Suicide prevention and awareness is an important topic that carries discomfort and stigma. As of 2020, suicide was the 12th leading cause of death in the United States and it is becoming more widespread. These statistics do not include people who had suicidal thoughts, identified a plan of action, or attempted suicide. Suicide is often preventable.  In this post, there will be information on suicide myths, tips on how to cope with suicidal thoughts, and how to respond when someone you care about is experiencing suicidal thoughts. As they say in sports, the best defense is a good offense. While it is uncomfortable at times to talk about suicidal thoughts, knowing how to prevent, respond, and avoid a recurrence​ of suicidal thoughts/behaviors is so important. 
   If you are experiencing thoughts of hopelessness and/or suicide, ask for help via crisis hotline, health care provider, or hospital. Having suicidal thoughts does not result in automatic psychiatric hospitalization; all professional services are intended to offer help, keep you safe, and avoid a disastrous and potentially permanent outcome. 

This is a short video talking about what I am currently doing for self-care. I hope that it encourages you to consider small ways that you can include self-care in your lifestyle! 

The National Institute of Health reports that approximately 21 million adults or 8.4% of all adults in the U.S. had depression in 2020. Of these 21 million adults, an estimated 66% received treatment. For decades, the common theory for the cause of major depression was low serotonin levels or a ‘chemical imbalance.’ A recent study from the University College London (Moncrieff and colleagues, July 2022) reviewed existing research literature and concluded that depression is not caused by low serotonin levels. While these conclusions are based upon the prior research findings of others, this article has become a hot discussion topic on social media and news. The conclusion that serotonin does not cause major depression is relevant because it suggests that SSRI/SNRI antidepressant medications such as Prozac (Fluoxetine), Zoloft (Sertraline), Celexa (Citalopram), Cymbalta (Duloxetine), and Effexor (venlafaxine) may not be the ideal treatment for major depression and depression symptoms. We need clarity on these confusing findings! In this post I will review the University College London research findings, depression treatment best practices, and my clinical practice findings on these topics. 

I hoped to write a blog on perfectionism and wanted it to be perfect.. er.. awesome, helpful, and useful. While revising this blog post, I did a simple google search on "thoughts of a perfectionist" and found over 44,000 articles in the search, related to this topic. When I narrowed down the search to the last 3 years, there were still at least 10 pages of search results. This led me to wonder, why is it that perfectionism still continues? Why are there individuals with anxiety and/or low self-esteem who aren't looking to change these thought patterns? Research does show a relationship where there is a greater likelihood for perfectionists to experience anxiety, test anxiety, eating disorders, depression symptoms, low self-esteem, sleep difficulties, and suicidal thoughts. However I believe that perfectionists don't exactly see these patterns as a "problem" or something that they can really fix even if they wanted to. They may not be aware that it is an issue. So how might a perfectionist proceed? How can friends/family be supportive?  

Hi Sequoia Counseling Friends,
   This blog post is part 2 of a series addressing self-care approaches to managing job burnout. If you did not see the first video or blog post on job burnout, I recommend watching/reading them first. This blog covers additional coping strategies from Acceptance and Commitment Therapy (also known by the acronym “ACT”).  ACT is considered a third-wave treatment approach (CBT is part of the second-wave) that includes mindfulness, cognitive behavioral therapy, and an emphasis on behaving in ways that are consistent with one's values and beliefs. If you are new to ACT (or even if you aren't), these strategies will provide a fresh look and new approach to stress and burnout management. 

Hi Sequoia Counseling friends, today's blog post is about job burnout. I've noticed that social
changes are impacting how we work and how we view work- these changes can be stressful and increase chances of job burnout. In this post, I start with a clear definition of "job burnout." From there I will talk about the effects, why it occurs and what maintains it, and some possible solutions. Are you ready? Let's go... !  

"What Is the Best Approach For Someone Living With Multiple Health and Mental Health Conditions?"
Often times serious and ongoing health and mental health conditions occur together and impact one another, as in the case of type 2 diabetes and major depression. What is the best approach when multiple complex diagnoses are present? A recent online article shared recommendations presented at the Obesity Medical Association Spring Conference by Nowreen Haq, MD. 

   Do you ever find yourself behaving in ways that deviate from social norms, traditions/values, or personal expectations? Have you ever felt disappointed in the outcome of a task or project and come down hard on yourself in spite of the time, effort, or money you put into it? One of the negative thoughts that we might have in these situations, are "shoulds"; as in, "I should have known", "I should have been more careful", etc. When these types of thoughts result in negative feelings and become habitual responses they can be trouble. Excessive and habitual shoulding on yourself is associated with the weakening of your confidence, indecisiveness, worry, and feelings of guilt, self-doubt, and fearfulness. If you are sensitive to feeling shame or grew up in an environment where shame was used to control behaviors, you  might have a tendency to evaluate yourself and your performance using "should statements".
     “Should statements” (also referred to as "must statements") refer to private thoughts we have to ourselves about past or present behaviors that we didn’t do, but should or ought to have. This is not the same as using “shoulds” in planning (eg “I have a free hour tomorrow; what should I do?” or, “I need help; who should I call?”). Psychologist Judith Beck described these thoughts as “precise, fixed ideas of how you or others should behave and you overestimate how bad it is that these expectations are not met.” Her example of an unhealthy use is: “It’s terrible that I made a mistake. I should always do my best.” 

     We learn some unhealthy thought patterns from observing others. Thought patterns can also develop as part of low self-esteem, or depression/anxiety symptoms that then become unhealthy habitual ways of thinking.
     Next time you catch yourself using “should” statements, consider why you didn’t choose to behave/perform in an expected or desired way. For example, perhaps there were too many things going on at the time or other circumstances affected the outcomes beyond your control. Choose to exercise self-compassion and acceptance. Remember that errors happen, and more than likely the outcome that happened isn't literally "the end of the world." We all have room for learning, growth, and grace towards ourselves and one another.  

     Thank you for reading along!    <3 Be well!  

I look forward to my future posts this summer on perfectionism and high standards, which is related to should statements. 

Pain is an experience that can describe how we feel physically and emotionally. From a physical standpoint, we think of pain as something bad that we want to avoid. If the pain is really bad, we might think of it as “suffering.” These ways of thinking about physical pain apply to emotional and psychological pain.

Pain is a needed experience because it is the mind and body’s natural way of letting us know that something is not right or that we are being harmed. In other words, the purpose of having an alarm such as pain informs us that an action needs to be taken. Pain can also be a sign that further investigation is needed (and action may not be necessary or appropriate). Ignoring these safety “alarms” can lead to future problems with recognizing when something is not right physically or emotionally.

If you are having thoughts about harming yourself or others, please do not wait to get help. Talk to your doctor, a therapist, or a crisis hotline.​

This video post explains how unproductive worrying and unhealthy ways of managing stress can contribute to health problems. I provide examples of how these behaviors can affect women's health, (men's health is also impacted). I finish by sharing different ways to respond when worried and anxious. <3 Be well !

A common concern I hear from patients is how to manage feelings of loneliness. These feelings result from seasonal changes and a desire to do activities again. People want to have fun things to look forward to! People want to have good friends to enjoy life with!

Paul MacLean said, “A sense of separation is a condition that makes being a mammal so painful” to reflect our need for social connection. If you are someone who is in need of friends, is interested in making or deepening social ties, keep reading! This post will explore barriers to finding and making friends and review professional advice on how to make forward progress and connect with others. 

Hello Sequoia Counseling community! I have seriously been missing in action from blogging the past few weeks (months?!) as things have become rather busy. Today I wanted to be a little more simple and less academic in my post. Here are two personal reflections or lessons that I would like to share at this time.​

​From the moment I became an independent adult, it seemed like time was flying by- with each year passing faster than the last. I began to reflect on how to make time slow down for the enjoyable moments and how to lengthen and create times for relaxation and renewal. On this note, researchers are studying how people spend their free time and how it affects their sense of well being and enjoyment in life. How can we take care of the things that matter and still have time to enjoy our lives?

​In their research, Sharif, Mogilner, and Hershfield (2021) discuss how many people experience this idea of “time poverty” and a sense of unhappiness due to stress and having too many things to do and not enough time. They wanted to study if having a significant amount of time to do whatever we wished would actually result in greater happiness and wellbeing.  

Are You Thinking About Stopping Your Antidepressant Use? 
   Approximately 13% of Americans 18 years and older reported taking antidepressant medication in the past month (NCHS Data Brief, August 2017). Antidepressants (commonly referred to as SSRIs or SNRIs) are typically prescribed for the management and treatment of depression and anxiety disorders. Depending on the type of healthcare professional and their experience, the first line of treatment for depression and anxiety is psychotherapy, medication, or some combination.  Approximately 40% or more of persons using antidepressants in one study discontinued their antidepressant medication too soon (Olfson et al, 2006). A successful treatment response includes improvements in duration, frequency, and intensity of symptoms; relationship satisfaction; initiation and completion of important daily activities; and improved physical health such as diabetes control, sleep quality, and pain perception.  As depression and/or anxiety symptoms improve, patients start thinking about weaning off antidepressant medication.  ​

What’s going on, Sequoia Counseling community! I am in a great mood today because it is the 4th of July holiday weekend ! This is a time to celebrate our country and the freedoms and gift we have to live here. As I think about the concept of independence, I also think about our ability to live independently, without relying upon the care of others. What can we do to live our best lives and prevent future health/mental health issues? The answer is to develop lifestyle habits that target your whole person health!
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A 2009 study of 23,000 adults found that basic life habits such as eating healthy, not smoking, exercising 3.5 hours a week, and maintaining a healthy weight resulted in an 80% reduction in chronic disease! Specifically, the researchers concluded that 93% of diabetes, 81% of heart attacks, 50% of strokes, and 36% of cancers would be prevented! That is amazing news! 

One of the most common emotions we experience as we emerge from the pandemic is anxiety. Psychologist Dr. Ellen Hendriksen comments that anxiety is particularly triggered by the high levels of uncertainty we face- uncertainty about vaccines, society reopening, new normal workplace, and the COVID-19 virus and variants. 

I also believe that a high level of anxiety comes with the unfinished business that we had pre-pandemic. What goals, decisions, or projects were put on hold? What conversations and relationship growth were avoided, stunted, hindered, or forgotten due to relational distancing? Perhaps old depression or anxiety symptoms are re-surfacing with thoughts of returning to pre-pandemic living. To be certain, the pandemic and its effects had a depressing and anxiety provoking effect on some level for everyone. How can we best thrive in this new phase?  

​Eating is a common coping strategy in response to negative emotions such as sadness and stress. Many times we choose foods that are high in sugars, salts, or saturated fats. Emotional eating can become a habit whenever life gets tough. In the chapter, “Eat, Drink, and Be Sedentary,” Epel and others (2018) ask the question, “Does eating behavior have consistent effects on changing emotional experience?” In this blog post, I will review their findings and offer comments and recommendations. 

Sleep deprivation over time can result in physical and psychological conditions. In “Eat, Drink, and Be Sedentary”, the authors share what they learned after reviewing research on how these behaviors influence our moods and coping. This post will review their findings on the effects of sleeplessness upon mood. I will discuss the short-term risks and consequences and explore at what point sleep problems become “real problems.”

   ​We are familiar with the idea that emotions (such as stress) can influence our behaviors, such as leading to an increase in eating junk food or binge watching shows on Netflix. But how do health-related behaviors such as physical activity, eating, and sleep impact our emotions? In “Eat, Drink, and Be Sedentary”, the authors share what they learned after reviewing research on how these behaviors influence our moods and coping. I hope this blog post will share new information that will help readers be more self-aware and encourage healthy habits.  

​Healthcare providers and staff, essential workers, and caregivers have demanding jobs and at times high stress levels. These elevated stress levels affect our ability to engage in healthy coping behaviors. Not only do we lose energy and motivation for healthy behaviors, we tend to engage more in unhealthy behaviors. This of course can be problematic over time. What are some manageable ways to develop healthier lifestyle practices? By prioritizing our wellness (our physical, psychological, and spiritual health) - we can prevent breakdowns in our physical/psychological health and functioning and increase our effectiveness in daily our roles. 

​Life during 2020 has been very challenging. We were forced to make changes to our routines that we weren’t expecting, we experienced significant losses, and we continue to live with unnatural, difficult, and scary circumstances that are in many ways beyond our control and without a clear end in sight. Researchers are studying how people around the world are thriving and preventing problems with depression, anxiety, stress, alcohol abuse, etc. that are becoming more common due to the pandemic, its effects, and coronavirus or health-related worries. How do people successfully cope? 

Life during and after the COVID-19 pandemic created so many different emotional reactions, including disappointment, fear/anxiety, and frustration. Under normal circumstances, when we strive for growth, change or achievement, we may encounter challenge and adversity. With the COVID-19 pandemic, maintaining normalcy and stability and just surviving was difficult. Whatever your current circumstance, here are some ways to cope with the lasting effects of the pandemic. 

As a therapist that takes a lifestyle medicine approach, I believe in helping you be as healthy as you can be. Diabetes is a common chronic illness which can be prevented. A UCLA study (2016) found that nearly 50% of California adults, including 1 out of every 3 young adults have either prediabetes or undiagnosed diabetes. Another 9% of adults have a diabetes diagnosis.  In this post, I share general tips and resources on how to protect yourself and loved ones from chronic illness and how to develop a healthy workplace culture. 

Life during the COVID-19 pandemic brought challenge and change. The unexpected and (seemingly) endless effects of the global pandemic also resulted in great uncertainty, fear, stress, pain, and worry. Since the pandemic has become more endemic in the U.S., do  you feel that time is moving faster, slower, or the same as before 2020? As time passes by, we may have a sense that  there's not enough time to do everything we need and want to (which can add to stress and feeling discontented). How can we avoid these time pressures and feel satisfied with the moments we live? For this reason, I want to offer 3 ways to continue building hardiness and resilience (in other words, the ability to remain calm in the face of crisis and recover quickly) so that stress levels stay manageable and not overwhelming.