Shoshana Shira Twersky

It’s great that you are motivated to work on the challenges that you’re experiencing in your marriage. If your husband is on board with joining you for couples counseling that would be ideal, but interestingly, not completely necessary for shifts to begin to happen for the better in your relationship. The truth is, if even just one of you starts making changes in a positive direction, it will impact the relationship as a whole. For example, let’s say one of the issues you struggle with is a lack in effective communication skills. If you begin all of your future interactions with your husband with first pointing out at least 1 small thing that is either validating, or that you appreciate about him, or that you understand his perspective about something, and only then proceed to communicate whatever point you wanted to make using “I” statements so your not telling him what he did wrong but rather telling him how you feel/what you need, the chance of him being receptive increase dramatically.

I’m not a psychiatrist and ethically it’s important for me to stay in my lane and respond within the scope of my area of expertise. That said, I can give you my experience working with clients dealing with anxiety over the course of a couples of decades. There are medications that you could take regularly (daily) these medications are typically prescribed for both depression and/or anxiety. These medications are SSRIs or SNRIs. The only medication that I know of that is taken regularly and is exclusively for anxiety is Buspirone. Medications that you would take as needed which is referred to as “PRN” wouldn't necessarily need to be from a class of medication called benzodiazepines, which can be problematic if you’re flying because of the side effects. There are PRNs that are being prescribed that help decrease anxiety that are being used as a-typical out of the box uses such as blood pressure medications and beta blockers such as clonidine and propranolol. You can speak with a psychiatrist to have a psychotropic evaluation and get your questions answered and that way you’ll be able to make an educated decision about what makes sense for you.

There are many strategies and ways to work with this. A common strategy is to engage in competing behaviors. For example, if you find yourself nail biting during particular times such as while watching television or reading, you might try engaging in other activities that occupy your hands during those times such as knitting/crochet or playing with a fidget spinner. You could also wear Burt’s Bees gloves which is a thin pair of gloves that allows you to use your hands and also moisturizes simultaneously (we don't want to just put on regular gloves which may feel punitive).

Counseling is incredibly effective for depression. Cognitive behavioral therapy is ideal; it helps you learn how your thoughts, behaviors and feelings are all connected and you only have to make a change in one of those three and the other two shift automatically. CBT can help you learn how to recognize maladaptive thinking patterns that lead to depression, and how to challenge and reframe the thoughts.

Depending on the type of anxiety you're experiencing, there are many many effective evidence-based treatments that can help decrease anxiety. CBT (cognitive behavioral therapy) is the treatment of choice for anxiety. It may involve helping you identify patterns of maladaptive cognitions, for example black and white thinking, catastrophizing, overgeneralization, personalization, etc. these are general ways of thinking that can lead to ongoing anxiety. Once the patterns are identified you would learn how to challenge and/or reframe them. Another way of working with anxiety is recognizing the difficulties with tolerating uncertainty and learning to live in the moment with mindfulness techniques. You might also engage in ERP (exposure response prevention) which is tolerating specific things that make you anxious beginning with the things that make you least anxious and working our way up. ERP isn't about throwing you in the lion's den with your most feared situations, but first teaching you relaxation techniques. There are also grounding techniques and meditative skills. ACT is a big one which involves allowing and accepting. There are DBT skills that complement this with radical acceptance skills and recognizing that which you have control over. I'll leave you with this:
Imagine a 5 story building on fire. See the flames waving violently out the windows of all floors of the building. Every floor is engulfed in flames. Can you picture it? You're standing there in front of the building tasked with the responsibility of putting this fire out. You have a hose in your hand, and the water that is coming out of your hose is going drip... drip... drip...
That's anxiety. What you actually need is the entire fire department and all the engines with huge hoses and shooting water to combat these monstrous flames. Anxiety is your perception of the problem being so out of control and your resources to tackle the problem being completely inadequate. "Perception" is the operative word here. It's a thinking problem. The anxiety is the feeling that gets created from the thought.

The problem with suicide is that it's a permanent solution to a temporary problem. Let's start with the issue of your parents and the comment your dad made regarding not talking to you dependent upon academic achievements. I don't know anything about your parents but I do know one thing for sure- Your dad has a limitation. A HUGE limitation. He expressed valuing your grades and academic achievements above and beyond valuing YOU as his son. I cannot even imagine the pain you must have felt and continue to feel from that. What is very important to recognize, however, is that was and is a reflection on your dad and HIS stuff and has nothing to do with you. By the way, to achieve "good grades" it takes more than being smart and studying. If you've been in an environment with pressure from your parents/dad to achieve "good grades, or else" it is incredibly difficult to work under that kind of stress/anxiety. A person's environment can greatly impact results. What I strongly suggest is that you reach out to a therapist and begin to work through some of this pain. You can always kill yourself at some later time, that isn't being taken away from you. At least you will have the opportunity to have a supportive person help you work through some of this stuff so you will be better able to make an educated decision about what you want to do. I think you've been through enough pain and you deserve to have some relief.

This is definitely worth consulting about with a medical doctor. You don't want to create an accidental infection, nor would you want to run the risk of making the scar worse. I am glad to learn you are getting help for self-harm, and my hope is that you have a relationship with your therapist in which you feel able to communicate and trust enough to get to the issues that precede the self-harm. Self-harm is the maladaptive way of coping with whatever it is that you're struggling with. I wish you much success with your process and healing.

Yes, therapy would be a great first step towards recovery and healing.

Absolutely, it does. Cognitive behavioral therapy is the treatment of choice for OCD.

I'm sorry to learn that people call you "psycho" it is uncalled for and yes, you are a human being with feelings and you deserve care like the rest of us. People are often ignorant about things they don't understand. I am not a psychiatrist but I will do my best to put in my two-cents: Based on the medications you listed, it appears you were being treated by the psychiatrist to help restore balance with the way your brain sends messages to other parts of your brain. It is not unusual for people to need help with this. For example, one of these messengers in our brain is called norepinephrine and when we don't have enough of it we become depressed. Too much of it creates stress and anxiety. Sometimes we need medication to help balance these levels of our messengers in the brain. You described hearing talking and crying sounds when you're alone. You also described feeling difficult emotions, intrusive thoughts, and perhaps urges to act. I strongly recommend that you see a psychologist and a psychiatrist. You don't have to deal with all of this alone! A psychiatrist can help you get back on the right medications that will give you relief by reducing the intensity of your symptoms, and a psychologist will help you work through your feelings and help you with your thoughts and behaviors. I think a cognitive behavioral therapist would be an excellent fit.

Psychiatrists do evaluations to see whether medication would be appropriate to help with your treatment. Psychologists or other licensed therapists would be appropriate to help with the actual therapy that will make more permanent changes with your thinking and consequently with how you feel thereby reducing your anxiety. My recommendation would be to start with a cognitive behavioral therapist and then see whether it makes sense to also be seen by a psychiatrist for medication to complement your treatment.

Thank you for your service! Typically, the best psychotherapy for PTSD would be a combination of cognitive and exposure therapies. The cognitive piece would focus on helping the person become aware of maladaptive thinking patterns and learn skills/techniques to challenge these patterns and reframe the thoughts and beliefs to ones that are healthy.
The exposure part is very important as well. It is common to experience nightmares, flashbacks, triggers, and get stuck in dissociative patterns associated with memories from traumatic things that have happened in the past. This often happens when the person remembers the traumatic experience(s) but keeps replaying the scary part in their mind over and over again like a broken record. With exposure therapy, we talk about the trauma is detail but we don’t stop at the scary part. We keep going… we talk through the part when the rescue team arrived… when the person got pulled out to safety… woke up from the coma… got to the hospital… survived to tell the story… We keep repeating the story again and again until it’s no longer “too intolerable” to speak about and we make sure to keep talking through the story past the trauma part all the way through until the end. The goal is to be able to talk about it until we can do so at a SUDS (subjective unit of distress) level of about 30% on a 0-10 scale of anxiety.

IPT focuses on the relationship between mood symptoms and interpersonal relationships. Basically we work to improve problematic relationships that trigger undesirable moods, and as a result of the work the symptoms decrease. We can also work on improving the mood which leads to more positive experiences in the otherwise problematic relationships. With CBT we focus on the relationship between thoughts, feelings, and behaviors. The premise is that we only need to make a change in one of those 3 areas and that change has an automatic impact on the other two. For example, focusing only on thought- a friend was scheduled to hang out and cancelled at the last minute. As a result, you thought to yourself that the reason the friend cancelled is because they probably didn’t want to hang out with you in the first place, you were probably their “back up” plans, and their ideal plans must have come through. Because you’re convinced that’s likely the case and in fact you start thinking that no one ever wants to hang out with you, you decide to stuff your feelings with junk food and you go to the freezer and eat a pint of Ben and Jerry’s ice cream. Now, same scenario only this time when the cancellation occurs you think to yourself that there may have been a last minute emergency on their end. You decide to use your unexpected free time to organize your photo albums which is a project you’ve had on your to-do list for a very long time. You feel accomplished when you are done. As you can see, the scenario of cancellation hadn’t changed, but your thought response, depending what you deduce for it to be, will have a direct impact on you behaviors and feelings!

The problem you’re describing is not uncommon. Cognitive behavior therapy can be very helpful with this. The good news is that you appear to have picked up on some of your patterns- the binging occurs late at night and in your kitchen. The key will be to figure out what purpose the binge eating is serving, help you with alternative coping skills other than eating, and also to learn what’s happening before the binging starts, because as much as it feels “out of control” something is preceding it that needs to be better understood, addressed, and worked through. I’ll give you an example- There are people that do “great” throughout the day and maybe even for several days restricting caloric intake and then at night all bets are off and the binging episodes begin. The restricting that precedes the binging is not sustainable! Sometimes it’s a matter of creating a healthier balance and distributing how much you eat more evenly throughout the day and evening, or maybe having something at night that you really enjoy/want (not everything in your kitchen) that you can allow yourself to sit down and eat slowly and mindfully. The anger you feel I suspect has to do with shame, and I strongly recommend you see a therapist to help you make changes in the direction of healing.

Depending on what you’re hoping to work on in therapy, there are different types of psychotherapy. Evidence-based treatments have been well researched and established to address different diagnoses. For example, cognitive behavior therapy is highly effective for depression and anxiety and many other things, dialectical behavior therapy works well to regulate intense emotions, and there are others as well.

I would suggest you talk to a licensed therapist about your anxiety. You mentioned this has been going on for two months- I wonder whether you can identify any changes or major events that occurred two months ago or leading up to that period that may have triggered your emotional response of anxiety. In therapy you can learn concrete tools how to manage anxiety and these skills are invaluable.

Definitely. This is something that can be treated in a fairly short period of time. I would suggest for you to find a qualified licensed cognitive behavior therapist. The treatment will involve some education about what is occurring. Interestingly, when you feel a panic attack coming on, even if it’s seemingly out of the blue, the truth is that it’s not “out of the blue” at all. Something preceded that panic/anxiety. There was a trigger right before the panic that typically happens so fast that we miss it, and therefore it’s common to think that the panic happens “suddenly” and “out of the blue”. In reality, a thought came first that told you there’s something bad or dangerous happening so it put your whole system into that fight/flight/freeze state. When there’s danger happening, that’s a good thing because it gives you the best chance for survival. But what happens when you have a sensitive trigger that keeps tripping the emergency panic alarm when there isn’t truly an emergency? That’s what is happening with panic attacks. We need to learn to recognize the difference between being triggered by memories from the past that are not occurring in the present, and real danger that is happening in the moment to help you not keep responding to these faulty emergency alerts as though they are real danger signals. You can learn so so much more about this with a psychologist and the how-to’s!! I wish you much success and serenity.

One important thing to note is that your stress is coming from your thoughts. There are things you are telling yourself, rules are being created that are increasing the stress, and in order to lower the stress you need to recognize you are the boss of these rules so you reserve the right to change them as well. For example, if you have a rule that you must call your parent everyday to check in and those calls turn into arguments and you dread them, you can change that rule and set a healthier boundary and decide the new rule is you will do a brief 5-10 minute check in at the beginning and end of the week. Another stress reduction tool is recognizing and accepting that we, as people, do not control what we are faced with in life, rather our task is to do the next right thing in front of us and let go of results which we have no control over anyway. There’s peace in letting go of trying to control that which you can’t and stop fighting. The pandemic, for example, it hit us all. You have the people that got angry at it, complained about it, resented it, became depressed and debilitated and feared the world is ending. You have the people on the other end of the spectrum who are upset it’s dwindling down, loved working from home, rejoiced in having more time at home with family and their kids, etc. As you can see, it’s not the “pandemic” per se but rather how people responded to it that really made the difference in their levels of anxiety and the latter is the part in which people have control. Then of course there’s the idea of allowing and accepting: it’s not always necessary to try and “fix”. Sometimes we need to feel, experience, and allow a process to unfold as it does.

Anxiety is a feeling you experience when you have worry/fear about something that has not happened yet. Therapy can help you be more present focused, living in the moment also known as “mindfulness”. People with excessive anxiety and or depression often ruminate about past events (depression) or worry about the future (anxiety) and thereby never really LIVE in the moment. Therapy helps you challenge and reframe your thoughts and by doing that the intensity of your anxious feelings (anxiety) decreases. The best type of therapy for anxiety is called Cognitive Behavioral Therapy (CBT).

Fear and anxiety are based on worries regarding things that have not yet happened. The uncertainty of the future probably adds to your anxiety and fear. The thing is though, it’s important to recognize we have zero control over life circumstances we are faced with (for example, who asked for the Covid-19 pandemic??) but we have 100% control over how we RESPOND to circumstances. Also remember that fear and anxiety are FEELINGS and even if they feel intense at times, they cannot hurt you and they are not dangerous and they will pass. Cognitive behavior therapy (CBT) has great present-focused coping skills to help reduce symptoms of fear and anxiety.