A photo of sunflowers and a colorful sky represent the benefits of finding the right treatment for anxiety and depression

Anxiety and Depression are common and treatable. But how do you determine your best treatment for anxiety and depression? It is definitely not a one-size-fits-all kind of thing. And, there is no reliable blood test. (But, there will be one day soon.)

At least initially, anxiety and depression often present as physical ailments rather than as classic mood symptoms. No surprise that many patients turn to their primary care physicians for care. Primary care doctors really do need to be well versed in recognizing how mental health conditions manifest– and in making appropriate treatment recommendations.

Treatment absolutely can improve quality of life. But, success of treatment varies…widely. So does the length of time before you feel better. And, of course, what is helpful for you may not be for your friend.

Let’s talk about the good news and then the less than good news.

The good news in the treatment world for anxiety and depression:

1. Treatment for anxiety and depression can be similar.

Cognitive Behavior Therapy (CBT) is a highly effective therapy for both conditions. CBT has considerable scientific evidence that its methods actually lead to improvement in mood and functioning. Its core principles have to do with changing thinking patterns. CBT tends to be short- to moderate-term. Its focus is on the present.

Psychopharmacology (medication) is another common treatment, and often the same medication (e.g. a Selective Serotonin Reuptake Inhibitor or SSRI, or a Selective Norepinephrine Reuptake Inhibitor or SRNI) is helpful for anxiety and depression. Examples of SSRIs include Prozac, Zoloft, and Paxil. Effexor and Cymbalta are examples of SNRIs.

There are other types of medications to treat depression alone, or anxiety alone.

There is some evidence that combining psychotherapy and medication works best for treatment of depression.

For anxiety disorders, CBT, antidepressant medications and anti-anxiety medications (e.g. Buspar) are helpful. Some research suggests psychotherapy is more effective than medications to treat anxiety, and that adding medications does not significantly improve outcomes from psychotherapy alone.

2. Many people find treatment helpful.

The benefits of therapy vary. For both disorders, CBT is the most effective form of psychotherapy.

The benefit of medication depends on lots of factors. One is the severity of the depression or anxiety. In general, the more severe the symptoms, the more likely the medication will help. In other words, antidepressants are more effective in treating chronic, moderate and severe depression. They don’t help much in mild depression.

Keep in mind…

3. If one treatment does not help, there are many other treatment options.

Lots of research on evidence based treatments is available. We know that sticking with the approach(es) is necessary to evaluate if what you are doing is helpful.

4. Techniques you can do on your own will help.

The kinds of things you can do are helpful throughout life, even when not suffering from anxiety or depression. These include journaling, exercising, meditating, doing yoga, doing a hobby, or playing an instrument.

5. Support groups are helpful, and exist in many local communities as well as nationally. Just make sure the groups are led responsibly by a licensed mental health provider.

The less good news:

  1. Trial and error are often required to find the best medication for you.

    This can be time consuming, especially when you are not feeling yourself. Finding a therapist who is a good fit for you can also be challenging. The ‘chemistry’ and expertise have to feel right.
  2. Insurance companies sometimes encourage medication over psychotherapy.

    Why? Because it is less expensive. This may be appropriate at times, but often psychotherapy is clearly indicated.

3. If you’re like many people, and you seek help from your primary care physician for anxiety and depression, know that treating mental health problems in a primary care setting can be less than ideal.

Primary care clinicians have time pressures and lots of conditions that warrant attention in every patient interaction. Their evaluation and treatment of mental health disorders may fall short of the ideal.

As with most health conditions, finding and accessing treatment is not necessarily easy. In the case of feeling anxious and depressed, pursuit of care can be extra difficult.

If you have no improvement after 4-6 weeks of treatment, discuss other options with your provider. Also, be sure to disclose any alcohol or other drug use. Both are linked to anxiety and depression, and are important to mention – especially if you are on medication.

How to determine your best course of action for anxiety and depression is specific to each individual.

In general, concrete steps to consider include:

  1. Contact therapists and psychopharmacologists who are on your insurance plan. Check out their website. Ask about their services. Consider looking at referral sites for names of providers who may be helpful.
  2. Consult your PCP for referral to a therapist and/or psychopharmacologist
  3. Consider using telehealth services if available.
  4. Read reputable articles to help you assess your symptoms, your needs, and the next best steps FOR YOU.
  5. Get moving! Whether cardiovascular, or strength training, exercise helps. Make it fun by dancing to music. Taking a Zumba class. Or how about yoga?

Suffering from anxiety and depression is not uncommon, especially in this post-Covid world.

There is no one-size-fits-all recommendation for how to approach treatment, or for which treatment to land on.

The two basic options are therapy and/or medication. For therapy, CBT is the treatment of choice. For meds, the treatment of choice is typically an SSRI. (There are lots of factors that determine specific treatment recommendations.)

CBT is often considered better than medication at preventing relapse. It is tends to be short term, and empowering to the person who learns it. As a psychologist, I love teaching CBT an do have a lot of respect for how helpful anti-depressants can be. If they help, it is because they are remedying a chemical deficit in your brain.

I am a MA licensed psychologist in private practice. If you’re struggling with anxiety and depression, and would like to learn more about working with me, please contact me here.

A whimsical painting of a woman's face, surrounding by koi fish, as if underwater and swimming with them

Not everyone with an eating disorder has poor body image, and not everyone with poor body image has an eating disorder. However, poor body image and eating disorders often do go hand in hand.

Let’s start by defining body image.

Body image is the relationship you have with your own body. As with most relationships, body image is complex.

Body image is important because of how it impacts your physical and mental health, relationships, and self-esteem.

It includes how you see/perceive your body, what you think about your body, and how you feel about it. Body image also includes beliefs and behaviors, and is strongly influenced by Diet Culture.

Diet Culture influences everyone’s relationship with their body, even if they aren’t dieting. Sometimes it’s disguised as ‘healthy lifestyle’, ‘clean eating’, or other such euphemisms. It glorifies thinness and intertwines weight with worth.

In addition to making you feel bad about your body and self, Diet Culture demands you be vigilant about eating and weight.

It says that to be worthy, you must be thin. And if you’re not in a thin body, you are to blame.

Diet Culture shows up as all-or-nothing, perfectionistic thinking regarding food, body and health. Rules to eat “x” but not “y”. To “start Monday” if you ‘blew it”. If not thin, then you’re fat.

It promises that if you follow external rules, rather than trust your body’s wisdom, you will succeed.

This kind of messaging makes having a good relationship with your body almost impossible.

Poor body image often begins in childhood. Thanks to Diet Culture, growing up with a neutral or even positive body image is more the exception than the rule.

Parents are not immune either. They don’t live in a vacuum. Diet Culture is so insidious that even recognizing it is a challenge. Sort of like fish not knowing they are wet. They often unknowingly perpetuate Diet Culture messages, for they have also internalized them.

There’s no shame here- Diet Culture impacts US ALL.

The main points include:

1.Poor body image is due to the internalization of Diet Culture.

2.If there were no poor body image, there would be no dieting.

3.If there were no dieting, there would be no eating disorders.

(Except Anorexia nervosa, which recent research suggests has a prominent genetic component irrespective of cultural ideals.)

How does negative body image present in eating disorders? There are many forms: body dissatisfaction, overconcern with weight and shape, body-related checking, avoidance behavior, misperception of size, and body-related cognitive bias.

There are three basic ways body image and eating disorders go hand in hand.

First, research finds time and time again that poor body image is one of the most common precursors to eating disorders. Second, it is the main symptom of many eating disorders, including Anorexia nervosa and Bulimia nervosa. Lastly, recovery requires improved body image. Without it, recovery is incomplete and/or short-lived.

Let’s look at each of the three ways poor body image and eating disorders go hand in hand.

1. As mentioned, poor body image is a risk factor for eating disorders.

Eating disorder prevention programs often target body image for this very reason. Poor body image is a risk factor for other problems, too, including depression, anxiety, and low self-esteem.

Why is poor body image so strong a precursor to eating disorders?

One reason is poor body image can and does easily lead to dieting, disordered eating, and then to an eating disorder.

Negative body image is a logical risk factor in eating disorders because people who develop eating disorders tend to highly value body shape and weight. Especially to define their self-worth.

2. Poor body image is a criteria in the diagnoses of two well known eating disorders, Anorexia nervosa and Bulimia nervosa.

In the case of either disorder, poor body image presents as body shape and weight hugely influencing self-worth. People with Anorexia nervosa also have a disturbance in how they experience their weight or shape. Sometimes they’re unable to recognize the seriousness of their current (often low) body weight.

The most common eating disorder is Binge Eating Disorder. Body image related concerns are not part of the diagnosis. However, about 60 percent of BED patients endorse overconcern with weight and shape. And avoidance behaviors and body checking too.

3. Why does recovery from an eating disorder require improved body image?

People with an eating disorder sometimes fear they’ll never feel at peace in their body. Especially if they give up their eating disorder behaviors. They inaccurately believe that their only hope to eradicate negative body image is to lose weight and maintain a body size closer to Diet Culture’s ideal.

Surrendering eating disorder behaviors, including dieting/restriction, is especially difficult in the Diet Culture World we live in. An important facet of treatment is to help people learn self advocacy, social action, and how to be the change they want to see in the world.

The good news is that full recovery from eating disorders is possible. Which means that improving body image is also possible.

There’s no shame here- diet culture impacts US ALL.

To move toward healing and freedom from food and body concerns, we have to dismantle and question the ‘truths’ that Diet Culture has enforced from Day 1. And, to consider how buying into these beliefs and messages (most often over and over again) has been destructive to attuning to your body, your needs, your hungers and your trust in yourself.  

As you begin to do this important self-inquiry, externalize some blame you’ve put on yourself.

Join me as we take down Diet Culture, together. Only then will body image collectively improve and eating disorder rates plummet.

I am a non-diet, Certified Intuitive Eating specialist and clinical psychologist in MA. If you’re struggling with your body image and/or eating disorder, please contact me here.

The image of a woman jumping for joy on a beach, representing a Highly Sensitive Person thriving

Learning how to thrive as a Highly Sensitive Person (HSP) makes a world of difference. And a difference in the world. Sounds cheesy but is true.

A Highly Sensitive Person scores high in Sensory Processing Sensitivity (SPS), a genetic trait associated with perceiving things up to ten times more intensely than other people. Research suggests 15% or so of the population has SPS. The trait occurs equally among males and females.

High Sensitivity has 4 key components.

Keep these 4 dimensions in mind when thinking about how to thrive in a world that is not always supportive of a Highly Sensitive Person.

  • Depth of Processing: you think deeply and process deeply too.
  • Overarousal/Overstimulation: you can get dysregulated or overwhelmed easily (but this makes sense due to depth of processing).
  • Emotional Responsiveness/Empathy: you are prone to feeling highs and lows. Also, you are naturally caring and compassionate.
  • Sensitivity to Subtle Stimuli: you tend to notice details. You are also more likely to react to sensory stimuli such as a tag in your shirt, a dripping faucet in the other room, or an odor others don’t smell.

Being Highly Sensitive is not a disorder. Nor is it a euphemism for being thin-skinned, too sensitive, easily offended, or unable to take a joke.

That being said, HSPs may feel slighted more easily than people without the trait. However, HSPs also tend to be more easily delighted, appreciative, moved by nature, and motivated to help humanity.  

black and white photo of an angelic girl bending over to smell a flower

HSPs suffer more in unsupportive environments and do extremely well in supportive ones, especially in childhood. This is known as differential susceptibility.

Differential susceptibility suggests that the four pillars (“DOES”) of High Sensitivity can make a difficult childhood that much more difficult for HSPs than for peers without the trait. However, in an environment that is supportive, HSPs fare even better than peers without the trait.

Dr Elaine Aron, who literally wrote the book on Highly Sensitive People in the 1990s, believes HSPs thrive under the following five conditions:

  1. Knowing the trait is real
  2. Reframing the past with the new understanding of HS
  3. Using the reframed understanding to heal past wounds
  4. Developing a lifestyle aligned with the trait
  5. Meeting other HSPs

Being Highly Sensitive is not easy, even though in many ways is a gift.

Think of the benefits for HSPS who endorse the above five conditions: Intuition, empathy, creativity, perception, insight, and love of nature to name a few. Wow!

Thriving or not, HSPs use a lot of brain power in everyday life due to depth of processing.

More specifically, HSPs notice (e.g. see, hear, pick up on) subtle things other people don’t. We naturally make connections between past, present, and future. We integrate internal and external experiences. HSPs are naturally equipped to do all of this because of a part of the brain of an HSP that is particularly active, called the insula.

Certainly, processing information deeply and making connections from what we notice and sense is a great strength. The downside is that we become depleted more easily because of all of the demands  

Embrace your exquisite sensitivity to discover depth, meaning, and emotions that are unavailable to the 85% of people without the trait of High Sensitivity (HS).

As an HSP, how do you manage exhaustion before the point of having nothing left?

You must know yourself. Meaning be aware of your basic needs for hydration, nutrition, sleep, rest, being outdoors, and alone time to recalibrate your nervous system.

Take downtime each day. Find ways to incorporate quiet moments, daily.

A collection of pretty teacups to represent the necessity for self care

Engaging in self-care along the way helps a lot and is what I call a ‘non-negotiable’. Dr Aron takes a short nap everyday as a way to energize. She also walks daily and has a meditation practice each day.

Your forms of self care may look very different. What matters is that the ways you care for yourself replenish energy and help you feel at ease. Your self care is likely different than someone else’s. And that is just fine.

Self-care is the secret sauce. As in essential for a Highly Sensitive Person to thrive.

Finding ways to reduce the amount and intensity of information your brain naturally processes is also helpful (along with ways to replenish what’s depleted). But be sure the techniques feel right. They will be different from what other people are doing, and that is perfectly fine.

I am a MA clinical psychologist passionate about Highly Sensitive People discovering and embracing their gift of High Sensitivity, and helping them to thrive! If you know or even suspect you are an HSP, and would like to learn more about embracing your gift, you can contact me here.

A drawing of a young woman with a globe she is leaning on has an expression of concern.

Eating Disorders are a diagnosable mental illness. So says the Bible for diagnosing psychiatric illnesses, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Published by the American Psychiatric Association, the DSM includes hundreds of mental health disorders categorized by symptoms, for both adults and children. Updated every few years, the current version is DSMV.

Eating Disorders have their own DSMV category, Feeding and Eating Disorders, or “FED” for short.

I’m not sure if the APA intended the pun or not.

Eating Disorders’ inclusion as a mental illness in the DSM has advantages.

First and foremost, recognizing eating disorders as a mental illness adds legitimacy. As a result, eating disorders are less likely viewed as a rite of passage, fad, choice, or attention seeking maneuver.

Another plus of recognizing eating disorders as a bona fide mental illness is earlier diagnosis and treatment. (And insurance coverage.)

However, identifying eating disorders purely as a mental illness is oversimplified.

Here are three reasons why.

First, let’s look at the numbers. The National Eating Disorders Association reports 20 million women and 10 million men in this country will have an eating disorder in their life. That is a lot of people.

Speaking of a lot of people…

Imagine randomly asking people questions from a disordered eating screening tool. Questions like, “How afraid are you of gaining three pounds?” “Compared to other things in your life, how important is your weight to you?”

The results of this experiment? You’d most likely find people without a diagnosed eating disorder reporting eating disorder symptoms.

So if many people suffer from what is considered a disorder (knowingly or not), is the disorder a disorder?

This is where Diet Culture enters into the equation. Or, as I like to say, fish not knowing they’re wet.

And Diet Culture is the second reason there is more to eating disorders than what the DSM has to say.

What is Diet Culture anyway?

It’s a set of beliefs that worships thinness and equates it with morality and success. Diet Culture is the lens through which we define attractiveness, worth, health, and our own bodies. It’s the air we breathe and one of the main factors affecting how we feel about ourselves.

What does Diet Culture have to do with eating disorders?

Everything!

Diet Culture perpetuates eating disorders and makes recovery much more difficult. As activist, Dance Champion, and Marathoner Ragan Chastain says, Diet Culture is “particularly dangerous to those with a predisposition for, currently suffering with, or recovering from eating disorders.” (Again, that’s a lot of people!)

So, how are Diet Culture and eating disorders linked?

“Thinner is better, regardless of the mental and physical cost” is a Diet Culture belief. So is the premise that anyone can be thin if they just try hard enough. These are the ingredients in a recipe for an eating disorder.

We’re surrounded by images and messages that reinforce this premise and keep us hostage.

The message is clear. You have to have a certain size (thin) body, and follow a set of rules (e.g. fitness and/or meal plans) to be successful, attractive, and worthy.

Again, this is fertile ground for eating disorders. (And a dark parody of taking the messages too far.)

The third way to think about eating disorders beyond the DSM is as a Culture bound syndrome.

A culture bound syndrome is “a cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context” (American Psychiatric Association).

What do culture bound syndromes and eating disorders have in common?

Research from 1995 on the island of Fiji addresses this very question. The mid 1990’s is when American television first began broadcasting in Fiji.

Prior to television, there was no such thing as eating disorders in Fiji. Even though there was a lot of emphasis on food.

But the food emphasis was on the joy of eating. And in delighting in the abundance of delicious food. The focus on pleasure is the opposite of Diet Culture messages.

By 1998, 3 years after “Friends” and “ER” were broadcast, that changed, especially for teenagers.

An astounding 11.3 percent of adolescent girls reported purging for weight loss. They said things like, “I want their (actresses’) body…I want their size.”

By 2008, 45 percent of girls had purged in the last month.

So, are eating disorders a mental illness? Yes.

But…

Complex biological, temperament, genetic, and sociocultural factors interact to yield an eating disorder. Diet Culture is a major player in that equation. Factor in Diet Culture messages, and eating disorders can be thought of as a Culture Bound syndrome.

Diet Culture harms you. Actually, it harms anyone with a body. That includes people who aren’t on a diet. And even people from a South Pacific island who until recently had a diagnosed eating disorder rate of zero.

So when thinking about eating disorders, please respect that many factors contribute to their development and maintenance. They are a mental illness, but so much more.

I am a MA licensed psychologist with a passion to help people of all sizes and shapes improve their relationship with food and their body. If you are struggling with an eating disorder and want help, please contact me here.

A photo of four girls of the tween years are sitting on a step, with just their legs showing from the knee down. They represent some of the influences on body image at that age.

Body image is the relationship you have with your body. Parents, your body image has likely changed over the years in some ways. But maybe not in others.

For tweens, body image is especially complex due to unique influences associated with age and development. Tweens are especially prone to feel self-conscious and to obsess about their appearance.

First, let’s unpack body image.

Body image includes how you think and feel about your body, and your perception of how it looks. Your body image may have little to do with your actual appearance, including your size, shape and weight. 

Just as bodies change over time, body image can too.

As an adult, have you ever joked that you would rather (fill-in-the-blank) than go back to middle school? Tween years are tough: Puberty. Peer pressure. Experimentation. Budding sexuality. Social media.

Almost as difficult as being a tween is parenting a tween.

Especially because tweens don’t know what they don’t know. Yet they think they know. And you do know.

Even though in tweens’ mind, you grew up in the Dinosaur Age. And are of course clueless. (Insert tween eyeroll here.)

Here’s a list of what influences body image for tweens:

  • Home environment
  • Parents
  • Peers
  • Social media
  • Culture and subculture
  • Abilities/disabilities
  • And everyone’s favorite, puberty
  • Direct comments/bullying/teasing
  • Menarche
This image has an empty alt attribute; its file name is christopher-campbell-SaQxt8rdLq4-unsplash-1024x691.jpg
Body image influences affect tween boys too.

The most visibly obvious influence on body image for tweens is puberty.

During puberty, a tween’s body goes through lots of changes. But at the same time, fitting in and looking cool or hot become more important.

This image has an empty alt attribute; its file name is mark-decile-wEUx4ZuRElk-unsplash-769x1024.jpg

Tweens are at greater risk of negative influences on body image if they:

  • act on pressure from family, peers or media to look a certain way
  • have a different body shape from peers or media images
  • self-objectify (Only see themselves from the ‘outside’)
  • compare themselves to others
  • have low self-esteem
  • participate in a group or sport that emphasizes a certain body type
  • have physical disabilities
  • have mental health challenges such as depression or anxiety

One of the most powerful influences on body image is comparisons.

In and of themselves, comparisons are not bad. In fact, we’re hardwired to compare ourselves to others. Our species has survived in part due to comparisons.

However, our ancestors did not have social media. Unfortunately, social media, and Instagram in particular, negatively influence a tween’s body image.

The negative impact is intense. Especially because tweens are bombarded with computer-enhanced images of bodies that are impossible to attain. The messages easily convince tweens that they’re flawed and need to improve upon their imperfections.

Parents influence tweens’ body image too.

As parents you have more influence than you may realize to help tweens with body image, no matter their size or shape.

Some of the ways you influence your tweens’ body image:

1. Role modelling. Be aware of the example you are setting.

Tweens watch you and your choices, even if they roll their eyes and seem to be annoyed most of the time. They are aware of your attitudes toward your body, even if they don’t comment. If you often criticize the size of your belly, for example, they are more likely to be critical of theirs.

2. Feedback. Be positive. Or at least neutral.

Critical remarks about your teen’s body are damaging. Comments only make them feel more down on themselves.

3. Teach media literacy.

Help tweens learn to be wise consumers of what they see and read in magazines and online. Definitely teach them about filters, photo edits and other tricks that fuel the beauty culture.

4. Emphasize interests and pursuits.

Encourage your tweens’ interests in whatever they show interest in. Maybe it is community service, music, sports, arts, or something else? Focus on their efforts rather than on the outcome.

Body image, the relationship tweens have with their body, is important. Their body image is a function of many factors. As parents, you’re among the most powerful of all influences. Keep communication open with your tweens so they can talk with you about the ups and downs in their life. Remember, your tweens are paying attention to what you say, and to what you communicate through your own behaviors and comments.

I am an anti-diet clinical psychologist in the Boston area, specializing in helping people of all ages improve their relationship with body. To learn more about how to support your tween during the turbulent tween years, please contact me.