, I too got to have my own weekly therapy. After a somber event happened, I needed a therapist to process my emotions. One therapist who replied to me in a timely fashion offered teletherapy to anyone in the state. She offered everything I needed – experience, knowledge, efficiency, she even liked the challenge of having other therapists as her clients! Perfect! Yet best of all, the flexibility of being online allowed me the flexibility I required to remain efficient in my own role as a therapist to the people I serve. It was simple: I only needed to log in to the teleconference platform right before the session start time. This allowed me to never miss a scheduled session, be proactive about my recovery, and let my “therapy time” truly be 45 minutes (rather than adding in commuting time, which of course could be delayed due to an accident or inclement weather!). Plus, this also meant I got to have more time for other commitments in my life.

Still feeling unsure about teletherapy? Here’s some perks.

There are numerous reasons why teletherapy is beneficial. Here are a few in summary.

Privacy (the BIG one!)

Have you ever ran into someone you know while in the waiting room? Worse, was it someone you have difficulty with because you two do not get along? Yep, talk about awkward. Back in high school, I remember being in the waiting room at a therapist’s office when suddenly a girl I knew came in to pick up her younger sibling. She was best friends with a bully who absolutely loved to torment me. Yep… awkward.

Want to hear another unsettling story? That practice was so disorganized with communication that there was always competition for rooms. One time while I was there, one of the therapists came into the waiting room to ask if any of us would be willing to have our session in the kitchen – the public kitchen, where staff and clients alike could come and go to get coffee. Yeah, I’m not kidding. Talk about a HIPAA violation!

Or maybe you have been spared such severe examples, but most of us can relate to at least this experience: Have you ever overheard the entire conversation between the patient and the clinician while at a doctor or therapist’s office? Or have attempts to soundproof the rooms still proven impossible? I’ve been there, too.

Fortunately, with teletherapy you do not need to be concerned about coming across someone you know in the waiting room, parking lot, or restroom. You can schedule your session for a time where you will have optimal privacy and confidentiality, whether that be in your home, your car, or even in your backyard. 


Going to a session is easy when you do not have to drive to and from the therapy office! Clients can schedule their session during lunch break, before work or class, during their baby’s naptime or when the toddler is watching Sesame Street, or any other gap. In turn, it allows me to offer a wider schedule to also suit my clients’ needs.

Flexibility is especially important for clients who otherwise would not be able to fit therapy into their schedules at all. For example, for my clients who are caregivers, it would be impossible for them to commit to in-person therapy because they would need to arrange for care for both the session and the commute. However, with teletherapy, they are only “away” from their loved one for 45 minutes, and they also have the option to step away from the computer to care for them, if needed. Or as another example, say the client has a serious medical issue. They can prioritize their doctors’ appointments without having to suffer from a late cancelation fee because chances are, I can fit them into another time slot for that week. This is not always the case for in-person therapists because they tend to have stricter “on the clock” hours.

Accessibility for People with Illness or Disability

Sadly, although therapists tend to think they are sensitive to those with medical issues, this is often not the case. Their hearts may be in the right place, but they simply do not understand why going to an appointment in-person can be a great challenge. It is one thing for an office to be “ADA-friendly” by having an elevator. But what if the elevator fails? What if the parking lot is full of potholes? What if there is no ramp at the entrance or no automatic door? What if the restroom door is very heavy? What if the person needs their caregiver to help ambulate them but the only appointment times available do not work for the caregiver?

What if the person has IBS or Crohn’s disease? Or maybe they are pregnant? The fear of waiting in line for the restroom is a legitimate concern for such people, in addition to the embarrassment that comes with nosy strangers.

If you have limitations due to an illness, disability, or medical procedure, you may be unable to make it into the office, which will hinder treatment during when it is most needed. Teletherapy removes these barriers by allowing you to “log in” from the comfort of your bed.

Continuity of Treatment for College Students

For some youth, their connection with their therapist is one of the healthiest, strongest relationships they have with an adult. They make great progress, tackling the core beliefs or issues or whatever it is that is hurting them… until they must discontinue therapy because they are moving away for college. In the best-case scenario, the therapist may just happen to know another therapist who is in that area and can take on the referral – but that is almost never the reality. Usually, the treatment is terminated, and the client is left floating, just waiting to hopefully get some help through the counseling center at their college. These colleges may not have enough counselors available to assist every student, lack the training needed for issues that go beyond “typical college stuff,” or other limitations.

On the flip side, with teletherapy, college students can keep their therapist, even those going to a college outside of their home state! In my case, I can keep every student who began with me in high school and has since left for a college that is far away. The only requirement is that their primary address must still be in New York, which usually is the case for college students as they tend to “go home” during breaks.

Reduced Wait-Times

In an in-person setting, there may be a considerable wait time to get an appointment with a particular therapist. However, remote-based therapists tend to have more time slots open and allow themselves to be more available. For instance, if someone needs to reschedule a session with me, that is much easier to accommodate because I can log on during a time when I usually do not work. On the other hand, an in-person therapist may only be able to offer times that are bad for the client, or say they are completely unavailable because otherwise they may have to drive to the office for just one session.

Effectiveness (yes, teletherapy is just as good as in-person therapy!)

Evidence-based research supports that teletherapy is highly-effective for most clients, issues, and modalities – and generally, teletherapy is just as useful as in-person therapy. Sometimes it is even more effective since clients may feel more relaxed being in their homes.

It is only a myth that teletherapy is a “diluted” version of in-person therapy. In truth, most modalities (i.e., EMDR, DBT) can be easily adapted to an online version. For instance, there is a website I use for the bilateral stimulation used with my EMDR clients.

For more reasons as to why teletherapy may be the right option for you or your child, click here.

Valerie Smith, LMSW

Doesn’t it drive you nuts when people tell you to “calm down” when you’re upset, anxious, panicked, or afraid? It drives me insane. I just think to myself, “Okay great…and how do I accomplish that without putting you through a wall?” Of course I don’t act on such thoughts! But I understand the frustration of feeling stuck in a dark, deep hole of anxiety while the bystanders at the top of the ditch are yelling down to me, “calm down!” or “it’ll be fine!” or “you’re overreacting!”. Which is why grounding techniques can be so beneficial when no one else can.

First, we should go over some basics of what anxiety and panic look like so we can better spot them before we feel completely unraveled in our experience with such symptoms. 

Fight or Flight Response

First, quick side note/science lesson…our bodies yield both the Sympathetic and Parasympathetic nervous systems. Housed in the Sympathetic nervous system is our “fight or flight” that prepares us to respond to danger. While fight or flight has always been essential to survival, the body can’t always tell what is a genuine danger versus when we are just emotionally uncomfortable or going through something. The Parasympathetic nervous system helps our bodies restore back to a state of calm when fight or flight is no longer needed. This information is important because it plays a GIGANTIC ROLE in anxiety, panic, as well as other mental health struggles. 

So when we have anxiety, there is constant worry that we can’t seem to shake most of the time in addition to maybe feeling restless, on edge, having a hard time focusing, feeling more irritable, physically tense, having a tough time sleeping and feeling easily fatigued quite a bit. I go through this myself and I can tell you firsthand that ignoring these symptoms will lead to feelings of anger and irritability, scatteredness, constant exhaustion, and like every little thing is an insurmountable task which will negatively affect your life across the board. Trust me, I know. 

What is Panic?

Panic is a bit different and more intense than your typical anxiety monster impeding on your day to day life. With panic, we actually feel like we’re having a heart attack or like we’re going to die! That’s right…there are instances when people have had to go to the Emergency Room because they thought they were having a medical emergency. Completely understandable given the symptoms of panic. If we look at symptoms of panic that include accelerated heart rate/palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain/tightness/discomfort, chills or heat sensations, numbness or tingling, feeling detached from ourselves or reality, fearing we are losing control, and fears of dying….it’s no wonder people may want to seek out a medical professional real quick. 

While I have never experienced a panic attack myself…I am willing to bet that if I ever do, I’m getting my butt straight to the Emergency Room because as humans, what are we supposed to think when all of that is going on without any clear medical explanation? I highly encourage anyone experiencing such symptoms, especially if this has never happened before, to seek medical attention immediately and rule out medical concerns before chalking this all up to panic!

However, once we rule out medical concerns and have an understanding of panic symptoms, we can better manage them without seeking unnecessary medical attention or escalating our anxiety/panic due to fear of the unknown. It is essential to understand that panic attacks are just that, panic. They cannot physically harm you and they tend to last about 10 minutes (while I’m sure it feels like forever!). So, we have to remember that it will pass and getting comfortable with discomfort is one of the first steps to getting through panic attacks. I’m sure that’s obnoxious to hear, but it’s true. 

Much of the time, what I’ve caught myself doing to alleviate my own generalized anxiety is to avoid, avoid, avoid. Whether it be avoiding a deadline or an uncomfortable conversation, dodging obligations/tasks all together feels good in the moment, for sure. While my education tells me that avoiding my anxiety like the plague only makes things worse, I admittedly engage in this behavior. And trust me, the education is correct…avoidance only feeds the anxiety monster that lurks beneath.

So what are we to do when anxiety and panic strike?  

Well, a form of coping called grounding skills seems to help many, including myself, to feel more centered in the present moment and ultimately activate my parasympathetic nervous system (that’s what we want). With grounding, we are essentially turning our attention to the present moment so that we can ultimately feel more calm and address potentially anxious triggers.

In grounding, we use our five senses to return to the present moment when feeling overwhelmed and like everything is on top of us. Grounding equips us with several skills to utilize healthy detachment from emotional pain with use of distraction until we feel ready to return to any given problem. The following 5 skills that I will list below can be used any time, in any place, and can be completely discreet. There are many more ways of grounding that will not be covered here but I encourage you to explore ways of grounding with your therapist to find the right fit for you. 

The 5-4-3-2-1 Technique:

This skill invites us to observe 5 things we can see, 4 things we can feel, 3 things we can hear, 2 things we can smell, and 1 thing we can taste. For example, if I am feeling overwhelmed I will stop and look around me, engaging in this technique to focus on something aside from my stressor for a few minutes until I can collect myself and face my problems with my head screwed on right. 

Body Awareness Technique:

Here, we are encouraged to focus our attention on sensations in the body and feeling of calm after the exercise is over. Below, you will find an example cited from

  1. “Take 5 long, deep breaths through your nose, and exhale through puckered lips.
  2. Place both feet flat on the floor. Wiggle your toes. Curl and uncurl your toes several times. Spend a moment noticing the sensations in your feet.
  3. Stomp your feet on the ground several times. Pay attention to the sensations in your feet and legs as you make contact with the ground.
  4. Clench your hands into fists, then release the tension. Repeat this 10 times.
  5. Press your palms together. Press them harder and hold this pose for 15 seconds. Pay attention to the feeling of tension in your hands and arms.
  6. Rub your palms together briskly. Notice and sound and the feeling of warmth.
  7. Reach your hands over your head like you’re trying to reach the sky. Stretch like this for 5 seconds. Bring your arms down and let them relax at your sides.
  8. Take 5 more deep breaths and notice the feeling of calm in your body.”

Grounding Statements:

When having anxiety or panic, a way to cultivate acceptance of discomfort and better managing symptoms, we can be kind to ourselves. Does it seem ridiculous? Maybe… but it can work! Focusing on positive words you say to yourself over and over in the midst of anxiety or panic can help you remember that you are strong, resilient, and can overcome difficult things in this life. Some examples of what you might say to yourself would be, “This is uncomfortable but I can accept it”, “I will let my body do its thing and it will pass”, “I survived this before and can do it again”, “this isn’t dangerous”, “no need to push myself, I can take a small step forward as I choose”, “these are just thoughts, not reality”, or “don’t worry, be happy”. 

Diaphragmatic Breathing:

I’m sure mostly everyone has heard of some form of deep breathing and I often hear clients tell me, “this doesn’t work for me”. Upon closer inspection, I find that people may try this once or twice, and when it’s not instantly working, they chuck it out the window. However, this form of deep breathing should be given a fair shot! Let me explain a bit more about how to engage in this skill, then I’ll explain why I feel so strongly that deep breathing really needs to be given a chance. 

So, how do we do this one? We put one hand on our chest and the other on our belly. Then, we inhale slowly through our nose, hold briefly, and exhale through our mouth. Some follow a formula of 4-6-4; ie. inhale 4 seconds, hold 6 seconds, exhale 4 seconds). Adjust to your comfort level. Make sure that upon breathing in, your belly is expanding out. Notice how your belly expands and falls with each breath. It is recommended to engage in this skill for at least 2-5 minutes daily.

The reason deep breathing works is because it levels out the oxygen and carbon dioxide in your blood. When you have anxious breathing, your oxygen and carbon dioxide levels are uneven, leading to the physical manifestation of anxiety that we talked about earlier. So to help activate the parasympathetic nervous system (the one we want) and ease the physical parts of anxiety, diaphragmatic breathing is a great one to try. Let me know how it goes!

Using Sense of Smell for Grounding:

It has been found that in anxiety as well as trauma, the sense of smell is largely connected to the emotional part of our brains. If you think about it, maybe something that smells oddly familiar to you but you can’t put your finger on it brings a sense of comfort and calm. I know for me, whenever I smell anything that resembles Thanksgiving dinner, I have a sense of ease thinking back to fun childhood memories, enjoying my grandmother’s cooking for Thanksgiving dinner. Her food is always on point!

So when we are feeling anxious and/or triggered in any way, we can use sense of smell to quickly return to the present moment. Ideas that some of my clients have found helpful over time is to keep a perfume and/or cologne soaked handkerchief on them, an essential oil bottle on them, or maybe a favorite kitchen spice. Candles and/or wax warmers at home can also bring a sense of peace and calm using pleasant scents. 

While anxiety can sometimes make us feel like we’re in a moving car with no driver, there are ways we can safely get back into the driver’s seat and navigate our symptoms safely, securely, and happily. Your therapist can help you navigate these tools and find out what may be the best suited for you and your needs. Anxiety will not get the best of us!

Jaclyn Martinez, LMSW

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Take the first step in healing.

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