Emotional Well-Being Blog

Mental Health and Alcohol Abuse

By: Courtney Liggera, Psy.D.

“Beer is proof that God loves us and wants us to be happy.” - Benjamin Franklin

It’s easy to be glib about drinking. It is, after all, a significant element of most social activity.  Drinking alcohol helps us let loose, shake off the strains of a hard day, and connect with good friends. It provides a temporary positive impact on one’s mood. It does all of the above… when enjoyed in moderation.

But alcohol abuse, particularly long-term alcohol abuse, can have devastating effects on your mental health, not to mention your physical health. (Apologies for not being glib about that.)

Alcohol abuse tends to increase mental disorders. Specifically, the odds of developing a mood disorder are 3.6x greater for someone abusing alcohol compared to one who does not.  The odds for developing an anxiety disorder are 2.6x greater (Balhara 2015).

The co-occurrence of alcohol abuse and mental illness is associated with:

●     Greater risk of various psychological, interpersonal, and social problems

●     Impaired decision making

●     Poor therapeutic adherence (not sticking with therapy)

●     Increased risk of relapse

●     Increased risk of self-harm (including the risk of suicide)

The brain depends on a balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting thoughts, feelings and actions – and, at times, our long-term mental health.

The calm feeling one can get after a first drink is due to the chemical changes alcohol causes in the brain. For many people, having one drink can make them feel more confident and less anxious. That’s because the alcohol is starting to depress the part of the brain that is associated with inhibition.

However, the more a person drinks, the more the brain starts to be affected. Regardless of the mood you’re in to begin with, when high levels of alcohol are involved, instead of that calm and relaxing feeling increasing, it’s more likely that a negative emotional response will take over.

In other words, reaching for a drink won’t always have the effect you’re seeking. While having a glass of wine or a beer after a hard day might help someone relax initially, in the long run it can contribute to feelings of depression and anxiety and make stress harder to cope with. This is because drinking a lot on a regular basis can interfere with neurotransmitters in our brains that are essential for positive mental health.

Drinking tends to alter one’s perception of a situation and impacts one’s ability to respond appropriately and accurately to all the cues around us. For example, if someone is prone to anxiety and notices something that could be interpreted as threatening in the environment, it's likely one will focus in on that and disregard other less threatening/neutral information. Or, someone might narrow in on a partner talking to someone they are jealous of, rather than noticing all the other people they’ve been chatting with before that.

If one drinks heavily and regularly, they are more likely to develop some symptoms of depression. That is largely  due to the fact that regular drinking lowers the levels of serotonin in the brain – a chemical that helps to regulate mood.

Someone who already experiences anxiety or depression is more likely to develop drinking problems. For some people, the anxiety or depression came first and they’ve reached for alcohol to try to relieve it. For others- drinking came first, so it may be a root cause of their anxieties.

If you tend to drink to improve your mood or mask your depression, you may be starting a vicious cycle. Here are some warning signs that your drinking is affecting is your mood:

●     Poor sleep after drinking

●     Feeling tired because of a hangover

●     Low mood (depression)

●     Experiencing anxiety in situations where you would normally feel comfortable

Here are some ways to prevent alcohol from affecting your mood and from increasing your dependency on alcohol:

●     Use exercise and relaxation to tackle stress instead of alcohol

●     Learn breathing techniques to try when you feel anxious

●     Talk to someone about your worries. Don’t try and mask them with alcohol

●     Always be aware of why you’re drinking

●     Don’t assume drinking will make a bad feeling go away, it’s more likely to exaggerate it

If you think you have a problem with alcohol or just want to talk with someone about how you are feeling, then the next step is to reach out to someone you trust or to go directly to a mental health professional who can ensure that you get the help and support you need. Getting help for alcohol abuse and mental health issues is much easier when you have people you can lean on for encouragement, comfort, and guidance. Without support, it’s easy to fall back into old patterns when things get tough.

For some individuals, abstinence from alcohol is the only workable solution. For others, drinking in moderation works. However, alcohol abuse works for no one.

HIV - Get Yourself Tested!

By: Dr. Courtney Liggera, Psy.D.

World AIDS Day is December 1st--it presents a worldwide opportunity for people to unite in the fight against HIV, to show their support for people living with HIV, and to commemorate those who have died.  

One of the best ways to join in this fight is to get tested for HIV. The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. And if you have any risk factors, a general rule is to get tested annually.

Despite a lot of growth in terms of people's understanding and acceptance of the HIV virus, there still remains a great deal of stigma around getting tested for HIV. Many people still fear that others will think less of them if they are diagnosed with HIV. They are also worried that they could be discriminated against if others learned of their HIV-positive status. As a result, they don't get tested even if they fall into a high risk category.

Additionally, some people won’t get tested because they are scared of the results.  In the early days of the HIV epidemic, many people saw being diagnosed with HIV as a death sentence.  However, there has been tremendous growth and development in the treatment for HIV-positive individuals. While there remains no cure, regular testing increases the odds of early detection, which drastically improves outcomes. 
Some folks don’t get tested because they think they don’t have any of the risk factors for HIV.

However, a 2011 study showed that 69% of HIV-infected patients said they weren’t tested earlier because they didn’t think they were at risk!  (Source: Medwiser, a nonprofit dedicated to providing insightful and innovative solutions to the HIV/AIDS crisis.) It is important to know all possible risk factors. Specifically, HIV can be transmitted through a number of bodily fluids, including: blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. If you have engaged in behaviors that put you in contact with these bodily fluids, you may be at risk for getting HIV. Examples are vaginal or anal sex without a condom or without being on medicines that prevent or treat HIV, or sharing injection drug equipment with someone who has HIV.

HIV testing is paramount in ensuring that infected people are diagnosed early and receive treatment which helps prevent new infections. According to Medwiser, here are some important facts about HIV testing:

  • 20% of individuals living with HIV don’t know they are infected
  • 49% of new HIV transmission are infected by people who don’t know they have the disease
  • Early diagnosis and treatment can decrease transmissibility by greater than 95%
  • HIV positive patients treated early will live an average of 11 years longer
Those who don’t get tested will be diagnosed late, when the virus may have already progressed to AIDS. This makes treatment less effective, increases the likelihood of transmitting HIV to others, and causes early death. .

A key part of taking care of yourself both physically and psychologically means finding a health care provider that you feel comfortable with and is someone with whom you feel you can be open and honest. The more you tell your provider about what’s really going on with you, the better they can help you. So talk with your healthcare provider about getting tested as soon as possible. Doing so will mean you are taking an integral part of HIV prevention and awareness.

Learning to Love Your Skin

By: Courtney Liggera, Psy. D.

If you've ever blushed from embarrassment, “glowed” from happiness, or experienced an “angry” breakout of your skin, you know that your skin can mirror what you are feeling within. Emotional issues, stress, and other psychological factors can activate or worsen certain skin conditions.

Just as psychological and emotional stress can lead to skin conditions, the reverse can also be true.  In fact, people with skin problems are at higher risk of developing psychological problems, and these problems can linger even after the skin gets better.  

Skin conditions can reduce one's quality of life, in terms of unfair judgments on one's appearance, or pressure to look “normal” or to comply with social standards.  As a result, people with a skin condition may:
●     experience decreased sense of body image,
●     have lower self-esteem,
●     avoid situations where skin is exposed,
●     feel anxious about people judging them,
●     withdraw from social interactions,
●     have sexual and relationship issues,
●     feel shame and/or disgust about their appearance.

While we can't necessarily control how our emotional state manifests itself in our skin, we can control how our skin problems impact our emotional state.

So what can you do to maintain a positive and healthy view of yourself when suffering from skin problems? Here are some ways to feel good about who you are regardless of how your skin looks:
●     Appreciate all that your body as a whole can do. Every day your body carries you closer to your dreams. Celebrate all of the amazing things your body does for you – laughing, breathing, dreaming, running, dancing, etc.
●     Keep a top-10 list of things you like about yourself -- things that aren’t related to your skin condition or what you look like. Read your list often. Add to it as you become aware of more things to like about yourself.
●     Remind yourself that “true beauty” is not skin-deep. When you feel good about yourself and who you are, you carry yourself with a sense of confidence, self-acceptance, and openness that makes you beautiful regardless of whether you have perfect skin. Beauty is a state of mind, not a state of your body.
●     Look at yourself as a whole person. When you see yourself in a mirror or in your mind, choose not to focus on specific parts of your skin. See yourself as you want others to see you -- as a whole person.
●     Surround yourself with positive people. It is easier to feel good about yourself when you are around others who are supportive and who recognize the importance of liking yourself just as you naturally are.
●     Shut down any negative thoughts that tell you your skin is not “right” or that you are a “flawed” person, and overpower those feelings with positivity. The next time you start to tear yourself down, build yourself back up with a few quick affirmations that work for you.
●     Do something nice for yourself -- something that lets your body know you appreciate it. Take a bubble bath, make time for a nap, find a peaceful place outside to relax.

The most important thing to recognize is that you are not powerless to minimize the overall effect that skin problems have on your daily life.  Give some of these techniques a shot - your mind is a powerful thing!

Is My Eating Disordered

By: Robin Hornstein, PH.D.

It is likely that you or someone you know has a “weird” obsession with food or their body. These days, the culture of beauty and perfection is understood even when we are young girls watching the world around us. Three year olds more commonly ask their moms if they are fat. You probably can give a lecture yourself on the media ruining the lives of many girls with standards of beauty that most of us won’t meet in our lifetimes. Most women also have been on some diet by the time they are 25 and have their own diets in their heads (cheat days, no carbs if you eat cake at a party, Paleo, Weight Watchers points, healthy eating, juice cleanses, calorie counting). The list is long and the demand on our psyches is high.  

I would argue that if more than 10% of your day is spent worrying about what you will or won’t eat and you are upset with yourself for losing the battle of these rules, you may have disordered eating or thinking about food. And if that time spent fretting is full of self-loathing, punishments, make-up time at the gym or other compensatory behaviors, you are headed for the emotional and physical suffering that can become an eating disorder. Further, if your worry interferes with socializing and intimacy with others on any level you are showing more signs of an eating disorder than you might want to live with day to day.

What crosses the line to an eating disorder? Well, first we need to know that the number one mental health disorder that leads to death is Anorexia.  It beats out suicide, which is quite alarming and perhaps should be classified as a suicidal illness. I imagine that most of you reading this can define the major diagnoses in the Eating Disorder list:  Anorexia, Bulimia, Binge Eating Disorder and Orthorexia may be familiar to you as you probably have read about these or have known someone who has struggled. Orthorexia is the least known and is actually best defined as a systematic elimination of foods one won’t eat as they are defined as unhealthy. The list is obsessive and ends up limiting many enjoyable life moments and affects mood and health. This disorder is not someone who says they don’t want to eat sugar – this is more a disorder where the body image and mood are affected by the choices that one will eat due to many factors. The underlying obsession leads to much anxiety, and Steven Bratmas, MD calls people with this disorder “health food junkies”.

In reality, if you see yourself in these descriptions and feel that you have any behaviors that you hide or get angry when you are confronted with them (bingeing, eating too few calories a day, exercising to excess, only eating certain foods, purging via vomiting or other methods etc.) you may require help to overcome these behaviors. And, it is not only our body that suffers. Living with an eating disorder is a disruption in your life.  It is a mental health issue and not just a will-powered choice. Most women with an ED (Eating Disorder) also have other mental health issues that accompany the ED behaviors.  

Depression, anxiety, obsessive-compulsive disorder and posttraumatic stress disorder are some of the illnesses that lead to or are caused by having an eating disorder. It affects all areas of one’s life. These disorders harm our bodies, careers, relationships, make us lonely, erode creativity and fun and hamper being a full and successful person in the world. What to do? Seek help. Tell someone and leave the secrets behind.

What I have learned as a therapist for the past 33 years is that secrets can lead to severe illness constricting our happiness and functioning. Tell your physician, a friend, anyone you trust and start to unwind how you got to this place. There are many types and levels of care and your people, as you trust them, can help guide you. One of my clients told me the other day that she goes to the gym and spends her time seeing who she is thinner or heavier than, who has greater endurance than her and how she will beat them next time. When I asked if this was an enjoyable use of her time or if she ever talked to anyone, she looked at me like I had three heads. Body image issues and eating disorders are issues of loneliness and a feeling of being less than everyone else. If this is part of your story, or someone you know, reach out for help. It is everywhere around you. A good team of a physician, nutritionist and therapist can help you untangle the web you are stuck in and find a full and rich life.

The Psychological Impact of Laughter

By: Courtney Liggera, Psy. D.

I was wondering why the ball was getting bigger.

Then it hit me.

We have all heard the saying “laughter is the best medicine” – and there is more than a nugget of truth in it.

Laughter has a significant effect on our bodies and our minds. Laughter triggers the release of endorphins and serotonin, which creates feelings of happiness, love, and euphoria.  Laughter also initiates a psychological phenomenon called “facial feedback,” whereby a certain expression can cause a person to have the corresponding emotion. Just the simple act of smiling from laughing can improve one’s mood.

As a result, laughter can be a powerful tool in everyone’s lives. It makes people feel good, and that good feeling remains even after the laughter stops. Laughter helps people maintain positive and optimistic outlooks even through difficult situations, disappointments, and losses.  Even more significant and powerful than getting relief from sadness and pain, laughter gives people courage to find hope in difficult times.  A laugh, or even just a smile, can help a person overcome significant obstacles.

There are several links between laughter and mental health.  Laughter helps to temper distressing emotions like anxiety, sadness, and anger.  Laughter helps you relax and recharge by decreasing stress, increasing energy, and helping you stay focused and accomplish more.  Laughter also helps change perspective by permitting people to see situations in more realistic and healthy ways.  It creates psychological distance which in turn, helps people avoid becoming overwhelmed.

We all can benefit from incorporating more laughter in our lives.  Here are some simple ways bring it on home:

1. Smile. A smile is the beginning of laughter and like laughter, it is contagious.
2. Count your blessings. Make a list of good things in life which will distance you from negative thoughts which can be a barrier to laughter.
3. When you hear laughter, go to it. People are often more than happy to share something funny because it gives them a chance to laugh again.
4. Spend time with fun, playful people. These are people who laugh easily, both at themselves and at life and find humor in everyday things. Their happy points of view and laughter are contagious.

By focusing on a few small changes and welcoming laughter into your life, you can make significant steps towards improving your overall mental health.

Coping with Holiday Stress

By: Randi Platt, M.Ed.

Shopping, baking, cooking, visiting, feasting, attending parties, drinking alcohol, money woes, loneliness, expectations for connection and fulfillment. What do these words all have in common? They are descriptors of our daily lives during the holiday season.

These words and the following video give a great summary of what usually causes stress around the holidays. "Stress" is the body's reaction to being overstimulated for extended periods of time. While our bodies are designed to withstand short bursts of mobilization, days on end of late hours, overeating, worry or a feeling of isolation can produce symptoms of moodiness, fatigue, pain, headaches and more.

Luckily, this video also gives some great tips going through the holidays and minimizing wear and tear on our brains, our bodies and our emotions. As a psychologist, I would also like to add a couple of tips gained from talking to people about their stress for the 33 holiday seasons of my career:

1) Take breaks from group and chronic activities. Allowing time for your body to recuperate from chronic stimulation will help it respond to stress with more resilience.

2) Consider staying in a nearby hotel if possible instead of staying with your family. This will provide natural breaks for rest and to maintain perspective.

3) Hydrate well. This helps to keep your energy up, maximize a feeling of fullness that helps curb overeating, and counteracts the possibility of overindulging with alcohol.

4) Make aspirations BEFORE the holiday season as to what values are most important for you to live out during this time (for example generosity, connection, being even tempered, demonstrating love or thoughtfulness). Write down your aspirations where you can see them each morning, to remind you of what you are striving for.

5) Be realistic. None of us live the lives of people in T.V. shows or novels. Each of us have quirks and imperfections, and most days are highly imperfect! Expect some stress and imperfection each day to decrease your possible disappointment.

Randi Platt, M.Ed. is a Psychologist, the head of psychology services at the Rittenhouse Women's Wellness Center, the Executive Director of Hornstein, Platt and Associates Counseling Centers, and a teacher of meditation at Thomas Jefferson University who has enjoyed being a healer in Philadelphia for the last 33 years.

How to Achieve Happiness

By: Randi Platt, M.Ed.

With the science of Psychology turning towards everyday experience, research is helping us understand how to achieve happiness and emotional well being with greater consistency. Contrary to popular belief, it is not important to build self-esteem.  The surprising news is that it is important to learn to feel compassion for self and others.  Those who regularly spend even brief amounts of time feeling gratitude, sending good wishes to others or being a good friend to themselves report greater happiness, connectedness and health. 

Tis' the Season

By: Joanne Perilstein, Ph.D.

Many people  feel excited about the  coming  holiday season and begin planning, and remembering past celebrations and  good family times together.  The media  and ads often hype the coming season  both because it is a shared  experience in the mass market and also  because it is a productive way to  encourage  shopping to boost sales and business.  The  festive lights and special events are also  ways to increase excitement and celebration.  So what’s wrong with it all?

The thing that can go wrong is that  people  build up their  expectations and typically remember only the  positive aspects of previous family experiences.  Then when reality strikes and there is conflict  at the dinner table among family members, or rekindling of old  strains and resentments and jealousies, people become greatly disappointed and dispirited. 

What to do?  Manage your expectations.  Try to be realistic when  imagining your family visits.  Keep in mind that it is very difficult for us mere mortals to live up to Norman Rockwell paintings.  Realize that family members  have flaws  and  try to concentrate on giving rather than getting.  Contemplating  what you are grateful for and trying to create meaningful experiences with loved ones  can counteract  some of the inevitable  disappointments that might occur.  Then if things go well, it will serve as an added benefit to the gratefulness and meaningfulness you are working on constructing. 

Here’s hoping you have an enjoyable  and meaningful holiday season!  

Spring Fever

We are approaching that time of year when many of us experience spring fever….a time when we feel energized and want to do many things from outdoor activities to spring cleaning within the home. At the Rittenhouse Women’s Wellness Center, I work with two groups of people: those wanting to pursue weight management and those wanting psychotherapy. From the weight management point of view, spring is a time when many of us prefer to exercise through outdoor activities which can nicely complement a healthy diet in pursuit of weight loss. Physical exercise is very helpful in maintaining a positive mood and outlook on life, so much so that the American Psychiatric Association is now recommending exercise as a strong treatment for the reduction of depression. An increase in social activities, which also may occur in the spring, is also useful in combating depression, or simply emerging from the winter blues! However, individuals who suffer from depression or bipolar illness are best advised to avoid excessive activity which might interfere with regular sleep patterns. Both individuals troubled by depression or bipolar illness are best served when they respect their need for regular sleep patterns. So the solution is simple: enjoy the springtime and the expanded activities that it often offers. If you want to begin an exercise program, this is the right time to start. Just remember to pursue your activities in moderation to avoid physical or emotional strain.

Overcoming the Winter Blues

Ever notice that in the winter, perhaps between November and March, you just feel sort of in the dumps? Maybe your motivation is lowered, you feel sad, things don’t seem as pleasurable as usual and your interest in work, socializing and entertainment seem to lose steam? Perhaps you also feel more moody, sad or irritable and even want to cry at times? If so, maybe you are having a bout of S.A.D… or Seasonal Affective Disorder. It isn’t totally clear what causes this, but there are several ways to treat it.

First of all, realizing your own vulnerability towards depression at this time of year is a good first step to solving the problem.

Some interventions that may help include the following:

Buy a full spectrum light. These can be found online (Northern Lights is a great brand). Try to use it in the morning before dawn. This can help extend the daylight so that your spirits lift.

Increase exercise. Often the cold weather discourages us from exercising. However, if we actively combat this tendency by self consciously increasing our exercise, we might find that the depression lifts.

Psychotherapy. If the depression really begins to interfere with work or socializing, psychotherapy can be helpful.

Medication. In some instances using anti depressants in combination with  some of the other interventions listed will also be helpful, especially if initiated at the beginning of the winter in November.

Nutrition. There is evidence that proves that good nutrition can also improve your mood.

In any event, don’t despair too much because inevitably winter ends and spring will emerge once again!

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