Mental Illness Archives - mind remake project

Overcoming Social Anxiety

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Social anxiety, the intense fear of social situations, is a serious and debilitating condition

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In this post, I’ll define and describe social anxiety, list its triggers and risk factors, and discuss treatment options as well as coping strategies for overcoming social anxiety disorder.

Photo by samer daboul on Pexels.com

Anxiety’s Adventures in Social-land

With social anxiety, every social interaction is an adventure of sorts; you’re in “flight-or-fight” mode, prepped to face the danger that lies ahead… which is telling the waiter what you’ll have for dinner. Once again, your sneaky brain has tricked your body into preparing for a battle when you only need to answer the question, “Would you like fries with that?”

This article is written from both a professional and personal point of view, as I was extremely shy as a child and struggled with social anxiety in adolescence and as a young adult.

What Is Social Anxiety?

People with social anxiety disorder (SAD) experience a persistent fear of social situations in which they fear they’ll be scrutinized and humiliated. This fear leads to avoidance, impacting their ability to make friends, go to school, get a job, and be successful at work.

Examples of anxiety-provoking triggers include:

Walking into an unfamiliar place such as a gas station or store
Using a public bathroom when someone else is there
Being asked to self-introduce in front of a group
Entering a room full of people
Eating in public
Having to ask for directions or help
Speaking with an authority figure
Giving a presentation
Going on a date
Using public transportation
Being the center of attention

It convinces you that every situation will have a terrible outcome. It convinces you that everyone sees you in the worst light.
Kelly Jean (Blogger)

A distinguishing characteristic of social anxiety is that the anxiety response is disproportionate to the trigger or event. For example, while it’s normal to feel somewhat anxious before making a speech or meeting your significant other’s parents for the first time, it’s not normal to experience intense fear or distress.

The following are signs of social anxiety:

Blushing
Sweating
Stuttering
Rapid heartrate
Avoiding eating and/or drinking in public
Avoiding using public restrooms
Limiting eye contact
Submissiveness
Speaking in a soft or slow voice
Rigid body posture
Self-medicating with alcohol or other substances (e.g., drinking before a party to alleviate anxiety symptoms)
Diverting attention to others
Coming off as arrogant or aloof
Being highly controlling of the conversation
Hoarseness or vocal changes when speaking
Feeling restless or irritable
Fidgeting
Presenting with extreme poise
Increased empathy

Social anxiety is often misunderstood and underrecognized. SAD is different from simply preferring to avoid social events. People with social anxiety may enjoy social gatherings where they feel comfortable and safe, such as with close friends or family members. However, they may avoid other enjoyable social events due to their anxiety.

Social anxiety disorder can feel like being under a spotlight. The spotlight is uncomfortable and the person with SAD may go to great lengths to avoid it and not “get caught.” A person with social anxiety feels embarrassed about being embarrassed.

Nobody realizes that some people expend tremendous energy merely to be normal.
Albert Camus

Additionally, people with SAD may not seem anxious, even to those who know them well. This is because they have learned to hide their anxiety or disguise it as something else, such as disinterest or aloofness. They may become withdrawn or overcompensate for their anxiety by being overly talkative and dominating the conversation. They may seem the opposite of anxious, completely poised or arrogant even, having trained themselves to not appear anxious.

Who Is at Risk for Developing Social Anxiety?

In the United States, social anxiety disorder affects approximately 7% of the population, with higher rates in women and younger adults. Rates of SAD decrease with age.

The typical onset of social anxiety disorder is in childhood between the ages of 11 and 13. It often starts as shyness but can also develop in response to a significant humiliating event, such as being bullied or having an accident in public. Although less common, SAD can develop in adulthood, usually in response to stress or a major life change.

There are a number of risk factors that contribute to the development of SAD including:

Genetics: People with a family history of SAD or other anxiety disorders are more likely to develop the condition themselves.
Environmental factors: Parents who act anxious or nervous are modeling this for their children.
Personality: Children who tend to be nervous or shy in new situations as well as children who fear rejection or punishment are more likely to develop social anxiety. A tendency to experience negative emotions, poor self-concept, and introversion are also associated with SAD.
Perfectionism: There is an association between perfectionism and SAD. Some people with SAD attempt to hide their symptoms by presenting as perfectly as they can.

How Is Social Anxiety Treated?

Treatment interventions for social anxiety disorder include medication and psychotherapy.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line pharmacological treatments for SAD. Another type of medication, beta-blockers (e.g., propranolol), can be prescribed to treat the physical symptoms of anxiety. They work by blocking adrenaline, which reduces a person’s heartrate and helps with tremors.

Cognitive behavioral therapy (CBT) and exposure therapy are effective therapeutic approaches for managing SAD, especially when combined with medication.

Complementary treatment interventions include exercise and mindfulness-based interventions.

In-the-Moment Coping Strategies for Social Anxiety Disorder

If you have social anxiety, there are a number of in-the-moment coping strategies that can help you manage your anxiety. Here are a few examples:

Self-talk: Talk to yourself in a positive and reassuring way. Tell yourself that whatever you’re facing can’t hurt you. (And you won’t die from embarrassment.) You can also try repeating a mantra to yourself, such as “This is nothing I can’t handle” or “I’ve been through worse and survived” to get yourself through the situation.
Remind yourself that everyone makes mistakes: When you feel embarrassed about something you said or did, remember that everyone makes mistakes or experiences social awkwardness from time to time. And don’t forget how quickly people forget. Hours or even minutes from now they’re not going to be thinking about you, so don’t dwell on it or let it ruin your day.
Learn to laugh at yourself: Laughing at yourself can help you to take yourself less seriously and to see the humor in the situation. This can help to reduce your anxiety by making you feel more relaxed.
Talk about it: Although it may seem counterproductive, some people find it helpful to purposely bring attention to their symptoms and/or condition. This takes the power away from your anxiety. For example, before a presentation lead with, “Bear with me, public speaking makes me anxious” or if you’re worried about blushing say, “I’m little anxious right now so I might blush.” You’ll find that most people are sympathetic.
Play the “so what” game: This is a helpful strategy for challenging your negative and/or distorted thoughts. When you’re feeling anxious, ask yourself, “So what?” What’s the worst that could happen? Once you’ve identified the worst-case scenario, you’ll realize that it’s not as bad as you thought it was.
“Dim” the spotlight: This is an avoidance strategy, not a long-term solution, but it can help you survive when you’re overwhelmed. Try to find ways to make yourself less noticeable. This could mean standing behind a podium, sitting instead of standing, or (literally) dimming the lights. You may actually build confidence this way to the point where you no longer need to make yourself less noticeable.
Bring a buddy: Sometimes it can be helpful to have someone with you for moral support. If you’re going to be in a social situation where you’re feeling anxious, have a friend or family member tag along. This can help you to feel more confident and less alone.

There is no one-size-fits-all approach, so experiment until you find what helps you the most.

To conclude, social anxiety disorder can be debilitating, but there are effective treatments for SAD as well as coping strategies for managing symptoms. You may have SAD, but that doesn’t mean you are SAD.

Be kind to yourself. Have self-compassion. Forgive yourself for mistakes and forgive your brain for betraying your body. You have social anxiety. So what? With time and effort, you can remake yourself and overcome.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Evans, R., Chiu, K., Clark, D. M., Waite, P., & Leigh, E. (2021). Safety behaviours in social anxiety: An examination across adolescence. Behaviour Research and Therapy, 144, 103931. https://doi.org/10.1016/j.brat.2021.103931
Gilboa-Schechtman, E., & Shachar-Lavie, I. (2013). More than a face: a unified theoretical perspective on nonverbal social cue processing in social anxiety. Frontiers in Human Neuroscience, 7, 904. https://doi.org/10.3389/fnhum.2013.00904
Li, J., Cai, Z., Li, X., Du, R., Shi, Z., Hua, Q., Zhang, M., Zhu, C., Zhang, L., & Zhan, X. (2021). Mindfulness-based therapy versus cognitive behavioral therapy for people with anxiety symptoms: A systematic review and meta-analysis of random controlled trials. Annals of Palliative Medicine, 10(7), 7596–7612. https://doi.org/10.21037/apm-21-1212
National Collaborating Centre for Mental Health (UK). Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society (UK); 2013. (NICE Clinical Guidelines, No. 159.) 6, INTERVENTIONS FOR ADULTS. https://www.ncbi.nlm.nih.gov/books/NBK327654/
Pelissolo, A., Abou Kassm, S., & Delhay, L. (2019). Therapeutic strategies for social anxiety disorder: Where are we now? Expert Rev Neurother, 19(12), 1179-1189. doi: 10.1080/14737175.2019.1666713
Pittelkow, M. M., Aan Het Rot, M., Seidel, L. J., Feyel, N., & Roest, A. M. (2021). Social Anxiety and Empathy: A Systematic Review and Meta-analysis. Journal of Anxiety Disorders, 78, 102357. https://doi.org/10.1016/j.janxdis.2021.102357
Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015). Exercise as treatment for anxiety: Systematic review and analysis. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine, 49(4), 542–556. https://doi.org/10.1007/s12160-014-9685-9

The Saddest Song of All Time

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A lyrical collage of heartbreaking songs from the 20th century that captures the essence of depression in music

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This is the first in a series called “Mental Illness in Music,” in which I will explore human emotion and mental disorders through song lyrics. In this piece, I reveal “the saddest song of all time,” a lyrical representation of sadness, heartbreak, and depression.

Photo by Liza Summer on Pexels.com

Throughout history, humans have used music to portray emotions. The tempo, rhythm, melody, and harmony of a musical piece can all be used to create a certain emotional mood. However, this post focuses on lyrics, which can evoke powerful emotional responses. Lyrics can stir up strong emotions, form a bond between strangers, transport us to a different place, or they can trigger personal memories or associations.

The “saddest song of all time” is a compilation of lyrics from different songs, spanning the decades from 1950 to 2000. I removed slang and edited the lyrics to be in first-person tense, so that the song would be a personal reflection on pain, rather than a description of the pain of others. The result is a haunting and emotionally raw composition that captures the pain of heartbreak, loss, and loneliness, i.e., the saddest song of all time.

Trigger warning: This post contains references to suicide and may be triggering for some people. If you are feeling suicidal or thinking about harming yourself, please reach out for help. You can call the National Suicide Prevention Lifeline at 988. You can find additional resources for suicide prevention and recovery here on this site. You are not alone.

Mental Illness in Music Series (Part 1): The Saddest Song of All Time

Hello, darkness, my old friend
I’ve come to talk with you again

I have nothing here to sell you
Just some things that I will tell you
Some things I know will chill you to the bone

I can still feel the breeze that rustles through the trees
And misty memories of days gone by
But we could never see tomorrow…
No one told us about the sorrow

The grass in the valley is starting to die
And out in the darkness the whippoorwills cry

I can’t spell away this hurt
That’s dripping down my cheek

My pouring tears
Are running wild

All I hear is the sound of rain falling on the ground
I sit and watch as tears go by

It’s plain to see
The sun won’t shine today
But [I’m not] in the mood
For sunshine anyway

Now the clouds have covered o’er
And the wind is blowing cold
I don’t need anybody
Because I learned to be alone.

…

I can’t remember anything
Can’t tell if this is true or dream
Deep down inside I feel the scream
This terrible silence stops me

Words like violence
Break the silence
Come crashing in…
Painful to me
Pierce right through me

I’m not half the man I used to be
There’s a shadow hanging over me
Oh, yesterday came suddenly

You remember the faces, the places, the names
You know it’s never over, it’s relentless as the rain

In the town of broken dreams
The streets are filled with regret

I’ve only sad stories to tell this town
My dreams have withered and died

Now those memories come back to haunt me
They haunt me like a curse
Is a dream a lie if it [doesn’t] come true
Or is it something worse?

I fall to pieces
Time only adds to the flame

And goodnight to the street sweepers
The night watchmen flame keepers

That hollow place where martyrs weep
And angels play with sin.

…

So, you think you can tell Heaven from Hell
Blue skies from pain?

I don’t build up illusion till it makes me sick
[I’m not] afraid of confusion, no matter how thick

Why does the sun go on shining?
Why does the sea rush to shore?

And the sunlight shining through the crack in the window pane
Numbs my brain, oh Lord

Life is but a memory
Happened long ago
Theatre full of sadness
For a long forgotten show

Time has a way of taking time
Loneliness is not only felt by fools
Alone, I call to ease the pain,

“Hello emptiness, I feel like I could die”

Emptiness
Is a place you’re in
With nothing to lose
But no more to win

Emptiness is filling me to the point of agony
Growing darkness taking dawn
I was me, but now he’s gone

No, I can’t forget tomorrow
When I think of all my sorrow

I look inside myself and see my heart is black
I see my red door, I must have it painted black

Accidentally like a martyr
The hurt gets worse and the heart gets harder.

…

[I’ve] used up all [my] coupons except the one…
Written on [my] wrist
Along with several thousand dreams

I’m sinking in the quicksand of my thought
And I [don’t have] the power anymore

I’m so hard to handle
I’m selfish and I’m sad

I’m beat, I’m torn
Shattered and tossed and worn

I could live a little better with the myths and the lies
When the darkness broke in
I just broke down and cried

I wear this crown of shit
Upon my liar’s chair
Full of broken thoughts
I cannot repair

No one knows what it’s like
To be hated
To be fated to telling only lies

And there’s a taste in my mouth
As desperation takes hold

Above me a bird slowly crawls across the sky
Why is there nothing now to do but die?

I tried and failed and I’m tired and weary
Everything I ever [did] was wrong
And I feel like going home

I was shivering inside…
I was swallowing my pain

I said, Mother I’m frightened
The thunder and the lightning
I’ll never come through this alone

Oh Mother, I can feel the soil falling over my head

Ice frozen six feet deep
How long does it take?

Now in darkness, world stops turning.

The Saddest Song of All Time Song List

The Sound of Silence - Simon & Garfunkel (1964) | Songwriter(s): Paul Simon 
Hello, darkness, my old friend 
I've come to talk with you again     

The Grand Tour - George Jones (1975) | Songwriter(s): Norro Wilson, Carmol Taylor, & George Richey
I have nothing here to sell you 
Just some things that I will tell you 
Some things I know will chill you to the bone   

How Can You Mend a Broken Heart - Al Green (1972) | Songwriter(s): Barry & Robin Gibb
I can still feel the breeze that rustles through the trees 
And misty memories of days gone by 
But we could never see tomorrow… 
No one told us about the sorrow     

Alone and Forsaken - Hank Williams (1952) | Songwriter(s): Hank Williams
The grass in the valley is starting to die 
And out in the darkness the whippoorwills cry     

D.I.V.O.R.C.E. - Tammy Wynette (1968) | Songwriter(s): Bobby Braddock & Curly Putman
I can't spell away this hurt 
That's dripping down my cheek   

Drown in My Own Tears - Ray Charles (1957) | Songwriter(s): Henry Glover
My pouring tears 
Are running wild     

As Tears Go By - The Rolling Stones (1965) | Songwriter(s): Mick Jagger, Keith Richards, & Andrew Loog Oldham
All I hear is the sound of rain falling on the ground 
I sit and watch as tears go by     

Kathleen - Townes Van Zandt (1969) | Songwriter(s): Townes Van Zandt
It's plain to see 
The sun won't shine today 
But [I’m not] in the mood 
For sunshine anyway     

Anywhere I Lay My Head - Tom Waits (1985) | Songwriter(s): Tom Waits
Now the clouds have covered o'er 
And the wind is blowing cold 
I don't need anybody 
Because I learned to be alone.    

One - Metallica (1988) | Songwriter(s): James Hetfield & Lars Ulrich 
I can't remember anything 
Can't tell if this is true or dream 
Deep down inside I feel the scream 
This terrible silence stops me     

Enjoy the Silence - Depeche Mode (1990) | Songwriter(s): Martin Gore
Words like violence
Break the silence
Come crashing in...
Painful to me
Pierce right through me     

Yesterday - The Beatles (1965) | Songwriter(s): John Lennon & Paul McCartney
I'm not half the man I used to be 
There's a shadow hanging over me 
Oh, yesterday came suddenly     

Adam Raised a Cain - Bruce Springsteen (1986) | Songwriter(s): Bruce Springsteen
You remember the faces, the places, the names 
You know it's never over, it's relentless as the rain     

Lonesome Town - Ricky Nelson (1959) | Songwriter(s): Baker Knight
In the town of broken dreams 
The streets are filled with regret     

Withered and Died - Richard & Linda Thompson (1974) | Songwriter(s): Richard Thompson
I've only sad stories to tell this town 
My dreams have withered and died     

The River - Bruce Springsteen (1980) | Songwriter(s): Bruce Springsteen
Now those memories come back to haunt me 
They haunt me like a curse 
Is a dream a lie if it [doesn’t] come true 
Or is it something worse?     

I Fall to Pieces - Patsy Cline (1961) | Songwriter(s): Hank Cochran & Harlan Howard
I fall to pieces 
Time only adds to the flame     

Tom Traubert’s Blues - Tom Waits (1976) | Songwriter(s): Tom Waits
And goodnight to the street sweepers 
The night watchmen flame keepers     

Dirge - Bob Dylan (1974) | Songwriter(s): Bob Dylan
That hollow place where martyrs weep 
And angels play with sin.     

Wish You Were Here - Pink Floyd (1975) | Songwriter(s): David Gilmour & Roger Waters
So, you think you can tell Heaven from Hell 
Blue skies from pain?     

Most of the Time - Bob Dylan (1989) | Songwriter(s): Bob Dylan
I don’t build up illusion till it makes me sick 
[I’m not] afraid of confusion no matter how thick     

The End of the World - Skeeter Davis (1962) | Songwriter(s): Arthur Kent & Sylvia Dee
Why does the sun go on shining? 
Why does the sea rush to shore?     

T.B. Sheets - Van Morrison (1967) | Songwriter(s): Van Morrison
And the sunlight shining through the crack in the window pane 
Numbs my brain, oh Lord   

Fruit Tree - Nick Drake (1969) | Songwriter(s): Nick Drake
Life is but a memory Happened long ago 
Theatre full of sadness 
For a long forgotten show     

In My Darkest Hour - Megadeath (1988) | Songwriter(s): Dave Mustaine & David Ellefson
Time has a way of taking time 
Loneliness is not only felt by fools 
Alone, I call to ease the pain,     

Bye-Bye Love - The Everly Brothers (1958) | Songwriter(s): Felice & Boudleaux Bryant
“Hello emptiness, I feel like I could die”       

The Sun Ain’t Gonna Shine Anymore - The Walker Brothers (1966) | Songwriter(s): Bob Crewe & Bob Gaudio
Emptiness 
Is a place you're in 
With nothing to lose 
But no more to win     

Fade to Black - Metallica (1984) | Songwriter(s): Cliff Burton, James Hetfield, Lars Ulrich, & Kirk Hammett
Emptiness is filling me to the point of agony 
Growing darkness taking dawn 
I was me, but now he's gone     

Without You - Harry Nilsson (1971) | Songwriter(s): Pete Ham & Tom Evans 
No, I can't forget tomorrow 
When I think of all my sorrow     

Paint It Black - The Rolling Stones (1966) | Songwriter(s): Mick Jagger & Keith Richards
I look inside myself and see my heart is black 
I see my red door, I must have it painted black     

Accidentally Like a Martyr - Warren Zevon (1978) | Songwriter(s): Warren Zevon
Accidentally like a martyr 
The hurt gets worse and the heart gets harder.     

Dress Rehearsal Rag - Leonard Cohen (1971) | Songwriter(s): Leonard Cohen
[I’ve] used up all [my] coupons except the one… 
Written on [my] wrist 
Along with several thousand dreams    

Quicksand - David Bowie (1971) | Songwriter(s): David Bowie
I'm sinking in the quicksand of my thought 
And I [don’t have] the power anymore     

River - Joni Mitchell (1971) | Songwriter(s): Joni Mitchell
I'm so hard to handle 
I'm selfish and I'm sad     

Trouble - Cat Stevens (1970) | Songwriter(s): Cat Stevens
I'm beat, I'm torn
Shattered and tossed and worn     

She’s Lost Control - Joy Division (1979) | Songwriter(s): Bernard Sumner, Peter Hook, Stephen Morris, & Ian Curtis
I could live a little better with the myths and the lies 
When the darkness broke in 
I just broke down and cried     

Hurt - Nine Inch Nails (1994) | Songwriter(s): Trent Reznor
I wear this crown of shit
Upon my liar's chair
Full of broken thoughts
I cannot repair     

Behind Blue Eyes - The Who (1971) | Songwriter(s): Pete Townshend
No one knows what it's like 
To be hated 
To be fated to telling only lies     

Love Will Tear Us Apart - Joy Division (1980) | Songwriter(s): Ian Curtis, Peter Hook, Stephen Morris, & Bernard Sumner 
And there's a taste in my mouth 
As desperation takes hold    

The Shortest Story - Harry Chapin (1976) | Songwriter(s): Harry Chapin
Above me a bird slowly crawls across the sky 
Why is there nothing now to do but die?     

I Feel Like Going Home - Charlie Rich (1960) | Songwriter(s): Charlie Rich
I tried and failed and I'm tired and weary 
Everything I ever [did] was wrong 
And I feel like going home     

Jealous Guy - John Lennon (1971) | Songwriter(s): John Lennon
I was shivering inside… 
I was swallowing my pain     

Night Comes On - Leonard Cohen (1984) | Songwriter(s): Leonard Cohen
I said, Mother I'm frightened 
The thunder and the lightning 
I'll never come through this alone     

I Know It’s Over - The Smiths (1986) | Songwriter(s): Morrissey & Johnny Marr
Oh Mother, I can feel the soil falling over my head     

Borrowed Tune - Neil Young (1975) | Songwriter(s): Neil Young
Ice frozen six feet deep 
How long does it take?     

War Pigs - Black Sabbath (1970) | Songwriter(s): Tony Iommi, Ozzy Osbourne, Geezer Butler, & Bill Ward
Now in darkness, world stops turning.

Do you have a lyric that you think would be perfect for the series Mental Illness in Music? If so, please submit your lyric using the Contact form by October 1, 2023.

References

Gabrielsson, A., & Juslin, P. N. (2003). Emotions in music. In P. N. Juslin & J. A. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 59-92). Oxford University Press.
Juslin, P. N., & Laukka, L. (2003). Expression and communication of emotions in music. In P. N. Juslin & J. A. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 73-104). Oxford University Press.
Krumhansl, C. L. (2002). Music and emotion: Theory and research. Annual Review of Psychology, 53(1), 625-660.
This Day in Music History (musicthisday.com)
Thompson, W. F., & Balkwill, L. J. (2007). Music and emotion: A cross-cultural perspective. Cognition and Emotion, 21(4), 767-786.
Wikipedia contributors. In Wikipedia, The Free Encyclopedia.

6 Ways I Experienced Depression

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Depression isn’t a comfortable topic, but it shouldn’t be taboo, which is why I’m sharing something deeply personal, how I experienced depression.

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True to my vision, Mind Remake Project features real-life experiences about living with mental illness and/or addiction. To date, a handful of guest writers have courageously shared about how they experienced depression or battled with alcoholism. On an even grittier, soul-baring level, an anonymous person, impromptu, shared in a comment about being homeless and addicted to drugs.

Image by María Prieto from Pixabay

Meanwhile, when it comes to my mental health and personal experiences, I’ve disclosed very little. Talking about this isn’t something I shy away from, but I find the subject rarely comes up. Polite exchange in social settings allows for topics limited to the weather, current events, career, physical health, etc. To openly discuss a mental condition is too taboo for the office watering hole or cocktail hour.

In the event that mental illness is mentioned, it brings about a palpable shift, an undercurrent of tension to the room. (I witnessed this phenomenon when I single-handedly [mouthedly?] shut down a lively group conversation; someone asked me how I got the scar on my ankle, and I answered honestly.) In response to the discomfort, some use humor to lighten the mood while others quickly change the topic; some become quiet, shifting nervously, while others exit the conversation.

Meanwhile, it’s perfectly acceptable to talk about, say, a colonoscopy, which is a medical procedure involving someone (a doctor, ideally) putting a scope up your butt. This takes place only after you’ve cleared out your bowels, a feat accomplished via pharmaceutically-induced diarrhea.

The above shows how stigma, even in a passive role, persists.

The absurdity of it is that in today’s society:

Explosive poops and scope up your butt = okay to talk about
Your mental illness = not okay to talk about, absolutely not!

And if someone feels uncomfortable (or fears making others uncomfortable) when talking about their depression experience, imagine how difficult it would be to seek treatment!

Thus far, as this site’s creator (a mental health professional who has struggled with depression and anxiety in the past), I’ve posted only research findings, information/resources related to mental health topics, and guest contributions, but have not shared my own experiences, including the very ones that influenced my career path while fostering empathy. That’s about to change.

I’m writing this post, not to provide resources or clinical tools, but to be transparent with readers about my own mental health and how I experienced depression. Also, this is to take a healthy risk while taking a stand against stigma, and, as always, in the hopes of helping anyone out there feel a little less alone.

How I Experienced Depression: Tears, Poetry, & Pain

In my teens and early 20’s, I experienced depression, including several episodes that were severe. And while nearly two decades separate me from those times, the memories can come back in a rush if, for example, I’m working with a client who is severely depressed, and I recognize the all-too-familiar signs. It attests to how powerful depression is.

This post is not to advise or offer tips for healthy coping; it’s simply to share my experience. The following are some of the ways I experienced depression and how I coped with it:

1. I cried

So much. Nearly every night, I sobbed myself to sleep. Life hurt so, so bad.

I cried during the day too, sometimes in the bathroom at school. Once, I couldn’t stop crying and I had to go home.

I took walks in the rain and wept with the sky. Other times, I would sob in the mirror, and it would make me cry harder because of how ugly I looked, red-faced and nose streaming. My puffy eyelids would be pink and swollen, like two fat earthworms.

Alone, I would sob aloud. When I thought others might be within hearing distance, I’d muffle my cries, hyperventilating into my pillow or a wad of tissues.

Supposedly, the tears produced by emotional pain contain a chemical (oxytocin) not found in the tears that spring from your eyes when you stub your toe or chop up an onion. The idea is that the release of oxytocin brings about a sense of relief and calm.

However, when a person is depressed, the crying persists, but without any sense of relief. My tears only brought headaches and more tears, a faucet I couldn’t shut off.

2. I skipped class

It’s possible my teachers wrote me off as a delinquent. I was regularly late to class, or I would leave early. In college, I sometimes didn’t go at all.

The teachers, professors, and pastors placed in my life to guide and mentor me ascertained that if I was serious about my studies, I would be on time, engage in class, or at least not have so many absences. I was reprimanded as they saw fit. But it’s hard to focus on school when you don’t want to be alive.

My reality was that I struggled to get out of bed in the mornings because I didn’t want to live – I woke up feeling disappointed that I was still alive, dreading the day. What’s more, being around others, attempting to hold it together, was too much to endure. I could barely function, and being surrounded by seemingly happy-go-lucky, oblivious classmates and teachers made it worse.

The pain of depression is all-encompassing and emotionally draining; to have to pretend to be okay on top of it devours whatever’s left. When I could no longer hold together the façade, I escaped.

3. I self-injured

The previously mentioned scar on my ankle is from a burn. I used a cigarette lighter to singe my own flesh. (The scar is still there, but today completely covered with a tattoo.) And my conversation-stopping response? It was just the truth, which was, “I was really depressed when I was younger so I would cut myself and burn myself with lighters.”

I even wrote a poem about self-mutilation (titled ‘Self-Inflicted Relief’) in which I graphically described self-harming, how Gillette became a weapon, and how the pain on the outside matched what was within.

Did it help to self-harm? Yes. It allowed me to express myself as well as punish myself. What’s more, it provided me with a sense of control.

Did I do it for attention or was it a cry for help? Not consciously, but maybe on a subconscious level? Self-harm is counterintuitive to one of our most basic, primitive drives: survival.

To purposefully hurt oneself goes against the self-preservation instinct. Due to this, when self-harm occurs, it means something is very wrong, and some form of ‘attention’ or help (i.e., intervention, treatment, etc.) is needed. In a roundabout way, a person who self-harms is getting their needs met by doing whatever it takes to survive.

4. I wrote

Trapped in a classroom, in my bedroom, or in my own head, alone with my pain, I wrote. In my depression, I journaled and I wrote poetry – lots and lots of poetry. It helped.

I also wrote notes and letters to friends. I wrote about boys and homework or drew peace signs or copied whatever the girls in the grade above me were scrawling on the covers of their composition books. The notes and letters I wrote served as distractions.

What I never wrote about to my friends was how sometimes, I wanted to die, or how I would feel paralyzed, turn bright red, and be irrationally embarrassed every time a teacher called on me in class (which I later learned was social anxiety). Those types of things were my deepest secrets, secrets I guarded with my life.

5. I ate and slept

If my depression had been a starving beast, and all I had to do to appease it was feed it, I would have conquered that monster the day I started college.

My first year at the small, private university I attended, I gained the ‘freshman 15’… each and every month. I worked in the cafeteria and, after serving lunch, I’d make myself a to-go box filled with double (sometimes triple) portions of everything. (Due to my social anxiety, I was never able to face the dining room alone. I would rather have all my fingers cut off – slowly – with a rusty tomato knife, than walk into the vast sea of students eating and socializing.) I’d take my cafeteria carryout back to my dorm room and eat by myself.

What’s more, I had round-the-clock access to junk food: chips, candy bars, milkshakes, etc. Eating was my main (sometimes my only) source of pleasure.

Along with the gluttony and lack of a social life came excessive sleeping. I’d go to bed early (as in, before 9’o’clock) every night and sleep until I had to be up the next morning.

In fact, my sleep habits were such a sure bet, the one night I stayed out past curfew, it went unnoticed by the resident assistant who did bed checks. She must have assumed that the dark lump of pillows on my bed was me because: when I had never not been in bed by 9:00 p.m.? And figuratively, I was a lump – a depressed, food-devouring lump of pillows and pain.

6. I tried to kill myself

What if you know with a certainty that things won’t change? What happens when you’re hopeless, drowning in your misery, and death starts to look more and more appealing? Sometimes, the only way to end the pain is to end yourself.

At least, that’s how I felt when I was severely depressed. That’s what the suicidal mind feels, thinks, and believes. But that isn’t (and wasn’t my) reality. Depression has a way of dimming your vision, making you forget that the world was once bright or that you’re not actually going blind.

For me to see the light, I had to stop viewing darkness as my fate, my friend… a long-term solution to my short-term pain. It never was. I wanted the pain to end, but I didn’t want to die. So, I lived. I learned to endure, and eventually, learned to love my life.

Conclusion

To conclude… depression really f***ing sucks. And it’s so lonely, bearing that heavy burden by yourself. And it gets so old, having to hide the pain all the time.

At least, that was how I experienced depression. It took me too long to learn that while it sucked, I didn’t have to deal with it alone or hide it. I only wish I had known sooner; I would have reached out and found the support and care I needed.

If you can relate to feeling depressed but think you can’t speak up or that no one will understand, you don’t have to go through this alone! Help is out there. It gets better. It will be better, you will feel better, and you will be better… I promise.

Guest Post: How CBT Can Heal Mental Illness

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CBT is a type of therapy that heals dysfunctional emotions, ideas, and behaviors. With CBT, harmful behaviors can be modified.

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Choosing a therapist is difficult enough, but it becomes perplexing when you see a long list of acronyms following their name. Cognitive behavioral therapy, or CBT, is one of those acronyms.

CBT, founded on the notion that our ideas create our reality and behavior, may be just what you need, whether you’re seeking assistance for mental health concerns or need a little additional support.

Cognitive therapy and behavioral therapy are two distinct therapy modalities combined in CBT. Cognitive therapy focuses on how ideas and beliefs lead to unfavorable feelings and behaviors. Behavioral therapy emphasizes the causes of behavioral patterns and how they can be changed to impact mood positively.

Image by mohamed Hassan from Pixabay

What is CBT?

CBT is a type of psychotherapy that uses solution-based techniques to heal dysfunctional emotions, ideas, and behaviors. It is helpful for various issues, including depression, anxiety disorders, problems with alcohol and other drugs, general stress, managing one’s anger, marital problems, eating disorders, and severe mental disease.

Establishing new, healthy behavior patterns motivates patients to confront unhelpful and misguided thinking. With CBT, it is hoped that harmful behaviors can be modified and rerouted by rewiring cognitive pathways based on the theory that our ideas and perceptions influence human behavior.

It is essential to highlight that improvements in CBT have been made due to clinical and research-based work. A wealth of scientific evidence supports CBT, demonstrating that the techniques used indeed result in change. CBT is distinct from many other types of psychiatric therapy in this way.

How is CBT practiced?

According to Mary Heekin, a therapist at CBT Denver, “CBT is a practical, results-based, evidence-tested approach. It teaches people how thoughts and actions influence mood and other aspects of mental and physical health. People are given strategies to overcome challenges daily. CBT is very flexible and can benefit people with mental health conditions.”

CBT is based on several fundamental theories, such as:

Psychological issues stem from flawed or harmful ways of thinking.
Learned undesirable behavioral patterns can evidence psychological problems.
People with psychological issues can develop more robust coping mechanisms to help them manage their symptoms and improve their effectiveness.

In CBT, efforts are made to alter thought processes, such as:

Recognizing one’s thinking patterns that are problematic and then reevaluating them in the context of reality
Improving one’s knowledge of other people’s motivations and behaviors
Use problem-solving techniques to deal with challenging circumstances
Increasing one’s self-assurance as one grows in confidence

CBT treatment attempts to alter behavioral patterns. Such strategies include:

Confronting one’s fears without ignoring
Using role-playing to get ready for possibly awkward social interactions
Learning how to relax one’s body and mind

Not all CBT will implement each of these techniques. Instead, a collaborative effort between the psychologist and patient/client is used to analyze the issue and develop a treatment plan.

The goal of CBT is to assist people in becoming therapists. Patients and clients are assisted in developing coping skills to learn to alter their thoughts, disturbing emotions, and behavior through activities done both during and outside of sessions.

Instead of focusing on the circumstances that lead to the client’s problems, CBT therapists highlight what is happening in the present. Although some knowledge of one’s past is necessary, the goal is to move forward in time and create more useful coping mechanisms.

What conditions respond well to CBT?

Many mental ailments such as mood, anxiety, eating disorders, insomnia, and substance use disorders respond well to this therapy. While CBT is beneficial for people with mental health concerns, it can help anyone improve their quality of life.

Here are three common mental health disorders that are treated with CBT:

Bipolar disorder

CBT is helpful for bipolar disorder, seasonal affective disorder, dysthymia, and depression. If you have one of these disorders, it might be beneficial to recognize thought patterns contributing to mood problems and confront them by adopting a more realistic and positive perspective on your environment. In contrast to other treatment modalities, CBT emphasizes collaboration and goal-oriented therapy sessions.

CBT teaches several essential skills that target the core ways bipolar disorder affects you. These include:

Acknowledging the diagnosis. The first step is to understand and admit that your disorder is causing your symptoms. For mental health practitioners, teaching about the condition’s indications, symptoms, causes, and progression is crucial because it may be challenging for individuals with bipolar disorder to accept their diagnosis. Psychoeducation empowers people to receive needed assistance while also realizing they are not alone.
Monitoring overall mood. This is frequently accomplished by keeping a worksheet or notebook between sessions, which is then evaluated with your therapist. On a scale of 0 to 10, where 0 equals “depressed,” 5 equals “feeling OK,” and 10 equals “very irritable or heightened mood,” patients are asked to rate their mood daily. The goal is to increase awareness of mood shifts and triggers.
Restructuring cognitive processes. A patient can fix incorrect thinking patterns by learning to become more conscious of the impact that thoughts have on their mood, how to recognize problematic thoughts, and how to change or correct them. The therapist shows the patient how to analyze their thoughts, seeing errors like ‘all-or-nothing’ thinking and coming up with more reasonable ideas.
Frequently solving problems. This stage teaches you how to recognize a problem, devise potential solutions, choose one, try it out, and assess the results. Problem-solving is typically first introduced in therapy and then practiced in-between sessions. Problems arise in all life areas, including relationships, jobs, and finances. If none of these stressors are addressed, you risk experiencing a lapse more frequently.
Improving your social abilities. Some people living with bipolar disorder struggle socially, making them feel like they aren’t in control of aspects of their lives. You may improve how you manage interpersonal relationships by developing skills like assertiveness.
Making routine changes. Establishing a rhythm to your day through regular, scheduled activity helps to stabilize your mood. Examples include:
1. Working out in the early afternoon
2. Maintaining regular sleep and mealtime routines
3. Scheduling social activities
4. Performing household duties

Anxiety disorders

Patients who suffer from anxiety disorders benefit from CBT’s attention to thoughts and behaviors. CBT assists patients in experiencing fewer and less intense symptoms of dread, anxiety, and panic, as well as avoiding being controlled by their fear by identifying habitual thought patterns that result in the sense of danger.

Cognitive behavioral therapy is effective for issues with a physical foundation. It is founded on the idea that our negative thought patterns influence or even drive our behaviors and impulses.

CBT professionals use common techniques to help you manage anxiety and change your behavior.

1. Restructuring or reframing of the mind

Examining negative thought patterns is a necessary step in this process. People may frequently:

Overgeneralize
Believe the worst will occur
Give excessive weight to minute details

This thinking could influence human actions and, in some cases, might become a self-fulfilling prediction. The therapist will inquire about one’s mental processes in certain circumstances so one can spot negative patterns.

Once the patient becomes conscious, they can learn how to change them into more optimistic and useful ones.

2. Thought challenging

By using concrete examples from our daily lives, patients may challenge their thoughts and look at something from multiple aspects. Instead of simply accepting their beliefs as the facts or the truth, thought questioning might help people view things more objectively.

A person can attempt to rectify the unhelpful beliefs with more balanced and factual ones by becoming aware of when a cognitive distortion is present in their thinking after receiving education about them.

People with anxiety may find it difficult to reason through the issues. They may experience anxiety but be unable to pinpoint its source. Or they might fear things like social gatherings but not understand why.

3. Behavioral activation

You can plan an activity if anxiety prevents you from doing it by placing it on your calendar. Doing this lets you set up a strategy and stop worrying about it.

For instance, you might plan a meet-up with a friend in the park if you’re worried about your kids’ safety at the same place. The techniques you practice in CBT will inspire you to take action and deal with the situation.

4. Maintaining journals

You can connect with and become aware of your thoughts and feelings via journaling, also known as a thought recorder. It can also facilitate cognitive organization and clarity.

You may list the negative and uplifting thoughts you can replace them with. Your therapist could encourage you to keep a journal of the new abilities and habits you practice outside of therapy sessions.

5. Behavioral research

These are frequently employed when you have devastating thinking, which is when you predict the worst.

Like in a scientific experiment, we make assumptions about the possible activity results and write down what we believe will occur and what we fear may happen.

Discussing your predictions and whether they came true with your therapist may be a good idea. You’ll eventually realize that your worst-case situation is unlikely to occur.

6. Calming methods

Relaxation methods ease tension and improve your ability to think correctly. These, in turn, can assist you in regaining control of a circumstance. These methods could consist of:

Activities for deep breathing
Progressively relaxing the muscles
Medi tation

You may apply these techniques whenever you’re anxious because they don’t take much time, like in the checkout line at the grocery store.

OCD

Patients with obsessive-compulsive disorder use particular compulsions to escape their distressing obsessive thoughts temporarily. The automatic connection between obsessive thinking and ritualistic compulsive conduct is broken through cognitive behavioral therapy. Additionally, CBT teaches patients not to engage in rituals when they are worried.

The following methods are frequently employed in CBT to assist in treating OCD patients. Along with treatment sessions, calming techniques like deep breathing and progressive muscle relaxation can be used to reduce anxiety.

Here are some CBT techniques that are commonly used to treat OCD:

1. Exposure and Response Prevention Therapy (ERP)

Exposure and response prevention therapy is the most beneficial CBT technique for treating OCD. The patient is exposed to the anxiety-inducing obsessive thought during this procedure, but they are not permitted to engage in the compulsive action. They must deal with their anxiety until it subsides, and they get numb to it by doing this to avoid the brief relief that comes with the compulsion.

Among the elements of ERP are:

In vivo exposure – Sometimes known as “real-life exposure,” involves regularly exposing a subject to feared stimuli for a long time.
Imaginal exposure – The mental representation of a feared stimulus and the effects of exposure to the stimuli is known as imaginary exposure.
Ritual or response prevention – Avoiding ritualistic behavior after exposure to the feared stimuli is known as ritual or response prevention.

2. Exercises for deep breathing

Exercises focusing on breathing are pretty effective at reducing OCD-related anxiety and can be used during ERP. Deep breathing exercises come in various forms, but they all have the same goal of soothing the body by lowering the breath and pulse rate.

3. Progressive relaxation of the muscles

People can physically contract and relieve tension throughout their bodies via progressive muscle relaxation. Our bodies may activate the fight-or-flight reaction when we are under stress or anxiety, which frequently results in muscle tightness throughout the body. You may easily manage your stress by preventing your body from activating this response.

4. CBT and cognitive restructuring

Cognitive restructuring is a method of confronting irrational thoughts or cognitive patterns. This way, patients may replace these patterns with logical, sensible thoughts. The idea is to utilize facts to refute arguments founded on emotional reactions.

By recognizing the beliefs that lead people to turn to food, drugs, or impulsive behavior, these disorders can be treated. CBT teaches patients the skills to recognize the circumstances that could lead to bingeing on substances or acting impulsively, and it also helps to find alternate, healthier ways to cope.

How to find a CBT professional

Finding a competent therapist can be difficult. Though it may seem overwhelming to know where to begin, you can find a counseling practice that is ideal for you. Here are some things to consider when searching for a CBT expert.

Initiate your search

Ask friends and relatives for ideas. Online searches are a further resource for finding a CBT therapist. You can search a database on the Psychology Today website by state. Additionally, you can look through the National Association of Cognitive-Behavioral Therapists‘ directory.

Identify the characteristics you’re looking for in a therapist

Identifying the kind of therapist you would feel at ease with is helpful. Your ability to regain mental health will depend on how well you get along with your therapist. Ask yourself:

Who are you looking for in a therapist?
Do you prefer working with a particular gender?
Do you want an older or younger therapist?
Do you desire a spiritual component to your therapy?

Don’t compromise

It’s vital that you feel at ease with your therapist. It’s acceptable to look for a better match if they aren’t a good fit. Not everyone will be a good fit, and various therapists can address multiple concerns.

Online or in-person consultation

When you visit a therapist in person, you sit on sofas or chairs in their waiting room or office. However, as more therapists see their patients virtually, clinics now provide a more comprehensive range of possibilities for online therapy. You could discover that virtual counseling is more comfortable for you.

Certain businesses, like Online-Therapy, specialize in CBT. In addition to treatment sessions, they may provide you with additional beneficial materials like workbooks and live sessions.

Group or individual therapy

You may opt for CBT in a group therapy setting or individual counseling. In a group therapy session, a facilitator, typically a mental health professional with a license, works with a small group of persons experiencing related problems. The patient can get a one-to-one consultation with the doctor in an individual counseling session.

Conclusion

It might be challenging to deal with mental illness, but fortunately, there are actions you can take to get through them. CBT is a means to alter your negative thought patterns so that they have a positive impact on how you react to circumstances.

About the Author: Dr. Joann Mundin is a board-certified psychiatrist who has been in practice since 2003. She is a Diplomate with the American Board of Psychiatry and Neurology and a Fellow with the Royal College of Physicians and Surgeons of Canada. Currently associated with Mindful Values, she provides assessments and treatment for patients with severe mental illness.

50 Helpful YouTube Videos for Psychoeducation

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A collection of 50+ short videos for psychoeducation on various mental health topics for clinical use or for self-help.

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A collection of 50+ short videos for psychoeducation on mental health topics for psychoeducational use with clients, students, or for self-help.

For additional video resources, see 18 Best TED Talks for Addiction & Recovery.

YouTube Videos for Psychoeducation

The Brain

Depression, Bipolar Disorder, & Anxiety

Emotions

Grief

Meditation & Mindfulness

Relationships & Communication

Self-Esteem & Self-Compassion

Stress

Substance Use & Addiction

Trauma & PTSD

Interview: Substance Abuse Counseling

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An interview with JS, a substance abuse counselor who works with people from all walks of life.

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JS is a certified substance abuse counselor who works at a residential treatment center in northern Virginia. The following article is about his work, thoughts on relapse, what it’s like to lose a client, stigma, and valuable advice for anyone considering a career in addiction counseling.

Photo by SHVETS production on Pexels.com

Interview: “They Are Just People”

JS works at an intermediate-length residential center for adults with substance use and mental health disorders. The clients live in shared dorms and adhere to a daily schedule that includes counseling, psychoeducation, groups, 12-step meetings, and medication therapy.

Once a client successfully completes the inpatient portion of treatment, they transition to “re-entry.” In re-entry, clients reside in sober living homes and receive continuing care services. They are able to look for employment, start working, and “re-enter” the larger community. JS provides counseling and support services for this component.

Inspired to help

JS has personal experience with addiction. “I am a person in recovery… About a decade ago I found myself in a very dark place and had to get help… I met a substance abuse counselor [who] changed my life. He educated me, engaged me, and challenged me. He was instrumental in turning my life around.”

With his counselor’s encouragement and support, JS made the decision to get back on track. He realized that he wanted to help others who struggled. “My own experiences with addiction allow me to have an incredibly deep empathy for the clients I serve and the fulfillment I receive in return is unreal.”

“Addiction does not discriminate”

JS works with people from all walks of life. He’s worked with individuals who are homeless to young fathers to successful businessmen; from people in their teens to adults in their late 80’s. “There is no age, sex, gender, race, sexual orientation, religion, occupation, or economic class that is safe from addiction.”

As for the substances abused, the list is never ending, but JS regularly sees people addicted to alcohol, opiates (including heroin), cocaine, methamphetamine, and PCP. Many of the clients he counsels also have mental illness such as depression, anxiety, or bipolar disorder.

No typical days

According to JS, “typical” days don’t exist where he works. “There is no way to describe a typical day in this field. One day I could be [providing therapy] and another day could involve a trip to the emergency room or helping out with chores… I never know what to expect and I never get bored.”

Effective treatment planning is important for substance abuse counselors; JS meets with his clients to develop an individualized service plan. Clients come up with their own goals, and JS supplies interventions to help them achieve their goals over the next couple of months.

According to JS, client goals vary, ranging from attending 12-meetings to obtaining a driver’s license to enrolling in school; basically, a goal can be any life skill a person may need for success. Corresponding interventions could include providing bus tokens to get to AA meetings, linking to driving school, and helping to fill out college applications and apply for financial aid.

JS explained that adults who have been incarcerated or dealing drugs for a living miss out on major milestones such as learning to drive, attending college, renting an apartment, etc. Furthermore, basic skills that many of us take for granted, such as filling out an online form or depositing a check can be overwhelming for someone newly in recovery who never learned how.

JS meets with his clients at least once per week for therapy sessions. I asked what comes up in a typical session and his response was “anything and everything.” Sessions may involve reviewing goals, learning coping skills, poop jokes (his clients are all men), or processing childhood trauma.

Substance abuse and relapse

“Not good” was JS’s response when I asked what the success rate was for someone who completes re-entry. He explained that this is a reflection of the general rates of recovery in substance abuse, which are low. “It can be disheartening, working with someone for months and when they leave, they relapse in less than a week.”

JS explained that while relapse is a deterrent to the field for some counselors, he sees it differently. “For me, it will never be a deterrent. My battle with addiction was not easy, nor was it accomplished in a single attempt. Relapse is a part of my story. I would not be here if people gave up or lost hope that I could get better. For that, I will never give up or lose hope that my clients can recover, no matter how many times they relapse.”

For JS, losing a client, not relapse, is the hardest part of the job. “I’ve worked with many clients who didn’t make it. I’ve lost clients to overdose, suicide, and homicide. It never gets easier.”

JS grieves for his lost clients. “I find myself wading through the stages of grief until I reach some level of acceptance.”

What everyone needs to know about substance abuse

“The people I work with are just people. They are your sister, your cousin, your neighbor, or the guy in line at the grocery store. They are people with families, jobs, hobbies, and dreams.”

JS discussed ignorance and stigma; he shared that individuals with substance use disorders are often subjected to mistreatment, even from professionals in the field. “There are substance abuse counselors who perpetuate harmful addiction myths, once widely accepted as fact, but discredited by the scientific community decades ago.”

JS shared examples of common myths:

“All addicts are liars.”
“Addicts are lazy and selfish.”
“It’s not a disease, it’s a choice.”

“The lack of compassion when it comes to substance abuse is mindboggling and painful to encounter. Often, it stems from a lack of understanding or knowledge about substance abuse and those with substance use disorders. They are just people who are struggling with something far beyond their control. And those in treatment? They are just people trying to get better. And in case I didn’t make it clear; they are just people.”

Advice for new substance abuse counselors

“Be willing to learn. The field of addiction treatment is constantly changing. Standard practices from 20 years ago are now ineffective and outdated. If you want to do this work, be open to learning the newest treatment models, medications, and research on addiction. This field is not static, and we do our clients a major disservice when we quit learning.”

As a last piece of advice, JS suggested self-care for substance abuse counselors as a way to combat burnout. “Identify ways to decompress. This job is not easy. Some of the people you help will die. Compassion fatigue is a real thing and you must take care of yourself to care for others.”

“They are just people.”
JS

18 Powerful Memoirs About Mental Illness & Addiction

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Sometimes the best way to understand mental illness or addiction is through the eyes of someone who lived it.

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18 Powerful Memoirs About Mental Illness & Addiction

1. The Big Fix: Hope After Heroin (2017) by Tracey Helton Mitchell

Amazon Description: “After surviving nearly a decade of heroin abuse and hard living on the streets of San Francisco’s Tenderloin District, Tracey Helton Mitchell decided to get clean for good.

With raw honesty and a poignant perspective on life that only comes from starting at rock bottom, The Big Fix tells her story of transformation from homeless heroin addict to stable mother of three—and the hard work and hard lessons that got her there. Rather than dwelling on the pain of addiction,Tracey focuses on her journey of recovery and rebuilding her life, while exposing the failings of the American rehab system and laying out a path for change. Starting with the first step in her recovery, Tracey re-learns how to interact with men, build new friendships, handle money, and rekindle her relationship with her mother, all while staying sober, sharp, and dedicated to her future.

A decidedly female story of addiction, The Big Fix describes the unique challenges faced by women caught in the grip of substance abuse, such as the toxic connection between drug addition and prostitution. Tracey’s story of hope, hard work, and rehabilitation will inspire anyone who has been affected by substance abuse while offering hope for a better future.”

2. Come Back: A Mother and Daughter’s Journey Through Hell and Back (2008) by Claire Fontaine & Mia Fontaine

Amazon Description: “In powerful parallel stories, mother and daughter give mesmerizing first-person accounts of the nightmare that shattered their family and the amazing journey they took to find their way back to each other. Claire Fontaine’s relentless cross-country search for her missing child and ultimate decision to force her into treatment in Eastern Europe is a gripping tale of dead ends, painful revelations, and, at times, miracles. Mia Fontaine describes her refuge in the seedy underworld of felons and addicts as well as the jarring shock of the extreme, if loving, school that enabled her to overcome depression and self-loathing. Both women detail their remarkable process of self-examination and healing with humor and unsparing honesty.

Come Back is an unforgettable true story of love and transformation that will resonate with mothers and daughters everywhere.”

3. Drinking : A Love Story (1997) by Caroline Knapp

Amazon Description: “It was love at first sight. The beads of moisture on a chilled bottle. The way the glasses clinked and the conversation flowed. Then it became obsession. The way she hid her bottles behind her lover’s refrigerator. The way she slipped from the dinner table to the bathroom, from work to the bar. And then, like so many love stories, it fell apart. Drinking is Caroline Kapp’s harrowing chronicle of her twenty-year love affair with alcohol.”

4. A Drinking Life: A Memoir (1994) by Pete Hamill

Amazon Description: “Hamill explains how alcohol slowly became a part of his life, and how he ultimately left it behind. Along the way, he summons the mood of an America that is gone forever, with the bittersweet fondness of a lifelong New Yorker.”

5. Drunk Mom: A Memoir (2014) by Jowita Bydlowska

Amazon Description: “Three years after giving up drinking, Jowita Bydlowska found herself throwing back a glass of champagne like it was ginger ale. It was a special occasion: a party celebrating the birth of her first child. It also marked Bydlowska’s immediate, full-blown return to crippling alcoholism.

In the gritty and sometimes grimly comic tradition of the bestselling memoirs Lit by Mary Karr and Smashed by Koren Zailckas, Drunk Mom is Bydlowska’s account of the ways substance abuse took control of her life—the binges and blackouts, the humiliations, the extraordinary risk-taking—as well as her fight toward recovery as a young mother. This courageous memoir brilliantly shines a light on the twisted logic of an addicted mind and the powerful, transformative love of one’s child. Ultimately it gives hope, especially to those struggling in the same way.”

6. Dry: A Memoir (2003) by Augusten Burroughs

Amazon Description: “You may not know it, but you’ve met Augusten Burroughs. You’ve seen him on the street, in bars, on the subway, at restaurants: a twentysomething guy, nice suit, works in advertising. Regular. Ordinary. But when the ordinary person had two drinks, Augusten was circling the drain by having twelve; when the ordinary person went home at midnight, Augusten never went home at all. Loud, distracting ties, automated wake-up calls and cologne on the tongue could only hide so much for so long. At the request (well, it wasn’t really a request) of his employers, Augusten lands in rehab, where his dreams of group therapy with Robert Downey Jr. are immediately dashed by grim reality of fluorescent lighting and paper hospital slippers. But when Augusten is forced to examine himself, something actually starts to click and that’s when he finds himself in the worst trouble of all. Because when his thirty days are up, he has to return to his same drunken Manhattan life―and live it sober. What follows is a memoir that’s as moving as it is funny, as heartbreaking as it is true. Dry is the story of love, loss, and Starbucks as a Higher Power.”

7. Girl, Interrupted (1993) by Susanna Kaysen

Amazon Description: “Kaysen’s memoir encompasses horror and razor-edged perception while providing vivid portraits of her fellow patients and their keepers. It is a brilliant evocation of a “parallel universe” set within the kaleidoscopically shifting landscape of the late sixties. Girl, Interrupted is a clear-sighted, unflinching document that gives lasting and specific dimension to our definitions of sane and insane, mental illness and recovery.”

8. The Heroin Diaries: Ten Year Anniversary Edition: A Year in the Life of a Shattered Rock Star (2017) by Nikki Sixx

Amazon Description: “When Mötley Crüe was at the height of its fame, there wasn’t any drug Nikki Sixx wouldn’t do. He spent days—sometimes alone, sometimes with other addicts, friends, and lovers—in a coke- and heroin-fueled daze.

The highs were high, and Nikki’s journal entries reveal some euphoria and joy. But the lows were lower, often ending with Nikki in his closet, surrounded by drug paraphernalia and wrapped in paranoid delusions.

Here, Nikki shares the diary entries—some poetic, some scatterbrained, some bizarre—of those dark times. Joining him are Tommy Lee, Vince Neil, Mick Mars, Slash, Rick Nielsen, Bob Rock, and a host of ex-managers, ex-lovers, and more.

Brutally honest, utterly riveting, and surprisingly moving, The Heroin Diaries follows Nikki during the year he plunged to rock bottom—and his courageous decision to pick himself up and start living again.”

9. Lit: A Memoir (2010) by Mary Karr

Amazon Description: “Lit follows the self-professed blackbelt sinner’s descent into the inferno of alcoholism and madness–and to her astonishing resurrection. Karr’s longing for a solid family seems secure when her marriage to a handsome, Shakespeare-quoting blueblood poet produces a son they adore. But she can’t outrun her apocalyptic past. She drinks herself into the same numbness that nearly devoured her charismatic but troubled mother, reaching the brink of suicide. A hair-raising stint in ‘The Mental Marriott,’ with an oddball tribe of gurus and saviors, awakens her to the possibility of joy and leads her to an unlikely faith. Not since Saint Augustine cried, ‘Give me chastity, Lord-but not yet!’ has a conversion story rung with such dark hilarity. Lit is about getting drunk and getting sober, becoming a mother by letting go of a mother, learning to write by learning to live. Written with Karr’s relentless honesty, unflinching self-scrutiny, and irreverent, lacerating humor, it is a truly electrifying story of how to grow up–as only Mary Karr can tell it.”

10. Loose Girl: A Memoir of Promiscuity (2008) by Kerry Cohen

Amazon Description: “Loose Girl is Kerry Cohen’s captivating memoir about her descent into promiscuity and how she gradually found her way toward real intimacy. The story of addiction–not just to sex, but to male attention–Loose Girl is also the story of a young girl who came to believe that boys and men could give her life meaning.”

11. A Million Little Pieces (2005) by James Frey

Amazon Description: “At the age of 23, James Frey woke up on a plane to find his front teeth knocked out and his nose broken. He had no idea where the plane was headed nor any recollection of the past two weeks. An alcoholic for ten years and a crack addict for three, he checked into a treatment facility shortly after landing. There he was told he could either stop using or die before he reached age 24. This is Frey’s acclaimed account of his six weeks in rehab.”

12. My Fair Junkie: A Memoir of Getting Dirty and Staying Clean (2018) by Amy Dresner

Amazon Description: “Growing up in Beverly Hills, Amy Dresner had it all: a top-notch private-school education, the most expensive summer camps, and even a weekly clothing allowance. But at 24, she started dabbling in meth in San Francisco and unleashed a fiendish addiction monster. Soon, if you could snort it, smoke it, or have sex with it, she did.

Thus began a spiral that eventually landed her in the psych ward–and then penniless, divorced, and looking at 240 hours of court-ordered community service. For two years, assigned to a Hollywood Boulevard “chain gang,” she swept up syringes (and worse) as she bounced from rehabs to halfway houses, all while struggling with sobriety, sex addiction, and starting over in her forties. In the tradition of Orange Is the New Black and Jerry Stahl’s Permanent Midnight, this is an insightful, darkly funny, and shamelessly honest memoir of one woman’s battle with all forms of addiction, hitting rock bottom, and forging a path to a life worth living.”

13. Parched: A Memoir (2006) by Heather King

Amazon Description: “In this tragicomic memoir about alcoholism as spiritual thirst, Heather King—writer, lawyer, and National Public Radio commentator—describes her descent into the depths of addiction. Spanning a decades-long downward spiral, King’s harrowing story takes us from a small-town New England childhood to hitchhiking across the country to a cockroach-ridden “artist’s” loft in Boston. Waitressing at ever-shabbier restaurants, deriving what sustenance she could from books, she became a morning regular at a wet-brain-drunks’ bar—and that was after graduating from law school. Saved by her family from the abyss, King finally realized that uniquely poetic, sensitive, and profound though she may have been, she was also a big-time mess. Casting her lot with the rest of humanity at last, she learned that suffering leads to redemption, that personal pain leads to compassion for others in pain, and, above all, that a sense of humor really, really helps.”

14. A Piece of Cake: A Memoir (2007) by Cupcake Brown

Amazon Description: “There are shelves of memoirs about overcoming the death of a parent, childhood abuse, rape, drug addiction, miscarriage, alcoholism, hustling, gangbanging, near-death injuries, drug dealing, prostitution, and homelessness.

Cupcake Brown survived all these things before she’d even turned twenty.

And that’s when things got interesting. . .

Orphaned by the death of her mother and left in the hands of a sadistic foster parent, young Cupcake Brown learned to survive by turning tricks, downing hard liquor, and ingesting every drug she could find while hitchhiking up and down the California coast. She stumbled into gangbanging, drug dealing, hustling, prostitution, theft, and, eventually, the best scam of all: a series of 9-to-5 jobs.

A Piece of Cake is unlike any memoir you’ll ever read. Moving in its frankness, this is the most satisfying, startlingly funny, and genuinely affecting tour through hell you’ll ever take.”

15. Prozac Nation: Young and Depressed in America (1994) by Elizabeth Wurtzel

Amazon Description: “Elizabeth Wurtzel writes with her finger in the faint pulse of an overdiagnosed generation whose ruling icons are Kurt Cobain, Xanax, and pierced tongues. In this famous memoir of her bouts with depression and skirmishes with drugs, Prozac Nation is a witty and sharp account of the psychopharmacology of an era for readers of Girl, Interrupted and Sylvia Plath’s The Bell Jar.”

16. Smashed: Story of a Drunken Girlhood (2005) by Koren Zailckas

Amazon Description: “Garnering a vast amount of attention from young people and parents, and from book buyers across the country, Smashed became a media sensation and a New York Times bestseller. Eye-opening and utterly gripping, Koren Zailckas’s story is that of thousands of girls like her who are not alcoholics—yet—but who routinely use booze as a shortcut to courage and a stand-in for good judgment.”

17. Tweak: Growing Up on Methamphetamines (2009) by Nic Sheff

Amazon Description: “Nic Sheff was drunk for the first time at age eleven. In the years that followed, he would regularly smoke pot, do cocaine and Ecstasy, and develop addictions to crystal meth and heroin. Even so, he felt like he would always be able to quit and put his life together whenever he needed to. It took a violent relapse one summer in California to convince him otherwise. In a voice that is raw and honest, Nic spares no detail in telling us the compelling, heartbreaking, and true story of his relapse and the road to recovery. As we watch Nic plunge into the mental and physical depths of drug addiction, he paints a picture for us of a person at odds with his past, with his family, with his substances, and with himself. It’s a harrowing portrait—but not one without hope.”

18. With or Without You: A Memoir (2014) by Domenica Ruta

Amazon Description: “Domenica Ruta grew up in a working-class, unforgiving town north of Boston, in a trash-filled house on a dead-end road surrounded by a river and a salt marsh. Her mother, Kathi, a notorious local figure, was a drug addict and sometimes dealer whose life swung between welfare and riches, and whose highbrow taste was at odds with her hardscrabble life. And yet she managed, despite the chaos she created, to instill in her daughter a love of stories. Kathi frequently kept Domenica home from school to watch such classics as the Godfather movies and everything by Martin Scorsese and Woody Allen, telling her, “This is more important. I promise. You’ll thank me later.” And despite the fact that there was not a book to be found in her household, Domenica developed a love of reading, which helped her believe that she could transcend this life of undying grudges, self-inflicted misfortune, and the crooked moral code that Kathi and her cohorts lived by.

With or Without You is the story of Domenica Ruta’s unconventional coming of age—a darkly hilarious chronicle of a misfit ’90s youth and the necessary and painful act of breaking away, and of overcoming her own addictions and demons in the process. In a brilliant stylistic feat, Ruta has written a powerful, inspiring, compulsively readable, and finally redemptive story about loving and leaving.”

For additional book suggestions, visit Must-Read Books for Therapists and 25 Top Therapist-Recommended B ooks.

13 Websites for Free Self-Help

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Websites for free online self-help and personal development

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Free Self-Help Resources & Online Support

Are you searching for free self-help? This is a list of links to various sites and services providing self-help.

For free therapy workbooks, handouts, and worksheets:

1. Counselling Resource

Take psychological self-tests and quizzes, read about symptoms and treatments, compare types of counselling and psychotherapy, learn about secure online therapy, and more

2. DBT Self-Help

A site for individuals seeking information on DBT. This site includes DBT skill lessons, flash cards, diary cards, mindfulness videos, and more.

3. Healthy Place

Mental health information, including online assessments and breaking news

4. HelpGuide.org

Collaborates with Harvard Health Publications to provide a wide range of unbiased, motivating resources and self-help tools for mental, social, and emotional. 100% nonprofit; dedicated to Morgan Leslie Segal, who died by suicide when she was 29.

5. Internet Mental Health

A free encyclopedia for mental health information on the most common mental disorders. Created by psychiatrist Dr. Phillip Long.

6. Mental Health Online

Create an account to access free mental health services for mental distress, including programs for anxiety, depression, OCD, and other disorders

7. Moodgym

Interactive self-help book for depression and anxiety. (This resource used to be free, but now there’s a small fee.)

8. National Mental Health Consumers’ Self-Help Clearinghouse

A peer-run resource center

9. Psych Central

Information on mental health, quizzes, and online self-help support groups. The site is owned and operated by Dr. John Grohol, inspired by the loss of his childhood friend to suicide.

10. Psychology Help Center

A consumer resource featuring information related to psychological issues that affect emotional and physical well-being

11. Sources of Insight

Providing the principles, patterns, and practices needed for personal development and success; a source for skilled living and personal empowerment

12. Succeed Socially

An extensive, completely free collection of articles on social skills and getting past social awkwardness. It’s written by someone who’s struggled socially himself, and who has degrees in psychology and counseling.

13. Verywell Mind

An online resource for improving mental health. All content is written by healthcare professionals, including doctors, therapists, and social workers.

Guest Post: My Experience with Depression

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“I had absolutely no direction in my life. I was a loose cannon. An unguided projectile… I viewed life in a negative, nihilistic, cynical, and overall pessimistic way.”

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Note: This article, or parts of it, may have been posted to other blogs. It is not entirely unique to this site.

Guest Post: My Experience with Depression

Depression, also known by some as the silent killer. And for good reasons.

Little did I know I was going to find this out firsthand.

Early on in life, before the age of 16, everything was perfect. I had loving parents and, in general, a loving family. I had plenty of friends. I excelled in sports and did well in school.

Things were easy back then. The only ounce of responsibility I had was making sure I got passing grades. And what if I didn’t listen in school and got detention as a result? Well, he’s still a young kid who’s figuring out life. Got into a fight? Well, he’s still a young boy who doesn’t always thinks before he acts.

But my perfect world didn’t last.

My Experience with Depression

Around the age of sweet 16, my life started changing rapidly.

I stopped feeling happy and optimistic. At first, I thought it was just a phase everyone my age went through and that it would pass as quickly as it came. But it didn’t. I had a difficult time adjusting to my ever-changing environment and handling the pressure I believed was being put on me.

I didn’t know what I wanted for my future. My friends and schoolmates already knew what they were going to study when they went to college the next year. I, however, did not. I had no direction in life. I was a loose cannon, an unguided projectile, an immature and wild kid, busy with partying and drinking.

I started getting into frequent fights; I’m not a violent person, but the anxiety, negative emotions, feelings of helplessness, and an overall sense of feeling lost in this world led to physical confrontations with others. The fights were a reflection of my poor mental state.

Then I turned 18. My parents told me it was time to start taking responsibility for my choices and actions because this time “it was for real.”

In college, I decided to pursue the field of nutrition. Not because I had a strong desire to become a dietician, but rather, because people I knew from my home town were going this route, and I figured since I was interested in exercise/health, it might be a good fit.

Newsflash, it wasn’t.

I quit school two months in. Turns out choosing what course to study based on friends rather than what you want in life is not the smartest idea. (Who would’ve thought, right?)

The following year, I gave it another try. This time I studied occupational performance. Long story short, I managed to earn a college degree despite my depression.

After I graduated and started working as an occupational therapist in a physical rehabilitation center, things got better. I was motivated to help people relearn lost skills, improving their quality of life.

But in time, my thoughts turned dark again, becoming negative and nihilistic. I slept less and my sleep quality was poor. I would randomly wake up at night and cry because I felt so terrible. I withdrew from friends and family. I even discovered a way to measure the severity of my depression; when my mood worsened, I craved alcohol. Drinking was a way to self-medicate.

alcohol use — Image by succo from Pixabay

I continued to plow away at work, but an excessive sense of responsibility, perfectionism, and anxiety was eating away at my mental health. I was head deep into my depression.

One day, I woke up and found I couldn’t get out of bed. I had nothing left in the tank. I realized I needed to take some time off work to deal with my depression and get my life in order again. I called my parents and asked to come home.

At first, I didn’t leave the bedroom. There were successive days I didn’t get up to eat or shower. I was in constant mental pain. It was hell on earth.

One evening, I managed to get out of bed and sat down to eat dinner with my parents. They were silent, and looked tired and sad. Until this moment, my depressive haze prevented me from seeing how my illness impacted my family. I decided: that’s it, no more. It was my guilt that fueled the decision to fully contend with my mental illness.

Up until now, I was only living for myself, not participating and valuing what my parents, family, and others did for me. So, something needed to change. I needed to turn my life around. And with my life, my attitude.

I started seeing a psychologist and taking antidepressants. I took a sincere look at self, including undesirable traits I’d been afraid to face. I set goals for myself. And when I had zero desire to get out of bed, I pushed through. I made sure I did something useful every day.

After several months of therapy and medication, life became manageable. I talked more, was less irritable, and as a result, my life and that of those around me improved. At times I even looked forward to things!

How Depression Changed Me

Although the depression was tough on me, and there were times I didn’t know if I was going to make it, it brought about some positive changes.

I became more mature and resilient; I learned to put things in perspective and take necessary responsibility. But the two most significant aspects that changed were my so-called “intellectual arrogance” and the pessimistic way I viewed life.

Before, I considered myself a fairly intelligent fellow. The problem with this was that I overvalued intelligence, viewing other aspects in life as inferior.

Moreover, my attitude was overwhelmingly cynical and negative. What I failed to realize is that focus shapes experience. And if you only pay attention to the negative, you miss the beauty life has to offer. Now, I actively search for the good and beautiful things happening around me.

What Helped Me Get My Depression Under Control

In addition to medication and therapy, I found the following to be helpful:

Seeking help. We can’t do everything on our own, no matter how much we’d like to. There are times when you will need help to cope with your depression. In addition to professional help, seek support from family and trusted friends. You may find that feeling heard and understood is what carries you through the darker days.
Setting goals. I had no desire to do anything in life. I had no goals. For severe depression, I would advise setting smaller goals you think you would mind doing the least (minimal effort) and/or goals which you found important in the past (before your depression took over).
Taking responsibility. Although depression can be debilitating, practice taking responsibility for the things in life under your control. For me, it was easy to blame others for everything that went wrong, believing the world to be wretched and unfair, but it didn’t do me any good.
Exercising. Mental health and physical health go hand-in-hand. Exercise releases endorphins, the “feel good” brain chemicals related to pleasure. If you don’t enjoy exercise, try a hobby that requires some level of physical exertion. As an additional benefit, engaging in exercise can take your mind off the stressful things in life.

exercise — Image by Free-Photos from Pixabay

My Depression Warning Signs

For me, there are clear signs that indicate my depression is coming back or worsening. Keep in mind that warning signs vary from individual to individual. What might be a warning sign for me may not for you.

My desire to do anything decreases. Hobbies I enjoy like weightlifting and running suddenly mean very little to me. But it’s not just about hobbies. Things like getting out of bed and showering suddenly become difficult because I have zero motivation or energy.
My thoughts get darker and more negative. It becomes increasingly tough to see the positive things in life or the positive in people. I become cynical and pessimistic.
Overthinking. I tend to overthink when things go bad, which is basically what depression is for me: feeling bad.
Anxiety. Negative thoughts and overthinking lead to increased levels of anxiety. My anxiety about the little things in life may seem insignificant to others who don’t have a mental illness, but a simple act such as calling or visiting a friend can freak me out and lead to rumination.
Ruminating. Intrusive thoughts run through my head and there’s no “off” switch.
Irritability. I become increasingly irritable; I’m in a foul mood all of the time and the smallest things piss me off.
Increased desire to self-medicate. I experience a strong desire to drink. Alcohol impacts the brain by triggering a release of dopamine. This rush of dopamine creates feelings of pleasure and happiness.
Decreased sleep quality. My overall sleep quality gets worse, partly due to constant overthinking and ruminating. Anxiety and stress are also big factors. And when I’m able to fall asleep, I wake up throughout the night.

Conclusion

Depression is a terrible disease that may go unnoticed if the signs aren’t recognized or known. A person with depression might attempt to maintain a positive front, possibly because they don’t want to complain or they’re afraid of being misunderstood.

There are multiple symptoms of depression; my symptoms went hand-in-hand, playing off one another and creating a vicious circle of negative thoughts that sucked the energy and lust for life from me.

Depression symptoms are different for different people. Learning to identify the symptoms will help you to recognize depression in others. Furthermore, an increased awareness enhances empathy and enables you to better support someone with depression.

I give the following advice to anyone with depression:

Don’t give up.
Seek professional help.
Seek support from your family and close friends.
Set goals and work hard to achieve them.
Take responsibility for the things you can control.

wellbeing — Image by Free-Photos from Pixabay

Is there a cure for depression? No. Do I think I will ever be totally depression-free? Maybe. What I do know for sure is that my illness is manageable and livable at the moment. I look forward to what the future has in store for me. Which is a lot more than I anticipated at first.

About the Author:

Kevin Mangelschots is a writer and occupational therapist with seven years of experience in the field of physical rehabilitation. He is a long-time fitness enthusiast. Kevin lives in Belgium and has created a platform for other bloggers to share their life stories where he writes about his own experience with depression at retellinglifestories.com.

100+ Resources for Suicide Prevention & Recovery

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A resource list for suicide prevention and recovery

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(Updated 7/13/23) This is a resource guide for suicide prevention and recovery. There are links to educational sites, assessment/screening tools, trainings courses, recommended books, online support communities, mobile apps, and more.

Suicide Prevention & Recovery: 100+ Resources for Mental Health Professionals & Consumers

Education & Advocacy Sites

At-Risk Youth

Assessment & Screening for Suicide Prevention

Beck Scale for Suicide Ideation
Brief Suicide Safety Assessment Guide | From NIMH
Columbia-Suicide Severity Rating Scale | A PDF version of the CSSR-S (risk assessment version)
Imminent Suicide Risk and Treatment Actions Note | PDF download
Lifetime – Suicide Attempt Self-Injury Count (L-SASI) Instructions Scoring | (Source: University of Washington Center for Behavioral Technology) The L-SASI is an interview to obtain a detailed lifetime history of non-suicidal self-injury and suicidal behavior. Citations: Linehan, M. M. &, Comtois, K. (1996). Lifetime Parasuicide History. University of Washington, Seattle, WA, Unpublished work
Non-Suicidal Self-Injury Assessment Tool Brief Version | Full Version | Assessment tool created by Cornell Research Program on Self-Injury and Recovery
Reasons for Living Scale Scoring Instructions | RFL Scale (long form – 72 items) | RFL Scale (short form – 48 items) | RFL Scale (Portuguese) | RFL Scale (Romanian) | RFL Scale (Simplified Chinese) | RFL Scale (Traditional Chinese) | RFL Scale (Thai) | (Source: University of Washington Center for Behavioral Technology) The RFL is a self-report questionnaire that measures clients’ expectancies about the consequences of living versus killing oneself and assesses the importance of various reasons for living. The measure has six subscales: Survival and Coping Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide, Fear of Social Disapproval, and Moral Objections. Citations: Linehan M. M., Goodstein J. L., Nielsen S. L., & Chiles J. A. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51, 276-286
SAFE-T Pocket Card: Suicide Assessment Five-Step Evaluation and Triage for Clinicians | Free download from SAMHSA
Suicidal Behaviors Questionnaire | SBQ with Variable Labels | SBQ Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SBQ is a self-report questionnaire designed to assess suicidal ideation, suicide expectancies, suicide threats and communications, and suicidal behavior. Citations: Addis, M. & Linehan, M. M. (1989). Predicting suicidal behavior: Psychometric properties of the Suicidal Behaviors Questionnaire. Poster presented at the Annual Meeting of the Association for the Advancement Behavior Therapy, Washington, DC
Suicide Attempt Self-Injury Interview (SASII) SASII Instructions For Published SASII | SASII Standard Short Form with Supplemental Questions | SASII Short Form with Variable Labels | SASII Scoring Syntax | Detailed Explanation of SPSS Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SASII (formerly the PHI) is an interview to collect details of the topography, intent, medical severity, social context, precipitating and concurrent events, and outcomes of non-suicidal self-injury and suicidal behavior during a target time period. Major SASII outcome variables are the frequency of self-injurious and suicidal behaviors, the medical risk of such behaviors, suicide intent, a risk/rescue score, instrumental intent, and impulsiveness. Citations: Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): Development, Reliability, and Validity of a Scale to Assess Suicide Attempts and Intentional Self-Injury. Psychological Assessment, 18(3), 303-312
Suicide Risk Screening Tool | Free printable assessment
University of WA Suicide Risk/Distress Assessment Protocol | (Source: University of Washington Center for Behavioral Technology) Reynolds, S. K., Lindenboim, N., Comtois, K. A., Murray, A., & Linehan, M. M. (2006). Risky Assessments: Participant Suicidality and Distress Associated with Research Assessments in a Treatment Study of Suicidal Behavior. Suicide and Life-Threatening Behavior (36)1, 19-33. Linehan, M. M., Comtois, K. A., &, Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232

Low-Cost & Free Trainings

Applied Suicide Prevention Skills Training (ASIST)
CALM (Counseling on Access to Lethal Means) | Free online course (includes PDF handouts)
CAMS Foundational Online Training – CAMS Assessment™ & CAMS Treatment™
The Columbia Lighthouse Project | Offers free training on the Columbia Protocol (Columbia-Suicide Severity Rating Scale, CSSR-S), a tool for assessing suicide risk
Making It Matter with Micro-Interventions | A free 2-hour course
Online Training | Several self-paced courses from Maryland Behavioral Health
Professional Development Series from The Jason Foundation | For professionals who work with at-risk youth
QPR Institute | Suicide prevention training
Suicide in Military Members & Veterans | Self-paced course 💜
Suicide Prevention Resource Center: Online Courses

Toolkits & Guides

#chatsafe: A Young Person’s Guide for Communicating Safely Online About Suicide | A 34-page printable guide
After a Suicide: A Practical and Personal Guide for Survivors | A 40-page printable guide
Ask Suicide-Screening Questions Toolkit | From NIMH
Assessing and Treating Suicidal Behaviors: A Quick Reference Guide | A 24-page printable guide from the American Psychiatric Association
Children and Suicide Toolkit
Coming Out: A Handbook for LGBTQ Young People | A 21-page PDF guide from The Trevor Project 🏳️‍🌈
Coping with Suicidal Thoughts | A 7-page PDF
Finding Your Way Back | Guiding Their Way Back | PDF booklets for download
Healthline Suicide Prevention Resource Guide
How to Talk to a Child About a Suicide Attempt in Your Family | A guide from Rocky Mountain MIRECC for Suicide Prevention
A Journey Toward Health & Hope: Your Handbook for Recovery After a Suicide Attempt | SAMHSA publication
Manual for Support Groups for Suicide Attempt Survivors | A 144-page PDF manual
Preventing Suicide in Men
Safety Plans to Prevent Suicide Toolkit
SAVE Downloadable PDFs | Free printable resources
Screening/Assessing Students: Indicators and Tools (2015) | A 74-page PDF resource
SOS: A Handbook for Survivors of Suicide | A 36-page printable guide
Suicidal Ideation Risk Assessment | A 12-page PDF guide
Suicide Prevention Primer Toolkit
Support for Suicidal Individuals on Social and Digital Media | A 22-page PDF guide
Teen Suicide Prevention: We Can Help Us | SAMHSA publication
TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment | SAMHSA publication
Transgender People and Suicide Toolkit 🏳️‍🌈
Women and Suicide
Working with the Client Who Is Suicidal: A Tool for Adult Mental Health and Addiction Services (Sources: Simon Fraser University & BC Mental Health and Substance Use Services, 120 pages)
The Workplace and Suicide Prevention Toolkit

Recommended Books

Disclaimer: This section contains affiliate links. As an Amazon Associate I earn from qualifying purchases.

Dying to Be Free: A Healing Guide for Families After a Suicide by Beverly Cobain & Jean Larch

I Wasn’t Ready to Say Goodbye: Surviving, Coping and Healing After the Sudden Death of a Loved One by Brook Noel & Pamela D. Blair, Ph.D.

No Time For Goodbyes: Coping with Sorrow, Anger, and Injustice After a Tragic Death, 7th Edition by Janice Harris Lord

Reasons to Stay Alive by Matt Haig

Thirteen Reasons Why by Jay Asher

When Bad Things Happen to Good People by Harold S. Kushner

Suicide Survivors

After a Suicide: A Practical and Personal Guide for Survivors | A 40-page printable guide
Alliance of Hope
Finding Your Way Back | Guiding Their Way Back | PDF booklets for download
Friends for Survival
The Gift of Second
How to Talk to a Child About a Suicide Attempt in Your Family | A guide from Rocky Mountain MIRECC for Suicide Prevention
A Journey Toward Health & Hope: Your Handbook for Recovery After a Suicide Attempt | SAMHSA publication
Live Through This | Stories from suicide survivors
Manual for Support Groups for Suicide Attempt Survivors | A 144-page PDF manual
Our Side of Suicide
Reasons to Go on Living
SOS: A Handbook for Survivors of Suicide | A 36-page printable guide
Suicide: Finding Hope
Survivors of Bereavement Through Suicide
Survivors of Suicide Loss

Crisis & Chat Lines for Suicide Prevention

Befrienders Worldwide | Find a helpline by country
Boys Town National Hotline | 1-800-448-3000 or text 20121 ☎
Crisis Services Canada: Suicide Prevention & Support | 1-833-456-4566 or text 45645 ☎
Crisis Text Line | 741741 (Find local chapters here)
TheHopeLine | Chat with a HopeCoach (not available 24/7)
International Suicide Prevention Wiki | Worldwide directory of suicide prevention hotlines
LGBT National Online Peer-Support CHAT 🏳️‍🌈
Nacional de Prevención del Suicidio | 1-888-628-9454 ☎
National Suicide Prevention Lifeline | 1-800-273-8255 ☎
Remedy Live Chat | Chat with a “soulmedic”
Trans Lifeline | 1-877-565-8860 ☎ 🏳️‍🌈
Trevor Lifeline | 1-866-488-7386 ☎ 🏳️‍🌈
Veterans Crisis Line | 1-800-273-8255 (Press 1) or text 838255 ☎ 💜

Online Support

Alliance of Hope Community Forum
Chronic Suicide Support Online Forum
Connections Peer Support
Healing Conversations
IMAlive | Online crisis support
Lifeline Crisis Chat Community
Parents of Suicides/Friends and Family of Suicides Chat Room
Suicide Anonymous
Suicide Forum: Breaking the Silence
Survivors of Bereavement by Suicide Forum | Peer support
TrevorSpace | Online community for LGBTQ youth ages 13-24 🏳️‍🌈

Mobile Apps

📂 Printable Resource Sheet: Suicide Prevention & Recovery

Anxiety’s Adventures in Social-land

What Is Social Anxiety?

Who Is at Risk for Developing Social Anxiety?

How Is Social Anxiety Treated?

In-the-Moment Coping Strategies for Social Anxiety Disorder

References

Mental Illness in Music Series (Part 1): The Saddest Song of All Time

The Saddest Song of All Time Song List

References

How I Experienced Depression: Tears, Poetry, & Pain

1. I cried

2. I skipped class

3. I self-injured

4. I wrote

5. I ate and slept

6. I tried to kill myself

Conclusion

What is CBT?

How is CBT practiced?

CBT is based on several fundamental theories, such as:

In CBT, efforts are made to alter thought processes, such as:

CBT treatment attempts to alter behavioral patterns. Such strategies include:

What conditions respond well to CBT?

Here are three common mental health disorders that are treated with CBT:

Bipolar disorder

Anxiety disorders

1. Restructuring or reframing of the mind

2. Thought challenging

3. Behavioral activation

4. Maintaining journals

5. Behavioral research

6. Calming methods

OCD

1. Exposure and Response Prevention Therapy (ERP)

2. Exercises for deep breathing

3. Progressive relaxation of the muscles

4. CBT and cognitive restructuring

How to find a CBT professional

Initiate your search

Identify the characteristics you’re looking for in a therapist

Don’t compromise

Online or in-person consultation

Group or individual therapy

Conclusion

YouTube Videos for Psychoeducation

The Brain

Depression, Bipolar Disorder, & Anxiety

Emotions

Grief

Meditation & Mindfulness

Relationships & Communication

Schizophrenia & Related Disorders

Self-Esteem & Self-Compassion

Stress

Substance Use & Addiction

Trauma & PTSD

Interview: “They Are Just People”

Inspired to help

“Addiction does not discriminate”

No typical days

Substance abuse and relapse

What everyone needs to know about substance abuse

Advice for new substance abuse counselors

18 Powerful Memoirs About Mental Illness & Addiction

Free Self-Help Resources & Online Support

1. Counselling Resource

2. DBT Self-Help

3. Healthy Place

4. HelpGuide.org

5. Internet Mental Health

6. Mental Health Online

7. Moodgym

8. National Mental Health Consumers’ Self-Help Clearinghouse

9. Psych Central

10. Psychology Help Center

11. Sources of Insight

12. Succeed Socially

13. Verywell Mind

Guest Post: My Experience with Depression

My Experience with Depression