“There is no doubt that I have lots of words inside me; but at moments, like rush-hour traffic at the mouth of a tunnel, they jam.” -John Updike, writer (1932-2009)

Although the external causes of a roadblock are clear, the internal causes of this same type of block often boggle the mind. Tension builds, the mind freezes, the chest tightens and a situation much more frightening than the tunnel jam occurs. Elizabeth Gilbert talks about how our obsessions with our own utterances build up pressure crippling our ability to free flow in a variety of creative outlets. Even the ability to brain/idea storm is plugged creating frustration and fear.

As we are advised by many famous writer’s, “you are not alone”, and truly you are not. Suggestions abound in how to treat this ubiquitous experience such as take a shower, take a break, do something else, take a walk, a jog, run a marathon. Mixed results are reported by users.

Elkhonon Goldberg discusses the relevance of “Executive Functions”, those higher-level thought processes that control our ability to plan, initiate, sequence, organize, pace, sustain behaviors towards defined goals, all helpful sounding structures for creating, right. The prefrontal cortex, where this function resides also has the ability to imagine beyond the present moment into the past and into the future, or in other words to maneuver in the fourth dimension of time, the arena of story telling or putting disparate elements together in some coherent way.  Sounds like writing.

Executive Dysfunction is a disruption in the efficacy of the internal manager, thus interrupting the ability to plan and execute tasks. Russell Barkley describes this dysfunction as the inability to suppress a present behavior in favor of the past/present task of executive functions, checking emails rather than working on that next chapter perhaps. Disorders such as ADD and OCD hallmark executive function disabilities that make organization, focus and prioritization difficult with the similar result of an inability to complete the task at hand in favor of getting lost in repetitive or distracting tasks.

Writer’s block has been defined by Merriam-Webster as “psychological inhibition preventing a writer from preceding with a piece.”  A debate exists between those who define this process as the inability of a writer to think of what to write or as a cognitive obstacle, a block, that prevents the ability to move further in the creative process.  However, the result is the same, the lack of ability to create some desired result.  And the repeated occurrence of this struggle can result in decreased motivation, avoidance behavior, anxiety and depression.

Patricia Huston MD defines writer’s block as “a distinctly uncomfortable inability to write”, an understatement perhaps for those who experience it. A combination of uncomfortable feelings such as fear, disappointment, hopelessness, or frustration and distressing or distorted thought patterns of magnification, self or other blame, fortunetelling, or seeing the glass as half full trigger, exacerbate and maintain this condition. They mix together and fuel a spiral from a temporary state into a more chronic problem. One’s perspective narrows and the inner critic is fueled into power resulting in a cycle of self punishing talk interrupted by avoidance behaviors, in other words getting caught in all of those less important activities that can consume a moment, an hour, a day. The internal struggle intensifies and worse yet, nothing gets accomplished.

As stated, many suggestions and tips are out there, methodologies to address writer’s block that are quite helpful exist. Within this tendency to block creativity appears to be a deeper understanding of how to step into the flow of the creative when the desire or need to create is present. How to allow rather than impede stepping into this river of inspiration and movement is an ongoing inquiry for anyone who engages in this process.

I suppose those who are successful have found their own understanding of their very personal creative ebb and flow. Perhaps they discover a rhythm of the necessary and unnecessary to live some balance that keeps the minor block from becoming a major one. Rivers find their way around stones in their path. Artists find a way to work with or around the blocks that they encounter along their path of creation. Perhaps in the process of recognizing possibility within limitation, resolution results in taking a path that is just a little more human in what is frequently a super human endeavor.

“When we honestly ask ourselves which person in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares.”
? Henri J.M. Nouwen, The Road to Daybreak: A Spiritual Journey

I woke up thinking about the kind of friend I am and the kind of friendship that I offer to those closest to me.  What kind of friendship I offer clearly depends on the type of person I am but also on the level of openness about who I am being. I remembered Dr Art Hardy who developed one of the first anxiety treatments for agoraphobia. He determinded that there are six types of personalities who can interfere with an anxiety sufferer’s recovery in the type of care they offer. These types easily translate into how we show up in relationships and friendships and made me start thinking about how they would apply to the kind of friend I can be. You may recognize yourself or others in the kind of care you offer or receive in your friendships, how these type tendencies can creep in and take over and send the course of your friendship in an undesired direction.

The types are:

1. Overly Capable

2. Overly Domineering or Dictatorial

3. Overly Protective

4. Overly Critical

5. Overly Shy or Inhibited

6. Overly Objective

Recognize yourself yet? Asking where am I being too capable, too domineering and so on can help to clarify this tendency. Here’s some more information on each type.

The Overly Capable person believes in their skills and capacities but frequently to the detriment of the other person. They believe in their capacity to handle a situation, fix whatever problem occurs, do more and more and take over more and more in the relationship.

The Overly Dictatorial person wants to dictate and control what happens, dominate the decision-making process. They believe it’s their way or the highway and may infantilize the other person in the relationship, asserting their dominance.

The Overly Protective person responds too readily to the needs of the other. They are over solicitous and  over protective in their care of the other person. They try to protect the other person from the consequences and outcomes of decisions they are making or behaviors they are choosing.

The Overly Critical person criticizes, puts down or ridicules the other’s limitations and weaknesses. Their standards are high and the other person knows it.  Their derisive communications may be overt or covert, expressed sarcastically or expressed under a veneer of friendliness.

The Shy or Inhibited person holds back or may not even recognize their feelings in a relationship. They frequently play an invisible part in the relationship, are non expressive and allow the other person to fill up the relationship space.

The Overly Objective person is just that – overly objective, rational or logical. They apply reason and logic in the relationship without expressing understanding, empathy or compassion for the other person or what they might be experiencing.

Each type affects the relationship in different ways, increasing or decreasing behaviors in the other person.  The result can be imbalance, stress, resentment, under functioning, low self confidence, poor communication and many more problems for the friendship or relationship. Each type is an example of inauthentic care, or care that has a hidden or not so hidden agenda such as control, competition or power. These agendas undermine trust, intimacy and love and replace an authentic bonding process in the connection.

At times taking the above stance in a friendship may be appropriate and needed. In stressful times, taking a stronger approach may be helpful. Clearly a case of a little bit goes a long way, too much of these patterns tends to create a rigid and stressful friendship based on inauthentic care.

Authentic care is freedom of agenda, approaching the friendship with transparency about one’s motivations and priorities. We’ve all learned inauthentic care.  I see it occurring on a regular basis and am slowly learning the tremendous satisfaction of living a life based on authentic care, a freedom that I give to myself and others in the process.

In being up front about the above agendas, we escape the trap of becoming entrenched in them.  Acknowledgement of our vulnerabilities to the other creates a window through which a fresh kind of connection can occur. It’s like a vibrant breeze blowing through the friendship, taking out the old and bringing in something new and precious and alive. It’s both tantalizing and surprising and creates a way of relating that is exciting and creative and full of possibilities.

Your body can produce most of its Vitamin D from sunlight if there is enough.

Vitamin D supplementation is being used to increase longevity, build bones, strengthen the immune system, lower the risk of diabetes, heart disease, kidney disease, Celiac disease,  Depression, Panic,  Seasonal Affective Disorder (SAD), Tuberculosis, Multiple Sclerosis, high blood pressure, cancer and even to fight flu and colds. Research conducted in the past decade suggests that vitamin D takes a more important disease-fighting and preventative role than was once recognized.

Vitamin D deficiencies are more prevalent than previously known. If you live north of  San Francisco, Philadelphia, Rome or Beijing,  chances are that you are not getting enough vitamin D. If you do not get at least a 15-minute daily walk in the sun, are African-American or have dark skin, are elderly, are obese or overweight, or are an adolescent  you are at risk for having lower levels of vitamin D. It has been estimated that worldwide up to one billion people  have a Vitamin D deficiency or insufficiency and the further from the equator you live, the more likely you will be D-ficient.  The elderly have a reduced capacity to synthesize Vitamin D in the skin. Sunscreen reduces the skin’s capacity to synthesize this vitamin by up to 95%.

Regardless of cause, vitamin D deficiency has significant consequences, both medical and psychological. Vitamin D receptors are located in every tissue in the body, and needed  in every bodily function including the heart, brain, muscles, and immune system.

Hundreds of years ago, “Vitamin D” was misrepresented when it was first discovered. By definition, it is not a “vitamin”.  Vitamins are not produced internally, they must be obtained externally from either supplements or dietary food sources. Vitamin D is actually  a hormone. After consumption or skin absorption, Vitamin D is converted to its active hormone form in the liver and kidneys.  As a hormone, it aids in the absorption of calcium used to build strong bones, teeth and muscles and many other bodily functions. When skin is exposed to  ultraviolet (UV) radiation from sunlight, a form of cholesterol in the skin is converted into a precursor of Vitamin D, called “cholecalciferol”. This is the form of vitamin D measured in tests.

Vitamin D controls  between 0. 5% and 5% of the human genome, activating the regulation of the immune system through upregulation or downregulation, by increasing or decreasing  the protein that genes transcribe. Recent research on Vitamin D and gene regulation found that  the gene pathways influenced by Vitamin D intake controlled vital functions in the body such as the immune function, DNA regulation and repair, and cellular response to stress. The D hormone has also been shown to affect brain function and brain development through the controlled release of neurotransmitters such as dopamine and serotonin.

In areas of the brain associated with depression, Vitamin D receptors have been identified. Seasonal Affective Disorder, which is a mood disorder accompanied by symptoms of depression, increases in likelihood with lower sunlight at darker times of the year. It has been linked to lowered levels of Vitamin D which may also affect serotonin levels in the brain.

Vitamin D deficiency and insufficiency are both highly prevalent in adolescents with severe mental illness and depression.  The Vitamin D Council concludes that

According to a recent review, treating vitamin D deficiency in people with depression or other mental disorders may result in improvement in both long-term health and quality of life. Reports confirm that vitamin D has a positive affect on depression:

Women in Washington State increased their vitamin D levels to 47 ng/mL (118 nmol/L) by taking 5000 IU of vitamin D each day during the winter. In some of these women, their depressive symptoms lessened as indicated by the decrease in their scores on a depression test.

Your body has a mind of its own during a panic attack. A built in fight or flight alarm mobilizes the body to react in an extreme fashion to neutral and sometimes indeterminable triggers. Psychological rather than physical dangers become threatening. You perceive a situation as overwhelming and your body reacts. An argument with your boss, going to a party, driving in a new area, or virtually any situation is seen as dangerous and can lead to a sudden episode of extreme fear and apprehension.

Panic Attacks are a type of anxiety disorder.  They are characterized by out of the blue, recurrent episodes of extreme fear and apprehension.  Fear of death, loss of control, or illness, or more generally fear that something bad will happen accompany these attacks. The attacks can last a few moments or can continue in waves over a few hours. It is estimated that 10-15% of the population experience panic attacks occasionally with about 2% developing a panic disorder.  These panic disordered individuals begins to avoid circumstances that remind them of the prior panic attacks.

The causes of  these frightening attacks are not clear.  Genes appear to have some influence as twin studies show at least a 40% likelihood of occurrence. There are numerous factors that contribute to their onset including biological triggers, environmental triggers, childhood triggers and an accumulation of stressors. Both nature and nurture converge to launch an individual into this pattern. A combination of predisposing factors which occur biologically, environmentally or in lifestyle contribute to the development of  this condition.

Panic attacks occur in the area of the brain called the amygdala which is the fear center of the brain. This area becomes over activated during a panic attack.  When people experience stress, the sympathetic nervous system mobilizes quickly, energy is released and the body prepares for action to cope with predators or other survival threats. When the parasympathetic system , whose job is to to calm the body down, is unable to cope with this sudden arousal and stabilize the body, the individual may experience the heightened arousal state of panic where feelings of choking, a heart attack, fainting, going crazy or dying erupt.

These episodes of panic usually occur rapidly, abruptly and intensely. The adrenals release a large amount of adrenaline which revs ups the body leading to feelings of dread or terror. An individual experiences shortness of breath, excessive sweating, cold hands and feet, shaking or trembling, dizziness, contractions in the chest and throat leading to a sensation of being unable to breathe. The body is jolted into preparation to run or fight even though muscle contractions activated by the sympathetic nervous system can trigger a freeze response and a sense of immobility.

The panicked body triggers a change in breathing which affects carbon dioxide levels in the blood. The amount of carbon dioxide in the body accumulates building up quickly and activating a terror generating system in the body. Carbon dioxide experiments at the University of Iowa indicate that not all individuals with these imbalances in the body experience panic. For those that due, the panic feels unbearable.  Those with panic attacks appear to be more sensitive to carbon monoxide inhalation than those without the condition.

Hyperventilation occurs if you over breathe or breathe through your mouth either causing panic attacks or contributing to them through the aggravation of physical symptoms. The body increases in alkalinity resulting in feeling jittery. The level of carbon dioxide decreases and causes your heart to pump harder and faster. This can  result in lights appearing brighter or sounds appearing louder. Brain vessels constrict  and decrease the amount of oxygen that gets to the brain resulting in dizziness, disorientation, or a sense of unreality.

Due to the multi causality of panic attacks, a multidimensional approach to dealing with them is appropriate.  A few effective approaches include:

1. Reevaluate breathing patterns: Although conventional wisdom has recommended deep, slow purposeful breathing techniques for coping with panic attacks, current research is suggesting something different. Breathing shallowly, as though sipping air, can reverse shortness of breath, dizziness and other panic attack symptoms. Breathing slower and shallower can feel strange at first as though you are not getting enough air. Treatment modalities are available that employ objective mechanical feedback on the level of oxygen in the blood as you get used to this new type of breathing. The daily practice of 15 minutes of breathing twice a day is recommended to develop good breathing habits. There are many other types of breathing whose goal is to regulate the breathing pattern and slow the breath. Practicing these techniques when you are not anxious is of great benefit.

2.Do regular exercise: Exercise contributes to a reduction in muscle tension and stress and therefore all types of anxiety. There is growing evidence that  developing an enjoyable exercise regime that incorporates light aerobic exercise 4 times per week can reduce both anxiety and panic. Exercise has been shown to enhance mood, improve sleep quality, reduce physical and mental tension and improve energy levels. It can reduce stress hormones implicated in the development of anxiety symptoms, produce mood enhancing chemicals such as endorphins which regulate stress reactions in the body. It decreases anxiety sensitivity which is an individual’s sensitivity to the symptoms of stress. Research also indicates that exercise reduces the intensity and frequency of panic attacks.

3. Streamline your diet: Identify and eliminate food triggers through keeping a food diary. Certain foods appear to contribute to either the likelihood of anxiety or the intensification of the symptoms of anxiety or panic, decreasing sleep quality and increasing panic attack frequency. One of the biggest culprits is caffeine. It can trigger feelings of nervousness, irritability, anxiety and panic. Sugar can also lead to panicky feelings in the body.  Research indicates that heavy sugar consumption followed by abstinence can cause a dopamine imbalance that can increase anxiety. Other studies indicate that sugar consumption can affect the body’s ability to fight anxiety. It can cause mood swings, agitation and blood glucose irregularities which can all contribute to anxiety. Monosodium glutamate, a flavor enhancer, can cause dizziness, sweating, nausea and panic attacks. Observing and keeping track of your own reactions to what you eat and drink can assist in deciding what to increase or decrease in your diet to reduce anxiety symptoms.

4. Alcohol: Although many people drink alcohol as a way to calm down and relax, it can increase anxiety.Alcohol consumption causes blood sugar fluctuations and a build up of lactic acid which can increase agitation, stress, and anxiety. Limiting intake can be an effective part of an anxiety reduction program.

5.Observe, problem solve or distract: Catch your symptoms at an early stage: Although panic attacks appear to come from out of the blue, research indicates that changes in  physiology occur about an hour before a full blown attack. Recognizing your own anxiety warning signs and developing a constructive response can alleviate or minimize symptoms. Exit a situation that is increasing tension until the symptoms subside. Talk to someone to distract yourself and to decrease the extra stress that comes from trying to hide the anxiety. Remain in the present moment by noticing the details of external objects preferably using your other senses such as smell, touch and hearing. Use your ability to focus and concentrate on an activity such as a game, planning your day’s activity, solving a puzzle, or counting backwards by 3. Move to a different area.  Go outside or to a different room. Practice breathing along with coping statements such as I can ride through this, all is well and this too shall pass.

Seeing a physician to rule out any physical causes for your symptoms or to discuss the possibility of a short term course of medications is a good initial step to take in beginning your treatment  for panic attacks.  It is a treatable condition.  Many options for treatment are available and can be successful in ameliorating symptoms and in developing a panic free lifestyle.  The right approach can result in much needed relief for this condition.

Anxiety is the number one mental health issue for American women according to the National Institute for Mental Health and the number two issue for men after addictions. Only a small percentage of those with this condition receive treatment despite the fact that over 40 million adults suffer from it.

The average person experiences some worry over everyday concerns such as finances, health, work, relationships, or abilities. The anxiety sufferer experiences constant fear and preoccupation with these issues, and avoidance of situations that might trigger further anxiety arousal. The anxiety can range from a mild disturbance to a full blown panic attack.

Why does anxiety seem to be on the rise? Stressors and the resulting stress experienced by the general population has been on the rise in the last 50 years. Americans report an increasingly uncomfortable level of stress in their lives. The pace of life is rapid, the time to adjust and accommodate to changes is diminished.  Different sources estimate that anywhere from 50 – 90 % of adults conclude that they are experiencing stress in at least one area of their life. A period of stress usually precedes a bout of anxiety.

Stress is an arousal response to a situation, distress.  Anxiety is a reaction to the stress response, that includes worry, nervousness and panic. Stress is defined as emotional, physical or mental strain usually precipitated by an external situation or event, a stressor.  Anxiety is a subjective state of tension or uneasiness whose source is unclear, where the focus is internal. When stressed, an individual may experience a gap between what is being demanded of him or her in a situation and the perceived resources he or she has available  to respond to the situation. When anxious, the danger may be unclear, the feeling  that “something bad is going to happen.”

Thoughts, feelings and behavior are affected by stress.  The physiological responses to stress include headaches, muscle tension, fatigue, changes in sex drive, sleep difficulties, chest pains, or digestive problems. Emotional responses include irritability, inability to focus, sadness, or tension.  Behavioral responses include an increase in addictive behaviors such as smoking or drinking, social withdrawal, or angry outbursts.

A major stressor can trigger anxiety. Anxiety affects the body, mind, and emotions and can range in severity from mild uneasiness to severe panic.  The anxiety sufferer gets caught in a worry cycle of constant concern about daily activities, exaggerated focus on possible dangers, or persistent apprehension of a catastrophe. Fears of dying, going crazy or loss of control are common.  The body responds with heart palpitations, trembling, shaking, nausea, dizziness, hot flashes, and shortness of breath. Concerns mount about facing one or more of the feared situations. This worry or anticipatory anxiety leads to persistent avoidance of situations that might trigger or worsen the symptoms.

Anxiety is an integral part of today’s lifestyle. Sometimes when anxiety  arises in response to a specific situation, it is a reasonable reaction. Events that have the potential for loss or failure are challenges frequently faced with some anxiety. The anxiety provoked in these types of situations can provide momentum for facing these situations with increased attention and preparation if it is manageable.

Situational anxiety is a specific type of anxiety that differs from fear in that it is unrealistic and overblown.  Fear of driving on freeways, fear of conflict, fear of dentists or doctors are examples of this type of anxiety. The anxiety has not yet progressed to the phobic stage where anxiety producing situations are consistently avoided but they still induce uncomfortable symptoms for the individual facing the activity.

Even thinking about a particular situation can create distress and uncomfortable physical symptoms.  This is called anticipatory anxiety.  It is on the severe end of the worry spectrum. Thoughts are persistent and have an obsessive quality especially when the sufferer is faced with the feared situation. Anticipatory panic is the label given to a  pattern of the the worsening and intensification of the anxiety symptoms.

These experiences make it difficult for the anxiety sufferer to experience a sense of stability in their everyday life.  Daily life becomes either mildly or extremely unpredictable. Completing everyday chores, work, or even taking care of oneself can become overwhelming. Sleep can be disrupted, as can relationships and careers.

Treatment is about coming home to to a more consistent and manageable response to work, relationship and life challenges. Recovery is about developing an increased ability to cope with the stressors that arise. Finding an internal sense of calm from which one can respond to life in a more relaxed, authentic way is the result of a clear, focused approach to the treatment of anxiety, not as just a collection of symptoms but as a treatable condition reflecting the individual’s lifestyle. Effective treatment addresses the individual, not just the body’s reactions.

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”  –Leo Buscaglia, author (1924-1998)

Suffering and pain are such a part of life, and yet our response to these states in ourselves and others is often ripe with confusion and discomfort.  How are we with the pain that occurs on a regular basis?  How present can we be with the discomfort in ourselves and others so that we can move to a deeper level, find resolution and relax into acceptance and being available to ourselves and others.

We tell ourselves we are fine and brush off the “I’m fine” in others in order to avoid a dialogue with ourselves or with them, or to avoid the possibility of moving into a deeper connection. We’ve all experienced a sigh of relief when we speak to someone and feel listened to and understood, as though we could sink a little deeper into whatever surface on which we sit, the jaw drops, shoulders relax, toes uncurl.  Superficial discomfort and confusion disappears.

Emotions, even the very painful, become less uncomfortable and  more tolerable, even if there is a temporary escalation in discomfort .  Suffering dissipates. Turning inward, observing from that same unconditional part of ourselves, totally present for the emotional reaction of current or past experiences, offers that same sense of being understood.  Taking a small step back from being overly identified with  thoughts and feelings offers an opportunity for the pain to loosen and let go.

Self-regulation is this relaxed alert state from which the embodied states of suffering can be calmly witnessed. Rather than judging, evaluating or pushing away these reactive feelings and thoughts, allow yourself to observe, soothe and calm these parts of you.  Make room for the feelings and thoughts you or others experience, for the the human experience.  Contain these feelings within a state of compassionate understanding.

See these experiences through the eyes of compassion and with the ears of understanding. And next time you see suffering in the eyes of another or sense suffering in the eyes of some younger part of you, take a breath, be present, and become part of the transformation process, offering a little kindness.   Move towards rather than away from the pain and watch calm replace fear and suffering.

You are experiencing increasingly disturbing feelings such as stress, worry, hopelessness, sadness, irritability, or guilt.  You are breaking out into a sweat, experiencing tingling in your extremities, have shortness of breath, feel faint or dizzy, or feel continuously weak and exhausted. You find yourself questioning whether you are exaggerating, physically ill, or going crazy. You wonder who to turn to for help and wonder if you should see a doctor, a psychotherapist, or go to an emergency ward.

It is often difficult to discern which course to follow to get the most accurate diagnosis and treatment for confusing symptoms. Certain medical tests can help to exclude medical conditions as the cause of your suffering. Although physical conditions may not be the sole cause of the discomfort you are experiencing, they may be a contributing factor in the development and depression of depression and anxiety symptoms.

Low thyroid function, or hypothyroidism, is the most frequently associated medical condition with symptoms of depression. Thyroid hormones control cellular activity in the brain and the nervous system. Symptoms of forgetfulness, fatigue and slowed thinking can occur along with physical discomfort such as coldness in the extremities, reduced body temperature, weight gain and constipation when the thyroid is not functioning correctly. A diagnosis of this condition is made through blood tests that measure hormone levels.  If treatment is necessary, daily supplementation of hormones can reduce much of the discomfort.

Anemia is another possible contributor to depression.  It involves a decrease in the number of red blood cells that carry oxygen.  It can result in drowsiness, fatigue, irritability, depression, anxiety, insomnia,  and difficulty concentrating.  Anemia is diagnosed through a blood panel and treated with supplementation.

Hyperthyroidism can cause both anxiety and depression symptoms such as edginess, irritability, insomnia, palpitations, sweating, exhaustion, and anger outbursts. Radiation, drugs or surgical suppression of the gland  treat this disorder.

Other conditions that can cause mental health symptoms include some of the following disorders.

*Cushing’s Disease, which involves a low functioning adrenal gland, can cause fatigue, nausea, impotence, decreased appetite and other physical problems.  Blood tests will determine if this illness is a factor in causing your symptoms.  Supplementation and other treatments are effective in controlling this disease.

*Hypoglycemia, or low blood sugar,  can cause symptoms of confusion, fatigue, faintness, sweating, and nervousness.  Blood tests determine if this is a factor in causing the symptoms that you are experiencing. Treatment recommendations include eating frequent meals and decreasing the intake of  simple carbohydrates.

*Central nervous system injury and illness such as stroke, multiple sclerosis, head trauma,  tumors, and some cancers are associated with depression symptoms.

*Medications can also trigger depression and anxiety.  Sleep medications  can cause depression, drowsiness, amnesia or forgetfulness.  Prednisone and cortisone can lead to restlessness, confusion, hallucinations, mood swings, and personality changes.   ADD medications  can cause anxiety, irritability and insomnia.  Seizure medications  can cause depression, irritability, fatigue, and mental slowing.  Allergy and asthma medications can lead to agitation, insomnia, nervousness and drowsiness. Anxiety medications have the possible side effects of insomnia, depression, mental slowing, and confusion.  Antidepressants  have the possible side effects of irritability, insomnia, and agitation.   Beta blockers  can cause fatigue and insomnia.

Although this is only a partial listing of possible diseases or medications that can cause mental health symptoms, a physician can help you in determining the diagnosis of possible physical conditions and in assessing the proper use and dosage of any prescribed medication.  A medical professional can also assist you in assessing possible nutritional deficiencies, sleep problems, food allergies or other physical problems that may be contributing to your mental health condition.

A psychotherapist can work with you to reduce your mental health symptoms and to reevaluate any lifestyle factors which are contributing to your mental health condition.  A combined medical and mental health evaluation will offer you a more complete picture of  the factors that may be contributing to your discomfort.  This can result in developing a more effective treatment plan for your symptoms.

In the process of searching for the owner of a lost dog in the neighborhood, a 4 pound pomeranian who had run off and joined a walk with some large rather tough looking dogs, I received several calls from distraught owners of lost animals hoping that somehow we had found their pet. They had seen the sign or the Craig’s List ad and hoped we had found their animal companion. I was reminded when talking with each of them of the many people who are suffering, probably silently, in some stage of grief and loss during this festive season. I was reminded of how difficult it can be to celebrate the holidays when sad and when missing something that was beloved in life.

Holidays don’t take away these grief experiences  In fact they can heighten the experience, emphasizing what is missing or absent. Distraction can temporarily alleviate the pain of loss but invariably something brings the loss back to mind. The holiday expectations of happiness and joy, of companionship and family, often act as a hard backdrop to the realities of changed circumstances involving loss that have evolved in many people’s lives.

Intense grieving can last from three months to a year after a loss and frequently continues for several years. Emotions need attention, understanding and compassion during this period in order to be processed and integrated. Giving oneself kind attention calms the often painful feelings of sadness or anger or emptiness. Making some formal expression of remembrance, giving a donation, planting a tree, planning a memorial, can help to create a positive context for the loss. Allowing grieving space in amidst the festivities can help to soothe uncomfortable emotions.

Although there are different theories about grief, there is no right or wrong way to grieve. Finding a balance between grieving and continuing on with a productive life after the initial shock of a loss will aid in incorporating loss into life. Loss is part of our life and part of what make us cherish what we hold near and dear to our hearts.

One of my favorite poems emphasizes the importance of developing this capacity in our lives, this capacity to lose. Elizabeth Bishop describes this as the “art of losing.” What better way to describe this valuable life lesson and challenge, this truth about living.

“Do everything with a mind that lets go. Don’t accept praise or gain or anything else. If you let go a little you will have a little peace; if you let go a lot you will have a lot of peace; if you let go completely you will have complete peace.”  Ajhan Chah

Each day we faces challenges, novelty, adversity, conflict and the resulting feelings of discomfort, uncertainty, fear and frustration. We easily get stuck in either our focus on the events, the people involved or our reactions to them. We get caught in the merry go round of thoughts or feelings that are triggered and lost in the resulting internal chaos. We end up holding on to situations that neither warrant our attention or our focus.  Our moods are affected, our concentration is interrupted, our ability to be present to those around us impacted and our behavior is not what it could be.

Each of these situations offers us the possibility of seeing the situation and our reaction for what it is and letting go.

How do you let go of something that is bothering you or that is an obstacle to happiness? Do you feel irritated about mistakes or behaviors that fall short of your expectations and go over them again and again in your mind? Are you worried about how someone has reacted to what you said or did and can’t stop thinking about it? Are you facing situations where you feel a lack of control or feel powerless and worry constantly? Are you having difficulty letting go of unproductive thoughts or behaviors?

When uncomfortable or unpredictable life events occur, how you react determines the possible emotional and psychological fallout from the situation. If you have grown up with erratic individuals  or unstable circumstances, there is a stronger likelihood that your response to stressful occurrences will be to increase attempts to control yourself and your surroundings. Moving a lot, alcoholism, or changing schools repeatedly in childhood contribute to the development of feelings of vulnerability and can contribute to the development of maladaptive behaviors, coping mechanisms or styles of control. This can sabotage the letting go process.

The habit of controlling uncomfortable feelings interferes with learning to acknowledge, process, and let go of the feelings themselves. Frequently these attempts to control are rigid and ineffective. Unrecognized or discounted feelings, especially when combined with attempts to control, can fuel severe anxiety or a tendency to hold onto things rather than let them go.  Situations as mundane as missing a stoplight, getting the wrong change at the cash register, or waiting for someone who is running late can provoke an excess of anger and stress. When unrecognized, the resulting stress accumulates and leads to behaviors such as inappropriate anger, out of control anxiety, and possibly illness.

Learning to face these moments of stress with equanimity prevents small stressors from building to a problematic level and enables the process of letting go. Holding on is the opposite of letting go. This reaction keeps us stuck, unproductive and unhappy. We hold on when we attempt to control.

When we continue to feel irritated about mistakes in ourselves and others we are holding on to both the feelings of irritation and the thought that things should be different. When we do not notice or are not present for feelings that are evoked in difficult situations we end up unconsciously holding onto the situation and the feelings. We can get stuck in wanting to let go while at the same time engaging in old behaviors that promote holding on such as ruminating or engaging in continual distraction.

Letting go is the key to not getting stuck in these old habits. Letting go of thoughts, feelings and behaviors is possible and can be facilitated through the development of skills such as changing an attitude, altering a perspective or using an emotional release or regulation process.

5 Keys to letting go to letting go are:

1. Attitude Change: Note thinking patterns such as all or nothing thinking, catastrophizing, or underestimating your ability to cope that are perpetuating negative or perfectionistic thoughts about a situation, yourself or another. Switch to a more realistic attitude.

2. Feelings Release: Write your feelings out until fully expressed. Spend time being compassionately present for them. Exercise to release anger residue. Practice a conscience attitude of acceptance until the feeling passes.

3. Problem Solve: Use the abc’s of problem solving: a. identify the problem; b. brainstorm as many options as you can; c. list the pros and cons of each; d. decide on your first, second and third choices; e. action the first choice; f. evaluate the result and if dissatisfied try the second option. Continue until a solution is found.

4. Perspective Shift: Zoom above the problem and yourself and look at it from a distance, think Google maps, as though looking at a specific location from space. Put the problem in a prayer box to be resolved by something bigger than yourself. Imagine the advise you would give yourself five years from now about the situation.

5. Breathe into the Here and Now: Take three complete breaths focusing on the release of tension with each exhale. Slowly and steadily note and label 10 objects in your environment as you breathe. Notice and accept what your body and emotions are doing as if observing someone else.

By changing the habits that perpetuate holding on when stressed you can learn to let go of events as they happen. Rather than accumulate stress you can learn to release it when noted before it becomes problematic. Tackling smaller challenges is easier and more effective than waiting until they become overwhelming. Letting go can become a good habit when practiced. Learn to let go and live.