Are You Constantly Struggling? Try Grit.

According to the news, social media, and the American Psychological Association (APA), more people are struggling with anxiety, depression, and other mental health conditions than ever before. In response, numerous articles and research studies have been published suggesting the best ways to improve mental health. While there isn’t just one thing that we need to do to protect our mental health, or improve it, 18 years of clinical experience has taught me that some strategies work better than others, and some of them are more important. I believe in the power of resilience, which is the ability to bounce back from hardship with strength and tenacity. One essential and specific factor that is part of resilience is called grit. 

Defined as the ability to endure hardship, possessing more grit increases our tolerance for difficult circumstances without stealing our hope that things will get better. Some people naturally possess more grit, and they seem to be able to endure a lot of hardship without it breaking their spirit. But grit is something that you can work to increase, and doing so helps build resistance to depression, anxiety, and other mental health challenges. 

In her book Grit: The Power of Passion and Perseverance, Angela Duckworth discusses how to be gritty. She argues that the ability to endure hardship is part of what constitutes grit, but you also have to have a goal: something that you’re passionate about. While Duckworth focuses on how grit can help you achieve success, as a therapist, I’m interested in how grit can be used to improve mental health.  

If you’re currently experiencing hardship, practicing the following strategies can help you increase your grit to get you through this difficult time while retaining hope and ultimately improving your overall mental health. 

Accept that having grit takes effort

Sometimes you have to be persistent and keep going even if you don’t feel like it. Life isn’t fair, and it often involves more tough times than easy times. In the end, this makes the rewards and the triumphs even sweeter. But we have to get through the process first. This means we have to put on a symbolic suit of armor and remind ourselves on the hardest days that we can do hard things. 

Let go of grudges, mistakes, and disappointments

People with grit must be forward thinkers. Take notes and learn from your mistakes, but let go of the negative thoughts and feelings. Dwelling on past mistakes or broken relationships does not serve a productive purpose in improving your life or your mental health.

Always have a goal in mind

You don’t have to come up with a life-defining goal right now. Perhaps you just want to make it through the days without feeling terrible, or you’d like to have several consecutive days without a panic attack. Those examples are a fair place to start. You can also identify something small you’d like to accomplish. It doesn’t have to be running a marathon or starting your own company. Maybe it’s going to work more days than not or finishing a project that you started. Keeping goals in mind gives our brain a place to focus other than our troubles.

Find a passion that can be your purpose

While nothing may immediately come to mind, think about what you want to get out of life. Find a purpose, whether it’s related to your career, an opportunity to serve others as a volunteer, or a hobby. Find something that you love and pour your energy into it. Having a passion and a purpose gives you a reason to wake up every morning and feel enthusiastic about the day ahead. It also helps you focus on the harder days.

Enduring hardship is definitely an important part of grit, but no one can continuously withstand difficult circumstances without something to feel hopeful about. The strategies listed above can help you find hope through purpose and positivity, and then you’ll feel strong enough to be ready for life’s next challenge.

Photo by Fabrizio Conti on Unsplash

This blog was originally posted on Psychology Today 12/20/23. https://www.psychologytoday.com/us/blog/from-trial-to-triumph/202312/are-you-constantly-struggling-try-grit

How to Get the Most Out of Therapy

In her book Maybe You Should Talk to Someone Lori Gottlieb makes a very good case for going to therapy to deal with life‘s problems. She talks about her own therapy and why it’s important to consider therapy rather than dealing with one’s challenges on your own. The book was a best seller, and her case for therapy convinced thousands of people to give it a try.

While it’s great that more people are going to therapy to get help, they often don’t know what to do when they get there. Friends and clients alike tell me that they didn’t know what to talk about, their therapist just sat and listened and nodded, and they felt like it was a waste of time and money. 

As a psychologist, this is obviously discouraging to hear. This is why my first session with new clients not only gathers background information about them, but it educates them about therapy. I like to give them some things to consider so they use their time and therapy well, whether it’s six sessions, six months, or six years. Because some clients are having their first experience with therapy when they come into my office, I consider it a priority to help them understand how therapy can be helpful and how it looks different than talking to a friend. I like to call it a roadmap because most people who make the initial phone call to schedule an appointment have decided they should be in therapy, but it’s my job to help them learn what to do once they get there and how to make it productive. 

Here are some steps you can take to create your own roadmap for therapy. 

Find someone that you like talking to 

Not everybody can pick any therapist they want. If you can go out of network and get reimbursed or can pay out of pocket, you can chose your favorite out of as many therapists as you can find. If you’re limited by your health insurance network, you may only have a few to chose from. But within those limitations, it’s still important to pick the best therapist for you. 

Once you’ve identified somebody that is a practical, good choice, make sure that you enjoy talking to them. Therapy will be a chore if you don’t feel like you’re connecting or that they understand you. Ask questions on the first visit to make sure they have knowledge of the issues you would like to discuss, and ask how they conduct therapy to make sure you are comfortable with it. For example, some therapists just talk to you and expect you to bring up subjects that you would like to discuss. Other therapists are more interactive, giving advice or using theoretical orientations for which they’ve been trained, such as cognitive behavior therapy. Learn as much as you can about the way that they practice so that you can make a decision about whether to keep looking. 

I advise people to give the same therapist at least three sessions because sometimes it’s hard to fit in all your questions and gather all your info on the first visit.

Identify how you want to use therapy

There are a number of ways that you can use therapy. Ask yourself what you want to accomplish. 

Many people are quite content to go to therapy for an indefinite amount of time and have a safe space to talk about their feelings and thoughts. They may not have anyone at home that can be their unbiased sounding board. Many people also want to find solutions to their challenges, or they want to learn how to behave differently and change patterns of behavior that are unhealthy. Still others want to learn specific skills to cope with difficult and negative thoughts and emotions. Each of these goals for therapy is valuable, and there are therapists out there who can help with all of these things.

 It’s possible that you may not be completely sure how you want to use therapy, so that gives you a good opportunity to ask your therapist for guidance. Explain to them what is hard about your life and what challenges you are facing. A good therapist will help you brainstorm and figure out how you want to get started in making positive changes, or they will validate your desire to talk about subjects that are difficult to discuss with members of your family or your friends.

Think about your therapy when you’re not in session

Many clients have told me that from one session to the next they don’t think about what we’ve discussed or even remember what we discussed. I explain to them that they will find therapy more valuable if they reflect on things that have been discussed in between sessions. If it’s hard for them to remember from one session to the next, I recommend they take notes during the session. Therapy often leads to a process of change for clients, and it becomes harder to make changes if they don’t connect what they’ve talked about in therapy with what happens in the real world. 

Clients also come to the sessions saying it’s hard for them to remember the important things that have happened since the last session. In these cases, I recommend the clients take notes on what happens outside of therapy, so when they come to a session they can describe situations that may have affected them emotionally. Some clients choose to get a “therapy notebook“ where they keep their reflections after sessions and topics for future discussions, so when they come to therapy, they have material to discuss.

Come prepared to be present for the entire session

Some people say it’s hard for them to tune out their lives and make time for therapy sessions. They arrive at the appointment and their phone constantly buzzes with texts and emails. In order for therapy to be helpful, it has to own a space on your calendar. Schedule regular appointments, arrive on time, and turn off your devices while you are in session. Some therapists will start the session with a mindfulness meditation, which can be helpful in tuning out distractions so that you can be fully present in the moment. If your therapist doesn’t offer this, you could ask them about it, or you could do a brief meditation yourself in the waiting room. Feeling distracted during therapy makes it harder to remember what you discussed afterwards, and it may affect your opinion of the value of therapy.

While therapists vary in their level of expertise and experience, the quality of the therapist is not the only reason therapy may not feel valuable. Think about what you’d like to get from therapy and make a plan. Be intentional, and therapy can be a valuable tool in improving the quality of your life and your relationships.

This blog was originally posted on Psychology Today.

image from Canva

Five ways to improve the effectiveness of coping strategies

Many therapists talk about coping strategies. Developing healthy ways to deal with stress, anxiety, pain, depression, and difficult circumstances is a key component of evidence based practices for mental health. While talking about our problems can be useful, it is generally believed by professionals that clients must learn tangible strategies to respond to their thoughts and emotions. These strategies range from meditation and breathing exercises to writing down and challenging our negative thoughts. Cognitive-Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT) are two interventions that teach coping strategies to clients so they can better manage their intense emotions and learn how to respond, rather than react, to stressful situations and interactions.

Often, though, I hear from my clients that the coping strategies aren’t working. People become frustrated after trying a few times to implement new strategies without success. Sometimes, this is because they haven’t given them enough of a chance. Whenever we are trying something new, we’ve got to give ourselves time to practice it. Additionally, it can be hard to believe that coping strategies will work, especially when we’ve been reacting the same way for a long time. It seems difficult to believe that doing something as simple as pausing to take deep breaths could be helpful. But it’s important to keep trying new ways of coping with our feelings to improve our mental health. Here are some things to consider when it seems like nothing that your therapist suggests is working. 

1. Observe what you are thinking and feeling, when a coping skill hasn’t worked. For example, you tried taking deep breaths, inhaling and exhaling slowly. When you finished, you felt irritated and said to yourself “I don’t feel any better.” Respond to these negative thoughts or judgments about how it went by reminding yourself that it takes time to acquire a new skill. You can also remind yourself not to judge and that some experiences will be more helpful than others. 

2. Set realistic expectations. You don’t want to evaluate the success of coping strategies by how quickly you notice feeling different. Even after new strategies have been helpful, they won’t be as helpful every time. Sometimes, you’ll notice that you feel different right away. At other times, you will wonder whether the coping strategies make a difference at all. You should think about them as a tool for managing your feelings, and you want multiple tools in your toolbox. If one coping mechanism doesn’t seem to be working in a specific situation, try something else. But don’t evaluate their usefulness by how much they make a difference in one specific moment. 

3. Assess your attitude about using coping strategies. Talk with your therapist about your feelings regarding learning and using coping strategies. If you’re pessimistic about whether they’re helpful from the start, it might affect your expectations and your ability to keep trying them. Think about why you are resistant. You may be afraid that if they don’t work, it will be your fault. Or, perhaps, you are afraid to be hopeful. 

4. Reflect on how coping strategies will improve your quality of life and your relationships. While it may be hard to try new things and to keep trying strategies that are difficult, think about the outcome that you desire. For example, if you’re struggling to manage your anger, you may frequently explode when you’re having a disagreement with someone you care about. It would be great to learn how to respond to your anger and gain control over your emotions so that you can resolve conflicts easily and peacefully. Thinking about the outcome that you desire and the ways that it would change your relationships may motivate you to exert more effort in using new strategies. 

5. Reward yourself for success. Give yourself credit when you get the hang of new coping strategies. Remind yourself that you’re working hard and that you’ve done a good job. Feeling better will be its own reward, but it never hurts to treat yourself for a job well done.  

Even though coping strategies are going to be useful, they aren’t going to work easily and immediately. Learning and implementing new coping strategies is hard, and it’s important to acknowledge that it’s hard. However, if you work at it, you will keep learning and get better at using them.

How to be happy for others, even when you’re unhappy

In a recent blog post, I listed 10 qualities of mentally healthy people. One of the qualities that I mentioned was the ability to be happy for other people, whether we are happy or not.  

I completely understand that this is difficult, and it’s something that most of us have struggled with at one time or another. Being happy for other people, though, is good for our own mental health. It takes us out of our own head and allows us to focus on something besides our own thoughts, feelings, and   problems. Being happy for others, and expressing it to them, also grows our relationships. It’s important for others to know that we care about them and their lives, including what gives them joy. Most people want to be happy for others, but sometimes it’s hard, especially if your own life is full of challenges, and your own happiness seems out of reach. 

I chose to write this blog now because I know the holidays can be hard. It’s a time when many people do feel happy, and they love sharing their photos and experiences with their family and friends. Being happy for others can be especially tough at this time of year. Maybe your best friend gets engaged over the holidays and you feel lonely. Or you would like to have children, and you receive a holiday card with a picture of your friends and their children, smiling, and having a great time. It is possible to achieve genuine happiness for others and to become a part of their joy. Here are some suggestions.

Feeling happy for others doesn’t invalidate your own struggles

When we feel sad, anxious, and dissatisfied with the status of our lives, it’s easy to get stuck in those feelings. But it is possible, and mentally healthy, to experience both negative and positive emotions at once. Sharing in the happiness of others doesn’t change our own circumstances or emotions, but it can give us a break from them. Take some time to celebrate the milestones of friends and family, even if you don’t feel celebratory. Most of the time, our loved ones do not expect us to be euphoric over their happiness when we are having a hard time. But we may be surprised at how our mood can change when people we love are doing well.       

Reflect on how things change over time

Spend some time thinking about what others have gone through. Most people are not constantly happy nor do things always work out for them. In fact, feeling happy for the successes and joys of others can remind us that circumstances change. At least some of our friends and family have probably gone through hard times as well. Seeing how the lives of others change over time can be encouraging. The friend who was unemployed now has a new job. The sibling that was single has found a partner that makes them happy. Even though the happy news of others is not about us, the ways that the lives of others change gives us hope for our future. 

Challenge negative thoughts regarding the happiness of others

When it’s been a while since we’ve had happy news to share, it’s easy to get into a negative spiral with our own thoughts. But this makes it harder for us to be happy for others, and it ultimately doesn’t do us any good either. For example, we may think that some people have all of the good luck. Or we may wonder how others are able to get things they want when it feels like our own life is always challenging. Not only do these thoughts prevent us from being happy for others, they keep us stuck with a negative cycle in our own head. We must catch ourselves in this spiral and offer alternatives that are healthier. For instance, we can say things like “my turn is coming“ or “It’s good to see things work out.” Generate thoughts that get your brain out of the spin cycle of negativity. 

Express happiness to your friends out loud

Even if you’re not sure you’re feeling up to it, call your friend to congratulate them for their good news. Send a text to thank someone for the lovely holiday card, even if it reminds you they have a family you don’t have yet. It isn’t necessary to make a grand gesture if you’re not feeling up to it. But a small gesture to let them know that you care about their happiness and well-being will accomplish both the goal of strengthening your relationship and reminding you that good things come to us in time. 

Being happy for others does not and should not take away our own pain and suffering. But it’s important to keep exercising that muscle to keep our emotions balanced and to preserve healthy relationships. 

Photo by Dominic Sansotta on Unsplash

This blog was originally posted on psychologytoday.com on December 9, 2022. https://www.psychologytoday.com/us/blog/trial-triumph/202212/how-be-happy-others-even-when-you-re-unhappy

How to be more resilient: Five ways to bounce back from hard times

Everyone faces adversity during their lifetime. We live in a world full of challenges and obstacles to overcome. Some people face more adversity than others, though, and it can become hard to make sense of these disparities. However, we can shift our focus away from other people towards overcoming our own obstacles and channeling our experiences into personal growth. We can become stronger, and we can refuse to let hard times keep us from reaching our potential in living our best lives. Below are five ways to keep fighting the good fight and build your resilience when the going gets tough.

1. Declare that life is not fair. You probably already realize this. But it’s important to say it out loud and keep it in the forefront of your mind when you’re going through a trial. Some people seem to never struggle, and some people get everything they want. Ruminating on this fact will not help you conquer adversity. It will perpetuate the cycle of negative thinking and lead to a cynical attitude. Accept that life is not fair, but that things often do work out with time and effort.

2. Rethink how you feel about adversity. If you’ve experienced what seems like more than your fair share of adversity, this will be difficult. But thinking about adversity as the means by which you grow stronger, build resilience, and learn how to problem solve will decrease your fear of struggles in the future. If you aren’t afraid of what the future holds because you have the tools and the attitude to boldly face it, it becomes less daunting. You then have the agency to take adversity on with optimism instead of telling yourself you can’t handle it.

3. Collect your resources. Everyone has coping mechanisms that work best for them—people in their circle they can trust to support them, and personal attributes that help them get through dark times. You may not know your own capacity, so give some thought to what your superpowers are. For example, maybe you have a great social support network that you can access, or you make friends easily and can increase your support system. Perhaps you are athletic or physically strong, and that allows you to be healthy and alert. Maybe you have great analytical skills. Everyone has strengths they can access and build on. Finding yours during hard times will improve your self-confidence and empower you.

4. Reflect on past challenges that you have overcome. Remembering how you’ve gotten through difficulties in the past and how you navigated them can be a helpful tool and give you more hope and courage. If you find yourself struggling in ways that you’ve never experienced or to a degree that you haven’t faced before, it can still be helpful to reflect on things that you’ve conquered big or small. You want to remember that you have agency, and that you can persevere.

5. Identify something in your life that is stable/positive. Even during dark times in life, there is almost always something that we can count on. It may be a relationship with a relative, friend, or partner. Perhaps it’s a job that we love. It could be a secure home or living arrangement. Maybe it’s even a hobby that we enjoy. Remind yourself of the things that you can count on when there are a lot of changes going on around you or you are uncertain about the future.

Many of us have gone through circumstances where it feels like the only thing to do is raise the white flag and ask for mercy. You don’t feel like you have an ounce of strength left, and you want to ignore the world and pretend it’s not happening. Remember that most circumstances are temporary, and even if they include a permanent change, you can find the strength and resources to grow and evolve. You’ll never learn how strong and resilient you really are until you face adversity. Instead of hiding under the covers, change your mindset and tell yourself that you’re ready to go.

This blog was originally posted on psychologytoday.com on Nov. 7, 2022.

https://www.psychologytoday.com/us/blog/trial-triumph/202211/5-ways-bounce-back-hard-times

Photo by Kristjan Kotar on Unsplash 

Five Things You Should Know About Depression

Because the prevalence of depression and mood disorders in the United States has risen dramatically since 2020, understanding depression is more important than ever. It is necessary for those who are suffering from depression, and those who love them, to be educated about the symptoms, the best practices for treatment, and how loved ones and their community can support them. Below are five important facts to know about depression.                            

1. Not everyone who is depressed cries or has tearful outbursts. When people hear the word “depression,” the first image that comes to mind is somebody crying and continuously feeling sad. This can be true, but it is not always the case. Research shows that sadness and tearfulness are not necessarily obvious symptoms, especially for men. Many people suffer silently, not expressing their emotions. Others become angry as an outlet for their depression. The way that depression manifests takes many forms.

2. Trying to be positive does not cure depression. If you suffer from depression, or you know someone who does, you may have heard people saying how critical it is to keep a positive attitude, look on the bright side of life, or be grateful for what you have. While these statements are technically true for all of us, they can be incredibly frustrating for somebody who is suffering. Having depression is not like flipping a switch. You can’t get up one day and decide that you don’t have it anymore. Simply deciding to be positive is not the answer, and it will not make depression go away.

3. Depression can lead to physical pain and illness. Depression not only affects our thoughts, feelings, and behaviors, but it also affects our bodies. People with depression can and often do experience chronic physical symptoms such as stomach aches, headaches, bodily aches and pains, and fatigue. In some cases, chronic depression is related to worse outcomes in physical conditions such as heart disease, gastrointestinal conditions, and a compromised immune system. It does not cause these conditions but can affect how well the body tolerates them and responds to medical treatment.

4. Unless you’ve experienced depression yourself, you won’t fully understand its impact. This idea can be very frustrating for those who love and support someone who is depressed. But clinical depression is not the same experience as feeling down, having a bad week or having a negative attitude about life. It’s a mental health condition that can be serious and chronic and affect the person mentally and physically. Mental health treatment is essential for treating depression, rather than merely exercising, eating healthier, or thinking positive thoughts. Sometimes, people who have struggled with depression for decades still believe they should be over it completely and must be doing something wrong. The best thing you can do for yourself or for someone that you love is to understand that depression is a complex condition that requires intervention by a qualified professional.

5. Depression can be successfully treated but won’t be “cured.” The most evidence-based treatment for depression is cognitive therapy. Many people also benefit from medication. Therapy and medication will allow people with depression to function in their daily lives, to return to the activities they used to enjoy, and overall to feel like they’re capable of living the life they hoped to live. But treatment will not make someone permanently symptom free, and it cannot erase the mental and physical effects of being depressed.

Now that you know these five things, if you think you are depressed, you should talk to a mental health professional. If you’re in treatment and expecting to be completely well, talk to your existing provider about how your treatment is going, what you both can do to make it most effective, and understand the potential limits. Consider communicating honestly with those around you about how depression affects you, so people are aware of how intrusive and impactful depression can be.

If you’re loving and supporting people with depression, talk to your loved ones and let them know that you want to understand. Offer compassion without assumptions. Find evidence-based resources, including scholarly articles, to deepen your understanding.

Anyone impacted by depression should be open to learning more about it rather than assuming they know everything.

This blog was originally posted on psychologytoday.com on Nov. 7, 2022.

https://www.psychologytoday.com/us/blog/trial-triumph/202211/5-things-you-should-know-about-depression

Photo by Fernando @cferdophotography on Unsplash

How to Stay Mentally Healthy: A Wellness Checklist

We are living during emotionally challenging times. Recently, there has been widespread discussion of the mental health pandemic. More people are seeking mental health services now, and a shortage of providers is hindering their ability to get the help they need.

I’ve been thinking a lot lately about how we can turn our attention more to prevention and early intervention. There will always be a need for mental health services, and people will need to continue seeking therapy, medication, and other resources to address their emotional challenges. However, I wonder what it would look like if we worked to stay on top of our mental health before it reaches a point where we are in a crisis.

The concept that I am referring to is “mental wellness.” Through mental wellness, we can proactively achieve better mental health and protect ourselves from reaching a crisis point that leads to a breakdown in our emotional and psychological functioning.

Below are some questions to ask yourself, and some steps to take in creating your own mental wellness checklist.

1. Assess how you are feeling right now. There has recently been talk of primary care doctors conducting mental health screenings. But you don’t have to wait until you go to the doctor to find out how you’re feeling. Are you feeling anxious or depressed? If you aren’t sure, Google “What is anxiety?” or “What is depression?” and there will be no shortage of articles and blogs to help you find out (check to make sure the source you're reading is credible). Increase your awareness of what you are feeling and the extent to which it is affecting your functioning. If you decide that you are feeling anxious, for example, rate the severity of your anxiety on a scale from 1 to 10. A lower rating means you are a little bit anxious, and a higher rating indicates greater anxiety.

2. Determine how much your emotional state affects your daily functioning. Sticking with the example of anxiety, does the level of anxiety that you experience prevent you from living your life the way you want? It may affect multiple areas of your life, so make a list of those areas and think about how each area is affected specifically by your anxiety. If there are things that you would be doing, or relationships you might pursue if it weren’t for your anxiety, make note of those, as well. Everyone experiences anxiety sometimes, same for sadness or fatigue. But the extent to which those experiences affect our lives determines whether we need to do something about them. If several areas of your life are affected by how you are feeling, it is time to act. It’s never too soon to reach out to a therapist, but sometimes it’s easier to start by talking to a trusted friend or family member. Then, you can determine if you need more help than friends and family can provide.

3. Identify your sources of social support. A big part of mental wellness is knowing that you have people who love and care about you. There may be people around you that you haven’t thought of that you could talk to, or even invite out for coffee or a meal. If you need to talk to someone about the way you are feeling, and you’re having trouble coming up with who to talk to from your circle of friends and family, it may be time to increase your social support.  If you have trouble finding a confidant, this could be an area to explore with a therapist.             

4. Think about what you are looking forward to in the future. If you don’t have anything planned, maybe it’s time to put something on the calendar. Plan to do an activity that you enjoy, or invite a friend to do something. Having experiences to look forward to on the calendar, as well as taking the concrete steps necessary to make sure that they happen, can make the harder days more bearable.

5. Think about what you need to do to take better care of yourself. Determining how you feel and how it affects your functioning is the first important step. Assessing your resources and social support and identifying things that you look forward to are additional measures on your mental wellness checklist. Once you have addressed those items, you have enough information to figure out what’s missing. Then, figuring out what to do to take better care of yourself might mean filling in the gaps. Improving our self-care looks different for all of us. Sometimes, we need to increase our social support network to feel less alone. Other times, we just need to plan ahead so that we have activities we can enjoy, so the days don’t feel like a blur and we can lead a fuller life. But self-care doesn’t happen automatically: we have to be intentional.

It is possible to proactively create a mental wellness checklist that will allow us to stay on top of our emotions and create better experiences. This does not mean that our mental health will always be optimal, because life throws us a lot of curveballs. However, it does mean that we will recognize sooner that we are struggling and we will have some tools to increase our resilience so that we can live our best lives.

If you get to the end of your mental wellness checklist and there are items that you don’t have and feel like you can’t provide for yourself, then it’s time to seek professional help.

This blog was originally posted on Psychology Today on Friday, September 29, 2022.

Photo by Aaron Burden on Unsplash.

How do I obtain effective treatment for ADHD as an adult?

Attention deficit hyperactivity disorder (ADHD) affects roughly 8% of the US population. While historically it has been diagnosed in childhood or adolescence, a growing number of adults are pursuing diagnosis and treatment. It’s never too late to find out whether or not ADHD explains your difficulty focusing, being organized, struggling to remember things, running late, or losing things. Adults with ADHD can receive treatment just as successfully as children and teens, and the relief that comes with knowing why you struggle can be transformative. But it’s important to know which treatments are most effective because there are differences in how therapy works best when someone struggles with attention.

[Are you considering whether or not getting evaluated for adult ADHD is right for you? Check out “The Reality of Adult ADHD” for more information.]

First, make sure that you are properly evaluated for ADHD. Do not assume that problems with attention, focus, and lack of organization are attributed to ADHD. Rather than asking your primary care doctor to prescribe medication first, schedule an appointment with a psychologist who conducts ADHD evaluations with adults. The evaluation should consist of a thorough clinical interview, cognitive testing to assess performance on tasks that require attention, and collateral data collected from spouses, friends, or other trusted individuals who observe you in every day life. Failure to include any of these variables in an evaluation for adult ADHD means that it’s not complete. There are many reasons why people struggle to focus, including anxiety, depression, the side effects of other medications, a chronic medical condition, or the impact of trauma. Narrowly evaluating attention as though it’s only affected by ADHD neglects the possibility of important contributing factors that may need to be addressed in treatment. Comprehensive adult ADHD evaluations are conducted only by clinical psychologists with training and assessment. You cannot get the same level of assessment done by a primary care doctor or even a psychiatrist.  

[Learn more about the value of psychological evaluations here.]

Once the evaluation has been completed and you receive a diagnosis of ADHD, or ADHD with depression or anxiety, obtain referrals for a physician with experience managing medications for ADHD. Psychologists usually have a list of trusted providers to whom they can refer clients. The options for ADHD medications are more complicated than the Ritalin prescriptions of the past. Your ADHD symptoms may not be effectively addressed with one of the more common medications. You also want to make sure that your dose is adjusted for what your body and brain can handle, so you’re maximizing the positive benefits while minimizing potential side effects.

Once you’ve received the official diagnosis of ADHD, therapy is an integral part of getting the results that you want. Although medication is incredibly helpful in improving attention and focus, behavior change is a critical part of living a more organized life and accomplishing personal and professional goals. Cognitive behavior therapy (CBT) is a type of therapy validated by empirical research that works well in managing ADHD symptoms. Talk therapy, as it is known, is usually not enough to help clients become more efficient and self-confident as they learn how to navigate life with ADHD. Most clients tell me that merely talking about their struggles with a compassionate listener falls short of making necessary changes to modify their behavior. They also say that once they leave the session, they struggle to remember what was discussed, and it’s hard for them to assess tangible progress in therapy.

In contrast, cognitive behavior therapy provides more structure to therapy sessions. The therapist and client set short term goals and there are homework assignments, so the client has tangible achievements in therapy. This helps clients feel empowered, and it gives therapy a purpose. Since one of the symptoms of ADHD is talking a lot and getting off topic more easily, traditional talk therapy does not provide a platform for tangible outcomes. While talking with a therapist to process feelings of grief over time that was lost before the diagnosis of ADHD is important, it’s equally important to come up with a plan so that clients can feel hopeful with their new knowledge of the reason behind their struggles.

Interventions to help adults who is suspect they have ADHD must be comprehensive, to include a psychological evaluation, effective medication management from a competent provider, and therapy that is goal directed. It’s never too late to find out if ADHD has been holding you back. As an adult, you can still develop the tools and strategies to improve your daily functioning and live the life you want. 

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Why shouldn’t I stay angry? Reasons to manage anger for a healthier life

Lately, everyone seems to be angry. We hear it in the lyrics of songs, from the actions of celebrities and politicians, and from citizens frustrated with our government.

Being angry is a way to make our voice heard, to fight for our rights, and to let people know that we cannot be taken for granted. It is a common belief that anger protects us and that it can be our best weapon against being treated poorly. I will admit that being angry is appealing. It feels empowering to communicate to others that you’re angry because we feel like we are taken more seriously. Before we were angry, no one listened. Nobody cared what we had to say until our voice raised and took a forceful tone. Now, people know we mean business.

While the root of our anger is often justified, the actions that follow our emotions can have harmful consequences. That’s what makes anger a tricky tool to use in our relationships with others and in fighting for our rIghts. Often, it seems like a good idea when we are feeling angry to act on it, but later we have regrets. Or, even if we don’t, others let us know how our anger has affected them or our relationship with them. Below are some factors to consider when determining when and how to express your anger. It’s important to remember that anger is not a bad emotion, but depending on the way that it is expressed, it can either result in good outcomes or extensive damage.

Reflect on why you are angry

There are lots of reasons to be angry, both in our personal lives and in the world at large. This does not mean that we have to be angry about them, though. Anger becomes less meaningful when we use it as our reaction to everything we find upsetting. Because anger can be empowering, letting us know when something is not right, either in our world or in society, choosing carefully what to become angry about protects its value. For example, yelling at the barista because they got your beverage wrong may not be worth your anger, whereas getting angry at your partner because they aren’t considering your feelings in a big decision is important to get angry about. When we weaponize our anger over many small things, it becomes our default reaction. Others may not take us seriously because they perceive us as being angry frequently, and we walk around feeling emotionally triggered. Thinking about the best reasons to be angry is what truly gives us power. We are in control of our anger, rather than it being in control of us.

Understand how anger affects you physically and emotionally.

When we are triggered and we become angry, it can happen quickly. Before we know it, we’ve lost control and we are emotionally reactive. Many people say they are exhausted after having an angry outburst, experiencing fatigue, headaches, a racing heart, elevated blood pressure, and higher body temperature. They may also be tearful, feel sad, have regrets about their reaction, or be anxious about what happens next. Understanding how our body and brain respond to intense anger is important for our physical and mental health. There are circumstances in which it is important to acknowledge that something has caused us to be angry and to identify what that is. In those moments, before you react, take note of how you’re feeling physically and identify other thoughts and feelings that you were having. I call this being “mindfully angry,” and it can make the difference between using anger well versus letting anger take control. If you can do this, you may not experience the physical and emotional aftermath of uncontrolled anger.

Understand how your anger affects others

While we all have the right to become angry, and we know that anger is an important emotion to acknowledge, anger that becomes uncontrolled can be toxic not only to you but others around you. It is critical to understand that our emotions are not only about us, but they affect our relationships with others. While others’ opinions of us should not dominate our thoughts, they do matter to the extent that we want healthy relationships. When we are angry with others, we need to think about how to effectively communicate our feelings to maximize our chances of being heard and understood. Too much intense anger often leads to others shutting down and neither wanting to continue to listen to us nor seeking a better understanding of our perspective. 

The bottom line is that we can be attuned to our anger without letting it escalate to a level that affects us physically and emotionally. And we can let others know that we are angry with them without it negatively affecting our relationships. Anger doesn’t have to be intense for us to get our point across, nor does it have to fracture our relationships to resolve our conflict. Anger can be done well when we stay in control.  

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10 Characteristics of Mentally Healthy People

People keep asking me what it means to be mentally healthy. Previously, I have discussed things we can all do to achieve better mental health, but people want to know what it looks like when they get there. While this looks a little different for everyone, there are some common characteristics of people who are maintaining good mental health and building resilience.

10. You wake up every day and feel grateful about something. When you are having a bad day, or a bad week, you can look around you and observe other people being happy. It can be hard, in times of suffering, to acknowledge things you appreciate. But the ability to think of at least one thing for which you are grateful on a daily basis is a sign of resilience. It is a sign that you are driven to appreciate the good things or the good relationships that you have. Acknowledging these can improve your mental health if this is a regular habit.

9. You have something that you look forward to doing or experiencing. Maybe you have an event coming up with friends, or a vacation, or something as simple as a quiet night at home watching a favorite movie. Planning something that you can look forward to and finding some contentment and enjoyment in it is a sign that you are seeking positive experiences, which can decrease anxiety and feelings of depression. 

8. You let go of anger and you do not spend time holding grudges against others who have hurt you. While we have all had tough relationships and conflict in our lives at some point, holding onto it can prevent us from moving on with our lives. It can lead to internalized negative emotions such as anger, sadness, and even loneliness when it prevents us from finding other friendships or relationships. If you can successfully let go of anger and stop thinking about those who have hurt you, you are more likely to have peace in your life and achieve good mental health.

7. You enjoy the simple things in life. People who tend to maintain good mental health can have positive experiences doing simple things, like going for a walk in nature, laughing with friends and loved ones, or listening to good music. You can appreciate every experience even if it’s not exciting or elegant. 

6. You keep trying when the going gets tough. It’s difficult to stay motivated when you’re going through tough circumstances. You start to run out of energy and you lose hope. But people who are mentally healthy can generally keep going when the going gets tough, and sometimes that even makes them more persistent. 

5. You help others around you. The mentally healthiest and most resilient people are not self-focused. Even when your own circumstances are questionable, you continue to reach out to others and provide support as best you can. Depending on what’s going on in your life, you may not be able to do big things to help others, but you are always concerned for others and try to lend a hand. 

4. You take care of yourself. Mentally healthy people care about others, but not to an extent that you no longer maintain good self-care. You make sure your own needs are met because you know this allows you to be more available to help others and to be present in your relationships.

3. You have good boundaries in your relationships. Knowing when to say no, and knowing when to give yourself some space allows people who are mentally healthy to stay that way. It’s possible to be helpful without violating your own sense of space and privacy.

2. You are not envious of what others have. You don’t spend time comparing yourself to others or to what others have. You focus on what you want and what is within your reach.

1. You can be happy for others, even when your own life is challenging. The capacity to be happy for others, and to let them know you are happy for them, is an important aspect of mental health. It means that you can look beyond your own struggle or pain, and you are happy for others regardless of what is going on in your own life. 

Some of these characteristics may seem hard to achieve. Some of us have grown up in families where negativity, conflict, and fear are a constant fixture of life. It’s not always easy to shake those cycles and start our own new habits. Learning to reframe our thinking and be present to enjoy what’s around us are great skills to acquire as we strive for the best mental health.

This blog was original published on the Psychology Today website on June 17, 2022.

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