Saturday, October 17, 2020

Cheshvan: Prayer

Dear Friends,

This post is about the Jewish month of Cheshvan as it relates to The Chazak Plan: A 12 Month Journey to Spiritual Strength.

Rosh Chodesh Cheshvan begins Motzai Shabbat, Sunday night, the 17th of October and lasts for two days.

On the 7th of Cheshvan, in Israel, prayers for rain begin. For this month, focus on enhancing your prayers. You can pick a section of the prayers to say daily with understanding and input this into your checklist. In addition or instead, you can recite daily one Psalm with understanding (longer Psalms can be read over two to three days).

One type of prayer, popularized by Rebbe Nachman of Breslov, is called Hitbodedut; this is where we talk out loud to God in our native language, unburdening ourselves to Him. Try this daily practice for at least a week, preferably a month. See if it helps you feel closer to God and to feeling His support and guidance.

Even while we pray for help in specific areas of our lives, we surrender to God, acknowledging that only He knows what is truly best for us.

Questions for the month:

“Which section of the prayers will I focus on saying this month with understanding? Or, what can I do to enhance my prayers?”

“What issues are weighing on my mind that I can informally speak to God about?”

Article for the month:
How to Unlock the Hidden Power of Prayer

Take care and may God grant us success in the coming month,

Yaakov

Saturday, September 26, 2020

Saturday, September 12, 2020

You: As God Intended

 Dear Friends, 

This Friday night, September 18th, begins Rosh Hashanah. 

You: As God Intended

Have a Shana Tova!

Yaakov 



Saturday, August 29, 2020

The 7 Noahide Laws: Elevating the Human Being

According to Judaism, everyone, Jew and Gentile can earn a place in Heaven. A person does not need to convert to Judaism to lead a meaningful and spiritual life. In fact, Judaism discourages conversions. People are encouraged to serve God the way He made them: A Jew as a Jew, a Gentile as a Gentile. (If someone decides on their own to join the Jewish people and observe all the commandments, they are allowed to convert.) 

Every human being has a soul, a piece of Godliness within them. We are categorically different from animals, who do not have souls; we therefore must live very different lives. Animals live based on instinct; they kill, steal and mate at will. There are no rules or justice. Like animals, God gave us instincts and drives, but He also gave us a soul and free will; the ability to use our intellect to override our instincts. 

According to Jewish tradition, every Jewish soul was present at Mount Sinai. There, in order to forge a special bond with God, they made a commitment to follow His Torah, the 613 commandments. By following the Torah, they would lead exemplary lives and be, “...A light unto the nations (Isaiah 42:6).” 

Gentiles however, were not at Mount Sinai. They are only required to observe the 7 Noahide laws which God gave to Noah and his descendants. When a Gentile observes the 7 Noahide laws because God directed them to do so and not just because the laws make sense, they earn a place in Heaven.

Each Noahide law elevates a person above their animal instincts, and strengthens their soul’s connection to God. When someone observes the 7 Noahide laws, their actions proclaim: “I am not a slave to my instincts. I have a Creator and I follow His will and guidelines.”

The 7 Noahide Laws are:

1. Do not worship false gods. 

2. Do not curse God. 

3. Do not murder. 

4. Do not engage in forbidden relations. 

5. Do not steal. 

6. Establish courts and enforce justice. 

7. Do not eat a limb from a live animal.  

God gave these laws to humanity so that we can have a productive and peaceful society. Imagine how blissful life would be if everyone observed the 7 Noahide laws. Problems begin when people act like animals. The more we reclaim our Divine origins, the more godly our lives will become. 

Each of the 7 Noahide laws relates to a general category of conduct. For example, the commandment, “Do not worship false gods” includes belief in God and praying to Him. Also included in the 7 Noahide laws are general upright behavior such as being charitable and kind. In fact, the Prophet Ezekiel said about the Gentile city of Sodom which God destroyed, “Behold, this was the sin of your sister Sodom: Arrogance. She and her daughters had plenty of bread and peaceful serenity; yet she did not strengthen the poor and the needy (Ezekiel 16:49).” 

To help make the 7 Noahide laws part of your daily life, focus on the following three areas:

1. Do your best to stay away from forbidden relationships and be scrupulously honest when dealing with other people’s money (the two laws which most people struggle with). 

2. Strengthen your belief and gratitude to God, through daily prayer and reading spiritual texts and teachings. 

3. Look for daily opportunities to be charitable and kind and avoid anything which causes others physical, emotional or financial harm. 

When we look at the 7 Noahide laws, we see the type of life God envisioned when He created humanity. Lives of morality and ethics. Lives of spirituality and thoughtfulness for all of God’s creations. Lives suffused with belief in God and gratitude to Him. Lives of humility and kindness. Lives where justice and peace prevail for all. 

When the Messiah comes, he will usher in such a world, uplifting all of us, Jews and Gentiles. A time when, “...I will transform the peoples to a pure speech, so that they all call out in the name of God, to worship Him with one purpose (Zephaniah 3:9).” Then,  “…The earth will be full of the knowledge of God, as the waters cover the sea (Isaiah 11:9).”


There are a number of resources to learn more about the 7 Noahide Laws. Two websites among others are: https://asknoah.org and https://noahideworldcenter.org.

Wednesday, August 19, 2020

The FAR Plan: Three Steps to Emotional Health

When was the last time you felt really good, happy and content?

Many of us experience periods of low mood, anxiety, or irritability. How can we deal with these emotions and bring more peace and joy into our lives?

Many times, all that is needed is to make a few changes to our behavior or mindset. The FAR plan is for those experiencing mild to moderate emotional distress. If you are in moderate to severe distress, see a therapist and/or a psychiatrist. While under their care, you can then proceed with the FAR plan if you choose. (If at any point you feel like you might harm yourself, call 911, go to an emergency room or call the National Suicide Prevention Lifeline at 1-800-273-8255.) 

For a free depression assessment test, see here. The one for anxiety is available here

Below are tools broken down into three steps which form the FAR (Fortify, Allow and Release) plan for emotional health. Our default state is one of calm contentment. A depressed or anxious state is unnatural and often a sign that we need to strengthen an area of our lives. In the first step, fortify, we focus on fortifying our body, behavior, environment and mindset. In the second step, allow, the focus is on being okay with emotional distress, accepting it and not berating ourselves over it. The opposite of allowing, is resisting. Depression or anxiety can be a sign that we are resisting some aspect of our life. The more we let go and relax into the present moment, accepting the situation as it is and feeling compassion for ourselves, the calmer and happier we will be. In the last step, release, we focus on letting go of stress and tension. 

Fortify: 

Get adequate sleep. If you do not feel rested, you are more prone to anxiety and depression. If you are not sleeping enough, try going to sleep 15-20 minutes earlier each week until you feel refreshed in the morning. If you have trouble sleeping, consider the following tips: One hour before going to sleep, stop looking at screens which give off blue light and can keep you awake. Consider installing software, such as f.lux, to filter out blue light. Have a winding down routine where you engage in relaxing activities before sleep, such as journaling, meditation, light reading, or listening to relaxing music. Avoid caffeine, except in the morning, if it keeps you up. Avoid heavy foods right before going to sleep. Do not take late naps and keep to a set sleep/wake schedule. If you stay up late using the internet, install software to shut down the internet at a set time. Calming teas or capsules of chamomile, holy basil/Tulsi, valerian or herbal mixes specifically for sleep can be helpful. Some dietary supplements commonly used for sleep are: melatonin (either immediate release or time release, whichever works best for you), magnesium (some prefer the powder version) and tryptophan. Some benefit from sleep medication. (Talk to your doctor before combining supplements with any medication and do not take tryptophan with 5-HTP or St. John’s Wort, unless guided by a healthcare provider). More information on melatonin and valerian can be found here.

Eat healthy. Foods affect our moods. According to one study, eating a whole foods diet (vegetables, fruit, meat, fish, and whole grains) resulted in a 30% risk reduction for depression and anxiety compared to a typical western diet (processed or fried foods, refined grains, sugary products, and beer). 

A widely recommended research based diet is the Mediterranean Diet, which emphasizes vegetables, fruits, whole grains, beans, nuts, seeds and olive oil, along with moderate amounts of dairy, fish, poultry, eggs, and a limited amount of red meat (avoid sugar, white flour and highly processed foods except at special occasions). Chris Aiken MD recommends the Mediterranean Diet and quotes research that for some, the diet can be as effective as taking an antidepressant. 

An important part of a healthy diet is drinking mostly water. If you do not like the taste of your water, try a filter. 

Some people are sensitive to specific foods which negatively affect their mood. If you are interested in exploring that area, consider doing an elimination diet to determine if you have food sensitivities; the most common ones are to gluten or dairy. Articles or books explain how to do an elimination diet.

Exercise. The Mayo Clinic recommends exercising three to five times a week for thirty minutes or more, for mood enhancing effects. One study found that brisk walking for 20 minutes daily, for six weeks, enhanced people’s mood. You can also aim for between 8,000 – 12,000 steps per day, with 10,000 steps being the most often mentioned number. There are apps for smartphones or standalone pedometers to count steps. Include in your exercise routine aerobic exercise and strength training (lifting weights and core strengthening exercises). Some gain more benefits when they increase the intensity of the exercise or vary it; see what works best for you. Exercising in a natural setting and/or in sunlight has added mood enhancing effects. If you have an exercise partner, you will also gain social benefits and increased motivation to stick to your routine. At least once a week, see if you can do a morning brisk walk or jog with someone in the park.

If you are in a better mood when in sunlight or during the summer months, try using a lightbox. For more on light therapy and other tools to enhance mood, see TLC Elements.

Consider dietary supplements. If you are not interested in dietary supplements skip to the next section. For those interested, you can start by taking a multivitamin with magnesium and the coenzyme forms of B vitamins, such as methylcobalamin and methylfolate, or a separate B-complex with those coenzyme forms. Also, preferably get your vitamin D levels tested or take 2,000IUs daily. In addition, try a fish oil supplement (with 1,00mg of EPA) and Turmeric (Curcumin), 500-750mg twice daily. (Turmeric is also an excellent anti inflammatory. Some popular forms include BCM-95, Curamed, Meriva and those with black pepper to enhance absorption). If possible, have a medical checkup and be tested for low iron, B12 and thyroid function.

If you do not notice a difference after taking the above, consider adding supplements specifically for mood. Two common ones are 5-HTP and St. John's Wort. You can start by taking 5-HTP at bedtime, working up to 300mg (or take 100mg three times daily, best away from protein and with small amount of carbs such as a slice of apple or a rice cake). If after two weeks you do not experience any benefit, Peter Bongiorno ND of Put Anxiety Behind You writes that you can increase the dose to 200mg three times a day. If there is still no benefit, you can try a combination of 5-HTP and St. John’s Wort, but you will need to lower the dosage of 5-HTP. Peter Bongiorno recommends 100mg of 5-HTP three times a day with 300mg of St. John’s Wort three times a day. David Edelberg, MD, recommends a lower dose of 5-HTP, 100mg at bedtime along with St. John’s Wort (450mg twice daily) and a once daily B-complex (click here for his other suggestions). Start with the lower dosage of 5-HTP and only increase it if the higher dose gives you increased benefits and no side effects. 5-HTP is available in a time release formulation which may work better for some. Peter Bongiorno writes that some do better on Tryptophan than on 5-HTP. The dosage he uses when using Tryptophan alone is 500 - 2,500mg at bedtime, away from food but with a little carbs.

If those supplements are not helpful or cause side effects, consider three more. Two are Rhodiola and SAM-e. More information on Rhodiola, SAM-e, fish oil and St. John’s Wort can be found here: How to Prescribe Natural Medications? Part 1. Rhodiola can cause overstimulation, so start with the lowest dose on an empty stomach, then gradually increase it to 250-500mg and see how you feel. Peter Bongiorna writes that one can gradually increase the dose to as high as 1,340mg daily, if higher dosages are more helpful. A note about SAM-e: Patricia Gerbarg MD recommends the brand Azendus. If you take a different brand, make sure it is enteric coated and in blister packs. She recommends starting with 400mg and if tolerated after a few days, increase the dose to between 800-1600mg daily. Take it on an empty stomach around 30 minutes before breakfast or lunch. The third supplement is Lithium Orotate. This form of lithium is available over the counter and some recommend taking it with fish oil. The usual dose is 5mg with some practitioners using up to 20mg daily. If you find Lithium helpful and want to take it long term, especially at the higher end of the dosage range, have your doctor monitor it, as there is not a lot of research on it. An article on Lithium Orotate is available here.

When possible, work with a healthcare practitioner knowledgeable about supplements who can recommend specific products and dosages for you. If your emotional distress is severe and you still want to try supplements, seek out a holistic psychiatrist who can guide you.

Supplements may cause side effects, so add new supplements one at a time, stick to the recommended dosage and either lower the dose or stop taking it if you experience any side effects. Unless you are taking a recommended brand of a supplement, you may want to try two different brands before deciding that a supplement is not for you, as there can be significant differences between brands. If after a trial of around 6 weeks, you do not see benefit from a supplement, gradually wean off it. Do not take supplements if you are on medication without first checking with your doctor. Use reputable brands that are GMP certified, which shows attention to quality controls. If you think you may have Bipolar (I or II), see a doctor before taking supplements as some can exacerbate the condition. (For more on Bipolar II see here). For more on dietary supplements for mood disorders, Peter Bongiorno ND has a podcast here or you can read one of his books (or books by James Greenblatt MD).

Assess your environment.
Assess your job, school, relationships and living environment. Are any of them major contributors to your low mood or anxiety? If yes, speak to someone wise, with life experience or a recommended therapist to help you formulate a plan to address that area. One issue often related to jobs is finances. Being in debt, out of work, or living paycheck to paycheck can be an emotional strain. Speak to someone knowledgeable who can help you make a plan to reduce your debt, live within a budget and get career guidance. In terms of your living environment, is it cluttered? If it is, you may be surprised how much calmer and more relaxed you feel once it is decluttered. You may find it easier to have someone declutter it with or for you.

Set meaningful goals. Many struggle with a lack of meaning. We want to feel we are working toward something of value. Choose and write down a goal, something significant and worthwhile to strive for. Perhaps it is learning a new skill or hobby, advancing your career, spiritual or personal development, or doing something for your community. Break your goal down into mini goals and choose mini rewards for yourself along the way. At least once a week, engage in an activity which brings you closer to your goal. Have at least one goal which transcends yourself and is for the greater good.

According to Dr. Sonja Lyubomirsky, author of The How of Happiness, “Find a happy person and you will find a project.” What’s your project? What gives you meaning? How can you do those activities more often?

(Click on the title of Dr. Lyubomirsky’s book for a listing of, “Happiness-Enhancing Strategies.”)

Be of service to others. Each day, or at least each week, do something for someone else. It could be as simple as giving a sincere compliment, a charitable donation - even a token amount, or calling someone to see how they are doing, volunteering for an organization, visiting the sick or elderly, shopping for them or some other form of kindness.

Look for ways to share your time, talents and resources. Helping others reminds us that there are those who are less fortunate than us. When we help others, it takes our mind off our difficulties and reminds us that we can accomplish much good even while saddled with challenges. 

Strengthen your faith. Faith can enhance our emotional health. Imagine you believe the following with absolute certainty: The challenges you struggle with come from God for your eternal benefit. Part of your life’s purpose is doing what you can to overcome and grow from these challenges. No matter how bleak things look now, they will work out in the end; either in this world or in the next. God is with you at all times, giving you strength and courage to triumph.

How would you feel about your difficulties if you truly held those beliefs?

Likely you would feel better able to handle your challenges, which illustrates the power of faith to enhance our mood.

Why do some who already hold those beliefs still struggle with a low mood? First, if we do not remind ourselves of those beliefs, talking to ourselves with words of faith when we think about our challenges, the ego takes over and tells us how bad things are. Second, even after speaking to ourselves words of faith, reading psalms in a language we understand, praying to God and reading spiritual teachings, we may still experience depression and anxiety. Even very righteous men and women feel emotional pain at times. This is because the intensity of the experience or the biological underpinnings of our emotional distress override, at least temporarily, thoughts of faith.

We should not expect strengthening our faith to cure our emotional distress. But we will likely find that fortifying our faith will enhance our emotional health. See, “How to Build Unshakable Faith.”

Read a self-help book. In previous times, people lived in close proximity to older relatives and learned healthy attitudes to deal with challenges. Nowadays, we often lack that training. One solution is to find upbeat senior citizens to visit and learn how they dealt with life challenges. In addition, you can learn these skills from a good self-help book. Some popular self-help books for mood issues include:

Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks: A Workbook for Managing Depression and Anxiety by Seth J. Gillihan

The Upward Spiral Workbook: A Practical Neuroscience Program for Reversing the Course of Depression by Alex Korb. 

Feeling Great: The Revolutionary New Treatment for Depression and Anxiety by David D. Burns.

Be Grateful. According to research, being grateful increases our happiness. Begin your day expressing appreciation to God for at least one blessing in your life, preferably out loud and in your native language; elaborate on how you have benefited from this blessing.

Each day, make a conscious decision to focus on and be grateful for what goes right, the blessings inherent in every day and the bright side of difficulties. Savor and delight in life’s pleasures, enjoying them mindfully. Express appreciation for the help others give you.

In addition to appreciating what God and others have done for you, appreciate yourself. Focus on and take delight in your positive qualities; praise yourself for your achievements, good deeds and the challenges you have overcome. Also look for and praise the good you see in others.

At the root of a low mood is often a mindset of minimizing the good in our lives and maximizing the bitter (the things we have we wish we did not and the things we do not have we wish we did). To feel happier, do the opposite: Maximize what you have and what is going right and minimize what you do not yet have and what is difficult. (Minimizing difficulties means not blowing them out of proportion but still addressing them as appropriate.)

The next time you are in a low mood, ask yourself, “What bitter aspect of my life am I over focusing on? What blessed aspect am I ignoring?” Then switch focus; think about how the bitterness in your life is really manageable, and how the blessings in your life are really amazing.

When we are grateful for the blessings in our lives, we are more likely to not take things too seriously. Look for the humor in life. Throughout the day, remind yourself to smile, even if only a slight one; this will help you cultivate an inner sense of lightness and joy.

Part of gratitude is realizing that the gifts God gives us are not exclusively for our own use; He expects us to share a portion of them with others. Research shows that giving to others enhances our health and happiness; it even increases our longevity.

Allow 

Accept. Gratitude works well when we focus on the positive aspects of our lives. What about the painful ones? For those we need acceptance. Just like there are three forms of appreciation – appreciating what God and others do for you and appreciating yourself – there are three forms of acceptance, accepting the challenges God gives you, accepting others and accepting yourself. When you find yourself in a low mood, ask, “What am I resisting? Can I be more accepting of that? What aspect of my life can I be more grateful for?”

For discussions on acceptance, see, “3-Dimensional Acceptance: A Pathway to Peace and Power,” “Discover Your Inner Peace,” “Surrendering to God: 3 steps to transcend your ego,” and, “Adversity + Humility + Acceptance = Transcendence.”

Have compassion for yourself. There is a growing awareness of the importance of self-compassion, being kind to oneself, with books and websites devoted to the topic. Self-compassion flows naturally from self-acceptance; once we accept ourselves the way we are, we can be kind and loving to ourselves.

Ever notice that people may hate themselves because of a weakness they have, yet when they are dealing with others who have the same weakness, especially children, they feel no hatred, only tenderness and compassion? Why is that?

Because when dealing with others, we are better able to see the overall picture and not just focus on the weakness. When we look at the child, we are able to see the innocence, the inherent goodness the child possesses, and their struggle to overcome difficulties, which are no fault of their own.

Although our bodies age, the child inside of us remains. Never shame or insult that child. The next time you are about to berate yourself over a perceived flaw or failure, instead, bring to mind your many struggles and feel tenderness and compassion for yourself. Talk to yourself soothing words of support and encouragement. Show yourself the kindness, warmth and care you would show a child who is going through a tough time.

When you need to give yourself constructive criticism, do so lovingly and respectfully, after all, you are speaking to one of God’s children. Do not dwell on the past mistake, instead, focus on encouraging yourself to do better in the future.

In addition to extending compassion to yourself, tap into the compassion God gives you. He is constantly supporting you (Song of Songs 2:6), “His left hand is under my head and His right arm embraces me.” God tells you (Isaiah 66:13), “As one whom his mother comforts, so will I comfort you…” Pray to Him to send you comfort and strength. Then imagine waves of these feelings washing over you.

When you feel emotional distress, think while slowly breathing in, “God is with me,” and while slowly breathing out, “God is soothing and comforting me.”

After feeling Divine compassion, see if you can feel a sense of oneness with God. As Moses taught us (Deuteronomy 4:35), “…There is nothing beside Him.” In this state, there is no separate self receiving compassion from God. Instead, there is only compassion; there is only God.

Release

Connect with others. Social connection and support is crucial for our emotional health. Have family members, mentors and/or friends whom you talk to on a regular basis, enjoying their company and sharing your struggles with them. Sometimes, you need to vent, other times, you want advice or encouragement; let them know what you want. Many people have a set schedule of either daily or weekly heart-to-heart talks with a friend or family member. Look for someone to set that up with. An underutilized resource for social support is senior citizens. Many of them are good listeners with wise input.

Who’s your mentor? Life can be very challenging. The Talmud says (Berachot 5b), “A prisoner cannot free himself from prison.” Along those lines, Einstein is quoted as saying, “We cannot solve our problems with the same level of thinking that created them.” One of the biggest mistakes people make with mood disorders or with any challenge, is trying to solve it on their own. We need to humbly acknowledge that we will benefit from asking someone wise, with life experience, for help enhancing our moods (or dealing with any life challenge). If you have difficulty finding someone to advise you, a recommended therapist can serve that function.

Meditate. Throughout the day the mind is busy thinking thoughts, jumping from one topic to another. Take a moment to quiet the mind and be present. Meditation can help us do this. Meditate 1-2 times a day. Good times to meditate are in the morning, lunch time, after work, or before going to sleep. There are different meditation techniques, such as counting exhales from 1-10 and then back to 1. Or thinking calming phrases on the inhale and exhale, e.g., on the inhale, “I am” and on the exhale, “letting go” or “at peace” etc. Try different techniques until you find one that works for you. It can take time to train the mind to quiet down and to start to feel the relaxed feeling that meditation can bring.

Walk in nature. Going for a walk in the park or a hike on a regular basis, preferably with a friend but even alone is a great way to destress.

Journal. Journaling, especially about emotionally charged issues from the past and present, is a great way to let go of built up tension. You can also journal about things you are grateful for, tapping into the power of gratitude.

Tap into your creativity. Many find creative pursuits, such as drawing, singing, playing an instrument, engaging in a hobby etc. to be very helpful in reducing stress.

Turn on the music.
Music can boost our moods. Listen regularly to upbeat music, especially in the morning to set the tone for the day or after work to destress (if it’s inspirational music, even better). You can walk, dance or exercise to the music or just let it play in the background. Some enjoy classical music, such as the music of Haydn, Mozart or Beethoven.

Let go of addictive behavior. Addictive behavior can negatively impact our mood in a number of ways. We may feel badly about ourselves because we engage in those behaviors. In addition, those behaviors can take up valuable time and keep us from taking care of ourselves and being productive. For how to address addictions, see, “Overcoming Our Soft Addictions.”

Pray. Daily, engage in both formal prayer, including reciting psalms in a language you understand and informal prayer, often called Hitbodedut. This is where you talk out loud to God in your native language. Thank Him for His blessings, pour out your heart to Him about your challenges and ask for His help. Do informal prayer for at least 15 minutes a day for a week. If you find it helpful keep doing it each day.

The following FAR checklist is to help you pinpoint which areas to work on. Don’t feel overwhelmed if you realize you need to work on many areas. Just a few positive changes may be all you need.

The FAR Checklist:


1. Do I feel refreshed when I get up in the morning or am I not getting enough sleep?

2. Do I eat a Mediterranean style diet, focusing on whole foods and limiting sugars and refined grains?

3. Do I exercise at least 3 times a week, preferably in sunlight? Do I do both aerobic exercise and also strengthening exercises?

4. Do I feel better during the summer months or when out in the sunshine? If yes, have I done a trial to see if light therapy is beneficial to me (either natural sunlight or a lightbox)?

5. Am I interested in trying dietary supplements? Is there a professional I can ask for assistance?

6. Is there an issue weighing on me or an area I feel stuck in my life? Is my school, job, finances, relationships or living environment playing a big role in my anxiety or depression? If yes, who can I speak to address that?

7. Do I have an activity I’m involved in that gives me a sense of achievement, meaning or purpose?

8. Do I do acts of kindness on a regular basis?

9. Do I remind myself daily that my challenges come from God for my benefit and that He will help me overcome?

10. Do I think daily about at least one of my blessings and try to feel grateful for it?

11. Have I read a book based on cognitive behavioral therapy (CBT)?

12. Am I able to mostly accept my challenges while I work on them, or do I strongly resist the difficulties in my life?

13. Do I have self-compassion for my challenges or do I berate myself?

14. Do I often feel lonely? In the last week have I had a heart to heart talk with someone to express my feelings or at least enjoyed the company of a friend or family member?

15. Do I have a mentor? Who can I ask for advice on enhancing my mood or dealing with any of my struggles?

16. Have I tried meditation to quiet the mind?

17. Have I tried walking in nature or going for a hike, to help clear my thoughts?

18. For at least a week, have I tried writing about emotionally charged issues, from the past or present? Was it helpful? Is this something I want to make part of my daily or weekly routine?

19. Do I have any addictive behaviors that are keeping me stuck?

20. Do I pray daily? Preferably spending some time speaking to God in my native language, thanking Him for His blessings, describing my challenges and asking for His help?

Where to start?

Most of us should start with sleep, diet and exercise, or whichever ones we are motivated to address. If you are interested in trying dietary supplements, you can do that at the same time. If possible, increase and strengthen your social connections. Try combining exercise with a social component. Get together with someone at least weekly to go for a brisk walk, preferably in a park or near trees and grass. Also aim to combine social connection with a meaningful activity such as going to a class on spiritual teachings, volunteering, visiting the sick or elderly or some other form of kindness. Lastly, to address your mindset, focus on faith, acceptance and gratitude. For gratitude, you can write in a gratitude journal every day, elaborating on one or more things for which you are grateful. In addition, catch yourself when you are ruminating on a bitter aspect of your life and switch focus, either to something neutral which takes up your attention, or to a blessed aspect of your life. If you find that your mind keeps returning to anxious or depressive thoughts, read a self-help book or try therapy. 

After trying the above tools, experiment with other ones and see which ones work best for you. Whichever tools you choose, you can make a chart to keep track of how often you do them. You can use software such as Google Keep or Evernote to schedule weekly or daily recurring reminders. You may find it helpful to have a family member, friend, life coach or therapist check in with you weekly or even daily to confirm that you are doing the behaviors you chose. Knowing that they will be checking in on you, can give you added motivation to stay on track.

The tools of gratitude, acceptance and self-compassion, are especially useful in the moment, as emotional first aid. So the next time you feel down or anxious, find something for which to be grateful, whether a blessing in another area of your life, or a bright side of the painful situation. Then, talk to yourself words of faith, and see if you can be more accepting of the challenge. Lastly, remind yourself that you are going through a difficult time; give yourself compassion and feel God’s compassion for you.

After trying the tools, write down which ones work best for you. The next time you feel emotional distress, look at the list and do those tools.

If you are experiencing moderate to severe distress, or even if your distress is only mild to moderate but is not improving after trying some of these tools, then see a therapist and/or psychiatrist. For a therapist, look for a recommended one, preferably someone who practices cognitive behavioral therapy, as a lot of research has been done on that type of therapy. If you have experienced significant trauma in your life, see if you can find a therapist who specializes in that area, as there are specific interventions that can be used for that, such as EMDR, among others. Keep in mind that often people need to try more than one therapist/psychiatrist or medication(s) before finding the right one for them. Some therapists/psychiatrists are more skilled than others. If you are seeing one and either you do not feel understood, or do not see improvement, consider trying someone else.

If you are unable to find a psychiatrist on your insurance, and the ones people recommended are cost prohibitive, you may want to look into this service which pairs you with a psychiatric nurse practitioner and charges a standardized fee for intakes and follow up appointments: https://helloahead.zendesk.com/hc/en-us. They say they vet their practitioners and they currently charge $275 for the initial appointment and $160 for follow ups. They have multiple locations, but may not be available in your area.

If you have straight anxiety or depression, another option is to ask your primary care physician to prescribe something for that. If you think you may have Bipolar II (more on that below), best to see a psychiatrist. For an article which discusses primary care doctors prescribing antidepressants, see here.

A brief word on medications. Medication works best when used with other tools, especially Cognitive Behavioral Therapy. There are many psychiatric medications and it is both an art and a science to know when to prescribe what. If you see a psychiatrist, make sure to share all the symptoms you are experiencing. This will help them decide whether you have straight anxiety and/or depression, or Bipolar (I or II). For more on Bipolar II which many people are unfamiliar with, see here. The treatment is very different. For straight anxiety and/or depression, a psychiatrist will likely start with a selective serotonin reuptake inhibitor (SSRI) such as Lexapro. But for Bipolar (I or II), SSRIs can make things worse and instead mood stabilizers are used.

If medication does not help or you have too many side effects, even after trying a lower dose, consider Transcranial Magnetic Stimulation (TMS), an FDA approved depression treatment covered by some insurance companies. Outpatient mental health clinics affiliated with hospitals may offer TMS. Search for a TMS provider based on which equipment they use. Three manufacturers who have databases of providers who use their equipment are Brainsway, Neurostar, and Magventure. Brainsway’s protocols may be currently approved for more conditions.

Many treatment options exist and new ones are being developed. Never give up! Keep trying until with God's help, you find the right treatment for you. 


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