Therapy has become an indispensable resource for those aiming to enhance their personal growth. Often stigmatized in the past, therapy is increasingly recognized as a worthwhile investment for mental health, self-awareness, and emotional resilience. This blog post explores how therapy can empower individuals to grow, transform, and evolve in various aspects of their lives. Therapy Support: A Path to Self-Discovery Therapy provides a structured and safe environment for self-exploration. It encourages individuals to delve into their thoughts, feelings, and behaviors, leading to greater self-discovery. Through conversations with a trained professional, clients can uncover patterns that might be holding them back from their potential. For instance, a person struggling with relationships may realize through therapy that their fear of vulnerability stems from childhood experiences. Additionally, therapy often introduces individuals to therapeutic tools and techniques that facilitate self-exploration. Cognitive-behavioral therapy (CBT) can help individuals identify negative thought patterns and replace them with positive affirmations. This shift in perspective is crucial for personal growth and helps individuals foster healthier relationships with themselves and others. Therapy Support: Building Emotional Resilience One of the primary benefits of therapy is its ability to enhance emotional resilience. Emotional resilience refers to the capacity to adapt to stressful situations and bounce back from adversity. Therapy equips individuals with coping strategies that help them navigate life's challenges with greater ease. For example, a study from the American Psychological Association found that clients who engaged in therapy reported improved coping mechanisms when faced with stressful events. These coping strategies range from mindfulness practices to emotional regulation techniques, helping individuals to manage anxiety, depression, and stress more effectively. Moreover, developing emotional resilience through therapy can lead to improved problem-solving skills. When individuals learn to view challenges as opportunities for growth, they are more likely to tackle issues head-on, making them better equipped for future obstacles. Reflecting on emotions and experiences is essential for personal growth. Is Therapy Expensive? The cost of therapy can vary significantly depending on location, therapist experience, and session length. According to a survey by the National Alliance on Mental Illness, individuals who invest in therapy often experience significant improvements in their overall well-being, productivity, and relationships. Many people find that the skills they gain in therapy far outweigh the cost. Additionally, various insurance plans cover some or all of therapy costs, making it more accessible for those who might be on the fence about seeking help. Ultimately, the determination of whether therapy is expensive depends on personal circumstances and the perceived value of mental health services. When one considers the potential for life-changing growth, it’s not just an expense, but rather an investment in oneself. Finding peace and clarity through therapeutic practices. Therapy as a Catalyst for Change Therapy acts as a catalyst for change, propelling individuals toward their goals. Many enter therapy with specific objectives, such as improving relationships, coping with grief, or managing stress more effectively. Through guidance and support, therapists can help clients identify root causes of their issues, facilitating the development of actionable plans to achieve their desired outcomes. For example, someone disappointed with their career path might use therapy to explore their passions and identify steps toward a more fulfilling professional life. By outlining clear, achievable goals during sessions, the individual is not only guided toward growth, but they also gain accountability—the therapist helps keep them on track as they navigate challenges. Additionally, engaging in group therapy can provide valuable perspective. Learning from others' experiences often offers insights that can resonate on a personal level, reinforcing the idea that growth is a communal process. The Role of Self-Compassion in Therapy Another vital element of therapy is fostering self-compassion. This concept involves treating oneself with kindness and understanding, particularly in moments of suffering or personal failure. Many individuals struggle with harsh self-criticism, which negatively impacts personal growth. Therapists often teach clients how to practice self-compassion through guided exercises. For instance, when faced with failures or setbacks, clients can learn to speak to themselves as they would to a friend, discouraging negative self-talk. This shift can lead to improved emotional well-being and a greater sense of acceptance of oneself, paving the way for exploration and growth. Building self-compassion can take time, but it is essential for fostering resilience and enhancing self-esteem. A study published in the journal Self and Identity indicated that individuals who practice self-compassion typically experience higher levels of motivation and engagement, reinforcing the importance of this practice within the therapeutic process. Embracing Change Through Therapy Engaging in therapy means embracing change, albeit sometimes reluctantly. Change can be challenging and overwhelming, but therapy helps individuals navigate this terrain with support and guidance. By facing fears and uncertainties, individuals are empowered to take control of their life stories. One common therapeutic exercise involves setting small, achievable goals. This approach allows clients to experience success in manageable doses, building confidence as they progress. With each accomplishment, individuals grow increasingly motivated to tackle bigger challenges, creating a positive feedback loop that fosters sustained personal growth. Moreover, embracing change can mean reframing setbacks. A therapist might help a client view a job loss not as a failure, but as a chance to explore new opportunities. This perspective shift often leads to groundbreaking personal revelations and significant growth. The journey of personal growth is continuous and transformative. The Journey Doesn’t End Here Therapy is more than just a means to address mental health issues; it is a journey toward self-improvement and personal growth. By supporting individuals in self-discovery, building emotional resilience, and embracing change, therapy can create lasting transformations. For anyone considering this transformative journey, exploring local options, such as asking for "therapy near me," can be the first step toward making a long-lasting change. Keep in mind that the investment in therapy holds the potential for monumental personal growth, equipping individuals with the tools they need to thrive in their lives. As you contemplate whether therapy is right for you, remember that the path to personal growth is often best navigated with support. Accepting help is a sign of strength, not weakness, and may very well be the catalyst for the change you've been seeking.

Mental health is a crucial part of our overall well-being. Just as we take care of our physical health with regular exercise and nutritious meals, our mental health requires attention and care too. The importance of mental health care is often overlooked, but it plays a fundamental role in leading a balanced and fulfilling life. This blog post delves into various aspects of mental health care and why it matters for everyone. The Role of Mental Health in Our Lives Mental health encompasses our emotional, psychological, and social well-being. It affects how we think, feel, and act. Mental health also influences how we handle stress, relate to others, and make choices. According to the World Health Organization, mental disorders are among the leading causes of disability worldwide. In fact, nearly 1 in 5 adults in the U.S. experiences mental illness in a given year. Importance of Mental Health Care Taking care of mental health is just as important as physical health. Effective mental health care can lead to: Improved Quality of Life : People who receive adequate mental health care often report better relationships and overall satisfaction with life. Enhanced Productivity : Mental health issues can hinder performance at work or school. Addressing these issues can lead to increased focus and productivity. Better Physical Health : Mental health directly affects physical health. Stress and anxiety can contribute to various physical health problems, including heart disease and obesity. Understanding Different Mental Health Disorders Understanding mental health disorders is essential for effective care. Some common disorders include: Anxiety Disorders : This includes generalized anxiety disorder, panic disorder, and phobias. About 31% of adults will experience an anxiety disorder at some point in their lives. Depressive Disorders : Major depressive disorder is one of the most common mental health conditions. Approximately 7% of adults experience a major depressive episode each year. Bipolar Disorder : This disorder involves extreme mood swings that include emotional highs (mania) and lows (depression). It affects about 2.8% of the U.S. population. Understanding these disorders can help individuals recognize symptoms in themselves or others and seek appropriate help. Treatment Options for Mental Health Issues There are numerous treatment options available for individuals experiencing mental health problems. These may include: Therapy : Types of therapy, like Cognitive Behavioral Therapy (CBT) and dialectical behavior therapy, can be effective for various mental health conditions. Medication : Antidepressants, anti-anxiety medications, and antipsychotics can assist in managing symptoms. It's essential to consult a healthcare provider about the best options. Support Groups : Engaging with others who are facing similar challenges can be immensely beneficial. Lifestyle Changes : Incorporating healthy habits, such as regular exercise, a balanced diet, and mindfulness practices, can also significantly support mental health. Books can be a source of support and knowledge about mental health. The Stigma Surrounding Mental Health Care One of the significant barriers to mental health care is stigma. Many people feel ashamed or embarrassed to seek help for their mental health. This stigma can arise from misunderstandings about mental illnesses or cultural perceptions. Combatting stigma requires education and open conversations about mental health. When individuals share their experiences and normalization of mental health struggles, it becomes easier for others to reach out for help. How to Support Mental Health in our Communities Supporting mental health in our communities can have a widespread influence. Here are some ways to contribute: Raise Awareness : Educate others about the importance of mental health care. Share articles, organize community events, or use social media platforms to spread the word. Encourage Open Dialogue : Create a safe environment where people feel comfortable discussing their mental health. Listen without judgment and provide support when needed. Advocate for Resources : Reach out to local government and advocacy groups to ensure access to mental health services remains a priority. Be Supportive : If you know someone struggling with their mental health, simply being present can make a significant difference. Offer to talk or assist them in finding resources. Taking Your First Step If you recognize that you or someone close to you might be struggling with mental health issues, taking that first step can feel daunting. Here are some actionable recommendations for getting started: Self-Assessment : Reflect on your feelings and behaviors. Consider whether your mental health is affecting various areas of your life. Seek Professional Help : Look into mental health services suitable for your needs. Whether through a local clinic, community organization, or private practitioner, reaching out for help is vital. Develop a Support System : Surround yourself with supportive friends and family who can help you feel less isolated. Stay Informed : Read articles, books, and attend workshops to educate yourself about mental health. Knowledge is a powerful tool in managing mental well-being. Practice Self-Care : Integrate self-care practices into daily routines, such as mindfulness, exercise, or hobbies that bring joy. Awareness and understanding of mental health care can lead to better individual and community health. The importance of mental health cannot be overstated; integrating care into our lives fosters resilience and enhances societal well-being. Together, we can change perceptions, reduce stigma, and support one another towards improved mental health. Remember, it’s okay to seek help, and taking that step can lead to a healthier, happier life.

Supporting someone who is grieving: These 11 ground rules are essential. Few things bring comfort in the early days after meaningful loss. Words intended to help often only annoy. Yet research shows that love and connectedness are essential for healing in the wake of challenge or loss. No approach is perfect, but these 11 ground rules are essential for helping loved ones through grief and loss . You've been there—the awkward moment when someone you care for is in despair. Maybe their eyes are red and wet, or their shoulders are slumped and shaking. Maybe their chest heaves through shallow breaths. Maybe a preternatural silence has settled in, leaving them empty and mute. And there you are, between stimulus and response. You wonder what to say. You worry about having nothing to say or saying the wrong thing. You might even convince yourself that your loved one needs “time alone to cope,” when really, it’s your own discomfort that you’re trying to avoid. Research (Moore et al., 2022) shows that love and connectedness are essential for healing in the wake of loss, so, show you care by being there. While no approach is perfect, here are some essential ground rules. What Not to Say… 1. “Don’t worry. It will all work out.” While you may hope it’s the case, you don’t know it will. Grievers don’t need wishful thinking; they need love and support. What’s more, they cling to reliable information. If you can offer that, great. If you can’t, that’s OK; find another way to be helpful, like offering encouragement, rather than guarantees. Try saying, "You can find a way through this. I’m here for you." And follow through. Also, be a resource: offer to help the person put together an action plan or help with daily tasks. Be available if more emotionally difficult chores need to be done such as cleaning out a departed loved one’s home or planning a memorial service. Play point person for sharing “approved” information with extended communities, so your loved one won’t have to. Your presence is so much more helpful than false promises of certainty. 2. “Everything happens for a reason” or “We’re only given what we can handle.” While you may believe this, others may not. And even if they did believe it previously, grief has a way of calling deeply held beliefs and principles into question. It's best not to project your own onto theirs. This is especially true for people facing betrayal or injustice. Be present or a steward, by helping your loved one accept the situation with “benevolent honesty”—a gentleness with themselves as they absorb painful realities. Also, try helping them find something meaningful about the situation that they can hold onto. Don’t try to play God. 3. “Someone always has it worse.” Maintaining perspective is an essential part of overcoming grief, but it doesn’t always come easily. Grievers typically don’t want to hear about others’ pain—at least just then. Reminders of others’ suffering especially more than they are, only grate on a person’s patience. Instead, allow loved ones to be sad , mad , outraged, or cry—to express their emotions freely. Research (NIH, 2017) shows that you got to feel to heal. This said, if you see that a loved one is down more than up, then gently suggest they talk to a professional. 4. “I know what you’re going through.” Do you really? Have you been through the same set of circumstances, with all the same dynamics that this person has? Or are you unwittingly projecting your own experiences onto theirs? It’s important to be present with your loved one’s experience and emotional challenges first. Allowing a person to be heard is one of the best supports you can offer. Only then is it helpful to share snippets of your own experience, to show empathy and solidarity. 5. “Don’t be negative. Think happy thoughts.” While wallowing isn’t particularly effective for healing, don’t forget that grief isn’t a positive experience. Trying to shield a person’s suffering behind forced feelings of happiness isn’t going to make the pain go away. It’s just going to lodge it somewhere else. “Just be positive” and other happy-based platitudes are often just ways to fill an awkward silence. Instead of touting “just be positive,” try just being honest, like, “I wish I knew what to say to you. I can’t imagine what you’re going through. Please, let me know how I can help.” If you do want to focus on something positive, remind the person of their strengths, and encourage them to leverage those when the pain becomes especially heavy. 6. “If I were you, I’d…” or “What you should do is…” It’s natural to want to help someone who’s suffering, but grief is no time for a know-it-all. Loss is a highly individualized experience and affects each of us differently. How one responds depends on many factors, including personality , coping and attachment styles , biology, life experiences, faith/belief systems , and context. Just because you might prefer one approach, doesn’t mean it’s necessarily right for someone else. Let them ask for your opinion before you impose it. If you feel strongly that you have something worthy to contribute, consider saying, “Can I make a suggestion?” Or “Maybe you would find this helpful…” 7. “I told you so.” Big no-no. Sometimes life throws us into challenging situations that we didn’t ask for. Other times we contribute to our own suffering, even if it’s unintentional. While it is hard to stand on the sidelines and watch a loved one act in ways you wouldn’t, saying “I told you so,” after a distressing outcome, is unhelpful: it’s also condescending. You get no points for being right, but you do for being present. Rather than reminding the person of your good judgment, try helping them avoid making decisions that might cause further suffering. Also, brainstorm positive actions that could move them forward in a healthy way. What To Do… 8. Be patient and take your cue from your loved one. The healing process can’t be forced, hurried, or demanded, as much as you (or they) may desire it. If your loved one feels like talking, let them. If they need quiet, give them this too, including sitting in silence when you’re together. If they’re up for a laugh, great. Research (Cacioppo, 2003) shows that both positive and negative emotions are part of the grieving mix, sometimes even coming at the same time.) If they need a cry, that’s OK too. What’s important is to let the person lead, welcome, and attend to all emotions, and remember there is no “normal” timetable for healing. 9. Check in regularly, even if you don’t hear back right away. Most grievers have limited bandwidth because grief takes a toll on our body, mind, and spirit. If you reach out and your loved one doesn’t respond, it doesn’t mean they are rejecting you. More likely it’s that they haven’t had the energy to reply. Don’t give up; it’s good for them to know that others who at the ready. Check in regularly, depending on how close you are to them. But don’t demand a call back. Just let the person know you’re thinking of them and that you’ll continue checking in if that’s okay. 10. Give a person leeway. Try not to take things personally. Grief can push us to the limits of “us,” which is why grievers often say and do things that they might not otherwise. While it may hurt to hear a harsh remark or dismissal from a loved one, consider whether it’s just because of their current situation. And if the person did mean it, remember, all relationships have dynamics. If the issue is important, it can always be addressed in the future—after things have calmed down. This said, setting boundaries is also an important part of the healing process—for grievers and supporters. 11. Give yourself leeway, too. Being present to a griever isn’t easy. You may not always get it right. You may unintentionally stick your foot in your mouth; it happens. You will also have to manage your own emotions, including unpleasant ones, especially if it feels like the relationship is out of balance, with you giving more than you are getting. Learning to stay within your “window of tolerance” (DeMarco, 2024) can be helpful. Grounding and breathing exercises (DeMarco, 2020) can work to this end. It’s also helpful to accept that the relationship may be skewed for a while. Leveraging other friends and community can go a long way to ensure that you’re supported when you are supporting another. Michele DeMarco, Ph.D., Rev, - Website - Blog - References Moore, M., Palmer, J. K., Cerel, J., & Ruocco, K. (2022). Growth and Hope after loss: How TAPS facilitates posttraumatic growth in those grieving military deaths. Frontiers in Psychology, 13, 996041. NIH News in Health (2017). Coping With Grief: Life After Loss, National Institutes of Health. Cacioppo, J. (2003). Turning adversity to advantage: On the virtues of the coactivation of positive and negative emotions. In L. Aspinwall & U. Staudinger (Eds.), A psychology of human strengths: Perspectives on an emerging field (pp. 211-226). American Psychological Association. DeMarco, M. (2024). What happens when your stress exceeds your Window of Tolerance: 5 ways to decrease arousal. Psychology Today. DeMarco, M. (2022). 7 Surprising breathing exercises to instantly reduce stress: Conscious breathing, cellular breathing, and other easy techniques to feel calmer, Medium.

You have the power to create the life you want to lead. Being who you want to be and living the life you want to lead takes active steps. You can't move forward in your life if you are clinging to your past. Living without fear, making deliberate choices, and embracing your humanity will get you to "I'm good."   To what do you aspire? Who do you want to be, and what kind of life do you want to lead? To be happy, successful, impactful, rich, famous, loved? We all want to find and experience that elusive “Holy Grail” that we believe will fulfill our aspirations. However, as is commonly expressed in both ancient philosophical thought and modern-day self-help dogma, “once you get there, there is no there.” Instead, it is the journey that provides us with our so-sought-after sense of what I call “I’m good.” Though this brief phrase sounds simple, it carries with it profound meaning that includes feeling good about yourself, being in a good place in your life, feeling safe and secure, experiencing contentment, and having deep and nurturing relationships, just to name a few. You now may be asking, “If having aspirations like those described above are not the way to go, what steps should I take to find meaning, satisfaction, and joy in my life?” I have identified five that, if you strive for and achieve, you will, as the saying goes, “live a life worth leading.” 1. Let Go of Your Past An unfortunate, though inevitable, aspect of the human condition is that we all carry baggage with us from childhood into adulthood. What I mean by baggage are ways of thinking, experiencing emotions, behaving, interacting with others, and generally acting and reacting to our world in a way that was once functional (i.e., it protected us from some perceived threat) but is now nonfunctional (it no longer serves our best interests and interferes with our pursuing our most closely held aspirations). Without letting go of this baggage from our past, finding meaning, satisfaction, joy, and connection in our present lives is nearly impossible. Of course, freeing yourself from your baggage is no small feat because these burdens that we may have been carrying around with us for years not only produce deeply ingrained habits but also are wired into our brains. The result is that our baggage is highly resistant to change. Yet, there is considerable empirical evidence and first-hand experience that we all see that unpacking our baggage is possible. As the saying goes, though, there is no one road to Rome; rather, there are many ways to identify and let go of your baggage including seeing a trained mental health counselor  (my recommendation), reading, encounter groups, online courses, meditation, and support groups. 2. Know Your Values You can’t live a life worth living if you don’t know what that life entails. The simplest way to live such a life is to know your values. Values are a fundamental part of aspiring to be your best and do your best in your life. You may be wondering, “What do you mean by values?” Values are what we deem most important and how we establish priorities in our lives. They are the road signs on our journey because we go in a certain direction based on what we value in our lives. Perhaps the most common way people try to figure out what they value is to sit down and make a list of everything they believe in and then pick the ones that they believe are most important to them. At the same time, I’ve found this approach tends to make us choose values that we think  we should have rather than what values we actually do have. I have found the best way to know your values is to see what you devote your time, energy, and money to. Once you know your values, you can then make choices to live the life you want to lead based on those values. 3. Live Without Fear Most people are unable to be who they want to be or live the life they want to lead because of one elemental emotion: fear. What is everyone afraid of? Quite simply, they’re afraid of failure in many guises including rejection, school and career setbacks, unachieved goals, being judged negatively by others, judging themselves negatively, and, at its core, fear of confirming who they really  are—that is, total losers unworthy of respect and love. Because of this fear, most people are unwilling to take their shot—whether in careers, relationships , or anything of consequence—for fear of missing. The problem is that without being willing to take the shot, we can never score. As the hockey G.O.A.T. Wayne Gretzky once stated so profoundly, “I missed 100% of the shots I didn’t take.” At a deeper level, people live with the fear that the emotions they would experience if they fail would be indescribably excruciating (e.g., pain, sadness, guilt, embarrassment, shame, loneliness, devastation). No doubt, if you fail, you will certainly feel bad, and it might last a while. At the same time, we humans are resilient creatures, and, in time, the pain would subside, and you would be OK. Imagine what life would be like without fear of failure and pain. Every opportunity that arose, you would embrace. Every shot you would take. Every reasonable risk you would go for. Everything you ever wanted, you would pour your heart into achieving it. You would be liberated to pursue your dreams with confidence, courage, commitment, and gusto, and without doubt, worry, or anxiety. 4. Make Deliberate Choices Many years ago, a long-time friend visited me. Over dinner, as we talked about our lives, he said, “Jim, you designed your destiny.” His statement always struck me as important and as reflective of the life I was (and am still) trying to lead. I always had a clear vision of the life I wanted to live including being guided by my values and passions, having freedom in my career, living in a place that aligned with my interests, and having people in my life that brought out the best in me. Some years later, I realized that designing one’s destiny came down to simply making deliberate choices. Particularly these days in the age of the internet, it is easy to be influenced by the dominant messages of our popular culture (e.g., wealth, celebrity, status, and power are all that matter). With this influence, we often abdicate the choices we make to others. Even worse, many of these “choices” that are imposed on us are not only unhealthy but they also are downright toxic. Additionally, though we like to think of ourselves as evolved beings with a cerebral cortex and, more specifically, a pre-frontal cortex that separates us from animals, the reality is that we still frequently react to the world the same way our ancient ancestors did eons ago. In other words, we are guided far more often than we like to admit by primitive instincts, emotions, and reactions (e.g., fight or flight) that worked well for our forbearers but aren’t the least bit effective in life in 2024. Our pre-frontal cortex endows us with what is commonly referred to as “executive functioning,” which gives us the capacity to weigh immediate and future risks and rewards, delay gratification, organize and plan, control our impulses, and make deliberate choices. It also gives us the ability to resist our primitive urges, decide what is in our best interests, and then choose to take the latter road. You can think of your life as a series of forks in the road—bad road, good road. Your ability to engage your pre-frontal cortex and allow yourself to decide what the best road is for you and then take it is essential to fulfilling your life’s aspirations. 5. Embrace Your Humanity One of the biggest sources of unhappiness and dissatisfaction in people’s lives these days seems to stem from unhealthy messages they receive from our media-driven culture—most notably, the need to be perfect. Research has shown, for example, that users of social media curate their online persona to appear “perfectly” happy, when, in fact, they aren’t. Anyone who suffers from perfectionism knows (and I’m a perfectionist in recovery) that there can be no happiness or satisfaction in striving to be perfect because, as human beings, we are incapable of achieving perfection. As such, its pursuit is fraught with failure, insecurity, doubt, worry, stress, anxiety , exhaustion, and the list goes on, all entirely antithetical to any semblance of contentment or peace. Moreover, what most people don’t realize is that perfection is, at best, uninteresting and, at worst, downright boring, like that bright, shiny thing that loses its luster quickly. The antidote to this malady is to embrace your humanity. What this means is to not only to accept your idiosyncrasies and flaws but also to revel in them. Why would you want to celebrate your imperfections? Because it is those very “defects” that make us interesting, relatable, and, well, human. Jim Taylor, PhD - Blog - Book

Stanford Study Reveals Ketogenic Diet’s Impact on Mental Health Nearly half of bipolar disorder patients do not effectively respond to current drug treatments. Metabolic psychiatry uses diet to boost mental health, with ketogenic diet showing promise in clinical trials. A Stanford pilot study found that ketogenic diet led to remission in half of the bipolar patients treated This post is co-authored by Kirk Nylen, PhD and Burcin Ikiz, PhD. Forty-six million people worldwide are living with bipolar disorder , typically treated with medications such as antipsychotics, anti-seizure medications, antidepressants, and lithium, most often in combination. These drugs were discovered decades ago (lithium was introduced in 1949) and are generally thought to confer symptom-modifying effects in 50-60% of those treated. This means 40-50% of those living with bipolar do not respond in a meaningful way to existing medications, leaving millions with medically refractory illness. Critically, even patients who do respond often report adverse side effects, ranging from weight gain and metabolic dysregulation to sedation and cognitive impairment, which significantly impact quality of life. These side effects can lead to high levels of medication non-compliance. Psychiatrists have now begun to prescribe Ozempic to address the metabolic side effects of psychiatric medications like severe weight gain. But data are emerging from a new subspecialty of psychiatry that uses a dietary intervention—one that has one hundred years of evidence of efficacy in epilepsy and is known to improve obesity and diabetes—that could do that and more. The emerging field of metabolic psychiatry focuses on improving metabolic function to improve mental health. The field’s principal intervention is something patients can control: diet. Stanford Medicine’s Metabolic Psychiatry Clinic announced the peer-reviewed results of the first U.S.-based clinical pilot trial of a ketogenic diet for serious mental illness last month since a promising 1965 trial in schizophrenia. The four-month dietary intervention improved psychiatric symptoms in 21 patients diagnosed with either bipolar disorder or schizophrenia. Roughly half of the participants with bipolar disorder achieved remission. The study from Stanford University reports ketogenic diet shows promise for serious mental Led by Dr. Shebani Sethi, trained in obesity medicine and psychiatry, the trial employed a low carbohydrate, high-fat, moderate protein ketogenic diet. Side effects were minimal and generally resolved by the third week. In addition to their psychiatric diagnoses, participants were also either overweight, obese or had other metabolic abnormalities like insulin resistance or impaired glucose tolerance. Along with psychiatric symptom improvement, they showed dramatic metabolic improvements including weight loss, reductions in visceral fat, and elimination of insulin resistance. All those diagnosed with metabolic syndrome saw their condition go into remission during the four-month trial. The study saw an overall reduction in cardiovascular risk in spite of a small average increase in LDL cholesterol. The field of metabolic psychiatry has roots in a century of research and clinical care using a ketogenic diet to treat epilepsy. The dietary intervention stops seizures in about one-third of people with drug-resistant epilepsy, confers a meaningful improvement in seizures in another third, and has no effect in a third. These improvements are seen in people who have not responded to any drug therapies—those who would otherwise live with uncontrolled seizures. A ketogenic diet has been found to work through several mechanisms—perhaps the secret to its success. Metabolism of fat shifts the brain’s primary fuel source from glucose to ketones, inducing a state called nutritional ketosis, which improves brain function in those with impaired glucose metabolism. It also helps to heal metabolic disease, balance neurotransmitters, optimize mitochondrial function, reduce inflammation, and stabilize brain networks. The Stanford study builds on preliminary evidence already accumulating in the scientific literature. A small retrospective analysis of inpatients in France by Dr. Albert Danan and colleagues demonstrated that a ketogenic diet was well tolerated and yielded unprecedented improvements in mental and physical health in patients with serious mental illnesses, including bipolar. Dr. Iain Campbell at the University of Edinburgh, who himself put his bipolar II disorder into remission seven years ago, undertook a controlled analytic study of online reports, revealing significant and enduring mood stabilization or remission of symptoms in more than half of people on a ketogenic diet. The analytic study was followed by a pilot trial in bipolar disorder completed by Dr. Daniel Smith and Campbell at the University of Edinburgh that also showed both metabolic and psychiatric improvements. Building on the promising results from Stanford and Edinburgh, there are now at least twelve additional clinical trials, including several randomized controlled trials, around the world studying the effects of a ketogenic diet on metabolic and psychiatric symptoms in those diagnosed with serious mental illness. There is also a growing community of experts like Dr. Sethi employing metabolic psychiatry in clinical practice. Notably, Harvard’s Dr. Chris Palmer, author of Brain Energy, announced a $3M philanthropic investment to launch a Metabolic and Mental Health Center at McLean Hospital, one of the world’s leading psychiatric hospitals. Harvard-trained Dr. Georgia Ede, author of Change Your Diet, Change Your Mind, has treated thousands of people diagnosed with bipolar disorder and other forms of severe mental illness over the last decade. Ede runs a training course in metabolic psychiatry for other clinicians and maintains a directory of clinicians trained in ketogenic diet for mental health. Another Harvard-trained psychiatrist, Dr. Matthew Bernstein, Medical Director at Ellenhorn, has spearheaded the psychiatric treatment center to launch a new metabolic psychiatry program called Accord. Bernstein hopes insurers will one day reimburse for lifestyle programs that integrate evidence-based dietary interventions. The results of randomized controlled trials, currently underway, will be needed to persuade some psychiatrists to prescribe a ketogenic diet. But if those same psychiatrists begin to use Ozempic to counteract weight gain from psychiatric medications, maybe it’s time a dietary intervention proven to improve both mental and metabolic health in at least some patients also be put on the menu. Kirk Nylen is managing director of neuroscience at Baszucki Group, a philanthropy focused on transforming mental health outcomes, beginning with bipolar disorder, and supporting initiatives at the intersection of metabolism, psychiatry, and neuroscience. Kirk holds an MSc and Ph.D. from the University of Toronto and a BA in psychology from the University of Saskatchewan. Burcin Ikiz, Ph.D., - Website -

Exploring the over-diagnosis of bipolar disorder in mental health care. Bipolar disorder is significantly over-diagnosed in current mental health practice for several specific reasons. Understanding true bipolar disorder is essential for clinicians and patients. The consequences of incorrect diagnosis are usually over-medication and inadequate treatment for the actual problem One of the diagnostic fads in mental health, the over-diagnosis of bipolar disorder , is ongoing and problematic. This review aims to shed light on what makes this problem so tenacious. It is also a tool for people who may need to question their diagnosis. The diagnosis of bipolar disorder is applied these days with alarming regularity. We’ve all become used to “that’s my OCD ” when someone is double-checking; “she’s schizo” when a person is ambivalent; and “he’s so ADD” as a facetious diagnosis of anyone showing lack of attention. Now we hear “she’s bipolar,” meaning an individual’s moods change rapidly or are extreme. Each of these incorrect usages grossly minimizes the struggles of actual sufferers while mischaracterizing the diagnoses. The misuse of bipolar disorder has surpassed these casual statements and is now commonly misapplied by actual mental health professionals. Patients assume that this diagnosis explains their troubles when the truth may be more complex or much simpler. Throughout my career as a psychiatrist, aside from seeing patients, I have supervised many clinicians and reviewed many patient charts. Over the past 20 years or so, I have seen the diagnosis of bipolar disorder appear in charts and patient histories with implausible frequency. As a rule, I no longer accept these diagnoses until there is further proof. Unfortunately, my skepticism is usually borne out. From the 1950s to the 1980s, American psychiatrists tended to underdiagnose bipolar disorder compared to our European colleagues. If someone was very sick and had a chronic course, we usually labeled them as having schizophrenia. Eventually, we understood that severe mood illness was common and corrected our ways. However, from the 1990s into this century, things have changed. From 1996 to 2004, psychiatric hospitals showed a four-fold increase in the diagnosis of bipolar disorder for children and about 50 percent for adult in-patients. For out-patients during the same time period, we saw a previously unheard-of change. There had been up to a 40-fold increase in the diagnosis of bipolar disorder in children and a doubling in adults. Although there has been some correction for children , in adults, the trend continues. A recent large study of adult patients found that since the year 2000, psychiatrists have tripled their billed visits for diagnosed bipolar patients, while their visits for schizophrenia patients remained the same. Just a few years earlier, these visits were roughly equal, which makes sense as the prevalence of the two disorders is also roughly equal. The chief area of confusion in bipolar disorder is seeing moodiness or rapid mood changes (negative moods, anger outbursts, mood lability) along with impulsivity (e.g., spending a lot of money without forethought) as indicative of a bipolar disorder. While these might be important clues, they do not constitute the actual illness. In reality, they are common aspects of many problems, including depression , substance abuse, personality disorders , and even reactions to stress. By themselves, they serve only to invite more specific questions. Normal depressions often produce labile moods, anger , tantrums, and a range of emotional responses. As a matter of frequency, these changes from regular depression are much more common than from bipolar disorder. Bipolar disorder is a severe psychiatric disorder. It consists of alternating depression and manias, which often lead to hospitalizations and a chronic course of illness. Patients’ lives can be chaotic with loss of jobs and relationships and associated problems like drug and alcohol abuse and cognitive impairment. There are exceptions, but many people who function well in their homes and careers do not have bipolar disorder. The defining part of the illness is the existence of manias. These are episodes of several days to weeks (not minutes or hours) in which the person has very high energy, so high that they can go with little or no sleep for days without being tired (the patient will only stay in bed 1-4 hours, not all night tossing and turning). The high energy is reflected in behaviors such as rapid speech, excessive goal-directed activities (e.g., cleaning, doing repairs), and uncharacteristic conduct (spending, sexual, or grandiose in nature), as well as having a clearly high mood. High moods may be bright, expansive, grandiose, or very irritable. In cases that go untreated, the person may become fully psychotic with delusions and hallucinations. In true mania, all these things appear together for a significant time period: several days to weeks, as mentioned. Parts of these symptoms for shorter periods are not mania. Examination usually finds another explanation, such as alcohol intoxication, drug use, or, commonly, depression manifesting as anger. There is something called “hypomania,” in which a person shows all the symptoms for the same periods, but not such that safety is a concern. This is still a type of bipolar disorder. The manias alternate with depressions, which are just like other depressions. There is usually an interlude of normalcy between periods of manias and depressions. As the person has more and more episodes of illness, the time between them becomes shorter until there is no normal mood at all. Despite these clear diagnostic criteria, patients who do not fit them are frequently diagnosed. It is true that some people have mood shifts and behaviors that are difficult to diagnose. Bipolar disorder may be an important consideration here, as the symptoms may be concealed by other issues. A thorough evaluation with a co-reporter (an important element that is often overlooked in serious and complex cases) usually reveals the bipolar diagnosis. To make a point: spending too much money, having an affair, gambling, losing your temper, changing moods quickly, not sleeping well, feeling energetic, being grandiose, talking too fast, and having rapid thoughts are not, by themselves, bipolar disorder. All of these happen more frequently due to depression, substance abuse, personality disorders, and just being human than to bipolar disorder. Any of them may be a clue about a bipolar diagnosis. But bipolar disorder includes the full syndrome, as I described above. There have been several converging pathways that have led to the current situation. Over-generalization of research and over-reliance on questionnaires play large roles here. In the case of research, studies about bipolar disorder done on patients in psychiatric hospitals do not tell us what happens with the much larger group of people in clinics and offices. The results of these studies are commonly applied to office patients and give a misleading picture of the risk for bipolar disorder. As for questionnaires, I commented on them in a previous post. Briefly, they work best for screening, not for diagnosis. Another factor is newer medications. These medicines, called atypical antipsychotics (Risperdal™, Abilify™, and Seroquel ™ are common brand names), are effective in both bipolar disorder and common depression. Consequently, a clinician may not know which condition has improved when a patient feels better. If they assume the patient has bipolar disorder when she has only depression, over-medication with multiple medications will likely result. Bipolar disorder is both common and serious. We should not make the diagnosis without evidence that conforms to diagnostic criteria, nor should we accept diagnoses that raise questions (such as the common case of a person labeled “bipolar” who has never taken mood stabilizers and has been without symptoms for years). This problem with diagnosis has gone on far too long. Clinicians of all stripes should review this important illness. As for patients, they should also read the criteria and discuss how they fit, or not, with their own clinician. Mark Rego, M.D., - Website -

Many patients don’t want to take mood-stabilizing medications. What can be done? People with bipolar disorder often refuse medications even when they recognize the need for them. Family conflicts over autonomy and stigma can affect the person's willingness to engage in treatment. Clinicians can facilitate communication between patients and caregivers in coping with bipolar disorder. In young patients, non-adherence may reflect disagreement between parents in split households. As many as half of people with chronic psychiatric disorders such as bipolar disorder (BD) doesn’t consistently take their prescribed medications. The consequences—an increased risk of suicide, hospitalizations, social and work impairment, and medical problems —can be quite damaging, not only for the patient but for their families. What can be done? The psychosocial treatment that my colleagues and I developed for bipolar illness, family-focused therapy (FFT), engages the patient and family members in an ongoing process of psychoeducation about BD and training in communication and problem-solving skills (Miklowitz, 2010, 2019). One of its subsidiary goals is to enhance the patients’ acceptance of mood-stabilizing medications. In this article, I offer suggestions as to how psychologists, in conjunction with the treating physician, can work with the family to enhance the goals of pharmacological treatments. Causes of nonadherence Why would a person stop taking medications that would almost certainly reduce their risk of illness recurrences? The research literature emphasizes intolerable side effects (e.g., weight gain, hand tremors), financial burden, lack of insight into the condition, questions about the effectiveness of medications, or reactions to the physician or treatment environment. In our view, the patient’s relationships with family members (and their different views about the illness and its treatments) are potent factors in determining why some individuals accept medications and others reject them entirely. When a clinician encounters a person with BD who has refused medications, it is useful to start with a chain analysis: What sequence of thoughts, feelings, and events prompted the decision to stop medications (or to refuse them when first recommended)? What were the contributions of side effects, disbelief in the diagnosis, or societal stigma? Are there family dynamics contributing to this decision? Usually, family caregivers are supportive and recognize the need for the patient to be on board with their treatments. However, in their attempts to assure the patient’s commitment to medications, some caregivers unwittingly contribute to nonadherence. Engaging the family as an ally in treatment The first module of FFT consists of four or more sessions of psychoeducation, where clinicians explore the meaning of the bipolar diagnosis to the patient and family members: how are episodes of mania and depression experienced by the patient, and how is that different from what parents or spouses see? What are the early warning signs of recurrences, and what can the patient, the family, and the treatment team do when these early signs appear? In the context of this discussion, the patient’s feelings about medications like lithium, valproate, lamotrigine, or antipsychotics (e.g., risperidone) often come to the fore. Consider the following clinical scenario: Liam, an 18-year-old former patient with bipolar I disorder (name and identifying details changed), was hospitalized for two weeks with a manic episode. He was discharged from the hospital to live with his mother and sisters. He was ambivalent about taking his daily regimen of four 300 mg lithium tablets and depended on his mother to fill his prescriptions and arrange psychiatry appointments. He was still symptomatic when he came home, and his mother reacted by asking him, almost compulsively, whether he had taken his lithium that day. In what he described as “a blow for freedom,” he began leaving lithium tablets around the house for her to find: on the counters, behind the toilets, even underneath her pillow. When they began attending FFT, she was threatening to kick him out of the house. Liam acknowledged that he needed lithium but was only willing to take it if he could decide for himself. His mother wondered aloud how she would know if he was being adherent. Through a structured problem-solving exercise in FFT, they agreed that: (1) taking lithium was fully his decision; (2) she was only to ask him about the tablets if she found any around the house, and then at most once a day; (3) he agreed to let her know when he was running out; and (4) he allowed her to communicate with his physician to exchange information about his compliance and lithium levels. Although Liam never fully warmed to taking lithium, his mother’s willingness to back off from over-monitoring helped him remain adherent after his hospital discharge. In this example, lithium nonadherence became a proxy battle for Liam’s quest for independence and autonomy. Ironically, his unwillingness to be adherent increased the chances that he would have another illness recurrence and be even more under his mother’s thumb. But he knew of no other way to express his resentment. What if caregivers don’t agree on the need for medications? Sometimes, a patient’s unwillingness to take medications reflects an alliance with one of two parents against the other. Greta, a 13-year-old patient (name and identifying details changed), had “unspecified BD,” a common diagnosis in adolescent patients. She had a history of recurrent hypomanic episodes lasting one or two days each, during which she became irritable, spoke and ate rapidly, slept little, became highly distractible, and seemed full of energy. Her “crashes” involved full withdrawal into her bedroom, often missing school for weeks at a time. Greta’s parents were separated and on their way to a divorce . She lived with her mother for one week and then with her father for the next in a 50/50 custody arrangement. FFT sessions were arranged separately for the two dyads. Conflict and tension between the parents, and between Greta and each parent, were salient. About four weeks into FFT, during a session with her mother, Greta announced that she was no longer taking lamotrigine, which had been prescribed at a low dose of 50 mg. With gradual inquiry, she revealed that her father did not believe she had BD and had told her that she didn’t have to take lamotrigine or any other medication at his house. In a follow-up phone call between the FFT clinician and the father, he said, “I don’t think she gets along with her mother. That’s why she has mood swings. She doesn’t need pills.” A conjoint session was arranged for the two parents without Greta present. The clinician made clear why they needed a collaborative plan for her psychiatric treatments (both the FFT and the medication sessions) in the same way that they seemed able to coordinate her diet, schoolwork, and social activities. The clinician did not challenge the father’s beliefs directly but provided him with a recap of Greta’s diagnostic evaluation and explained why lamotrigine had been recommended for her mood stability. The clinician also encouraged the father to discuss the matter with the physician and then with Greta. After two parent-only sessions, the father agreed that he would encourage Greta to take lamotrigine when she was at his house, provided that the couple could reevaluate the issue in three months. This case illustrates how nonadherence in a younger patient can reflect a larger battle between parents, seemingly over health care but also over unresolved marital issues. Observations like these have led us to wonder how often young patients who are medically nonadherent have parents who inadvertently aid and abet their decisions. The importance of psychoeducation Committing to medications is difficult for people with BD due to side effects, costs, disbelief in the diagnosis, and the stigma of taking psychiatric drugs. It is much harder when families unwittingly contribute to the patient’s nonadherence due to misunderstandings about mood-stabilizing medications, excessive monitoring, or critical and blaming attitudes. Encouraging caregivers and patients to develop a cohesive approach to pharmacological treatment is critical to the patient’s mood stability and quality of life David J. Miklowitz, Ph.D., - Website - References Miklowitz, D. J. (2010). Bipolar disorder: a family-focused treatment approach (2nd ed.) New York: Guilford Press. Miklowitz, D. J. (2019). The bipolar disorder survival guide: what you and your family need to know (3rd ed.). New York: Guilford Press.

A Personal Perspective: Stereotypes about mentally ill people still prevail. Many of us have expectations about how a mentally ill person looks. People with mental health diagnoses—one in five of us—usually look like the rest of the population. Mental health stigma, like racial bias, can be subtle but damaging, and needs to be addressed when it happens. The other night I told a woman I’d just met at a party that I’ve written three memoirs about being bipolar . “I’d never have guessed,” the woman said. “You certainly don’t look like you’re bipolar.” At the time, I thanked her, because I couldn’t think of what else to say. But later in the evening, I started to wonder what the hell she’d meant. It’s true, some mental illnesses come with preconceived notions of how an afflicted person might look. Take depression , for example—we may expect it to be accompanied by a gloomy expression, slumped posture, and cast-down eyes. People with untreated schizophrenia occasionally exhibit a lack of grooming—unwashed hair or unkempt clothing. But bipolar disorder? What does bipolar typically look like? I suppose it depends on where you’re at on the spectrum. When I’m manic, for example, I dress and look very differently than when I’m depressed. I’ll wear upbeat colors like gold and coral, or a medley of stripes and bright prints. I’m usually feeling sexy then, and my clothing reflects it: it says, “Hey, look at me, I’m pretty.” Even my eye color changes, I’m told, from hazel brown to a gold-flecked green. Of course, when I’m depressed I turn New Yorker in a flash. Thank God black is always the new black; I can look in style, even when I’m suicidal. I do the minimum of maintenance then, which means I’ll run a comb through my hair, but that’s about it. Without any makeup, and swathed in funereal colors, I’m so pale I look like I’m practicing to be a corpse. And since that’s exactly how I feel, somehow the fashion fits. But the night of the party where I met that woman, I didn’t suit either stereotype. Yes, I was in a little black dress. But I was also wearing leopard print shoes, and a bold statement necklace. The outfit didn’t scream, come get me; but neither did it warn all approaches away. I don’t know what color my eyes were that night. But whatever the woman saw in them, to her I must have looked sane. Maybe that’s why I thanked her. But on reflection, I wish I could take that thank you back; I wish I could say to her, “What exactly does bipolar look like?” Maybe I would have made her squirm, but then maybe she would be one less person assuming that mental illness looks the same on everyone. Sometimes it’s only by asking uncomfortable questions that we can worm our way into the dark heart of stigma. Like racial bias, stigma about mental illness can be very subtle; and it can afflict even the most well-meaning, educated, liberal people. Let’s say you’ve never met someone who’s openly bipolar before; maybe you’re a bit apprehensive. What will they say? How will they act? Will you be able to cope? That fear and uncertainty may drive you to stereotype. It’s understandable—but it’s also wrong, and it’s destructive. The truth is, people with mental illness usually don’t look any different from the rest of the population. After all, one in five Americans takes some kind of psychiatric medication. That means your boss, your next-door neighbor, your doctor, a family member, a friend—a lot of them have a diagnosis. It doesn’t always show on the outside. But just because mental illness is invisible doesn’t mean it’s not entitled to the same respect and courtesy as more visible conditions. That woman at the party didn’t mean to hurt my feelings; but ultimately, she did. If I’d told her I had cancer , she wouldn’t have said, “Funny, you don’t look sick.” It wouldn’t be polite. But I contributed to that awkward moment, too, by not calling her out on her ignorance. Instead, the teaching moment passed, and I was just left with a nagging discomfort. We can’t leave it up to the uninformed to eradicate mental health stigma. It’s everyone’s responsibility—mine and yours—to seize the opportunity whenever it presents itself, whether that’s at a lectern or a cocktail party. Let’s make the world squirm a little bit, for the greater good of us all. Terri Cheney - Book -

Personal Perspective: Proper sleep is essential for mood stability. Sleep disturbance is a defining feature of bipolar disorder. Mania is characterized by a decreased need for sleep, while depression often causes prolonged sleeping. A healthy sleep cycle is necessary for bipolar recovery and should be treated as a priority. I was on the brink of snapping at my boyfriend this morning, because his mattress app scolded me that I’d overslept. This opinionated mattress is one of those fancy jobs that hooks up via Bluetooth to your phone and measures all sorts of things you didn’t even know you had, like HRV (heart rate variability). I’d been in bed for a little over 9 hours, and the app took it upon itself to warn me that, “Too much sleep can be a bad thing, so try not to make it a habit.” I showed the text to my boyfriend, thinking we would share a laugh about it. Instead, he said, “Sweetie, sleep is that company’s whole business. They must know what they’re talking about.” He obviously forgot that I’m bipolar . And that I’ve written three books about the subject. And that if there’s one thing, I feel like I’m a semi-expert on by virtue of my illness, it’s the subject of sleep. Sleep disturbance is considered a defining feature of bipolar disorder in all its phases (Harvey, A., American Journal of Psychiatry. 2008 July; 165(7):820-9). A severely decreased need for sleep is one of the most common symptoms of mania, while depression is often characterized by hypersomnia (sleeping for very long periods). It’s possible that sleep issues are so common among bipolar individuals because of a biological vulnerability—i.e., a genetic abnormality in their circadian rhythm system (Wehr, et al., American Journal of Psychiatry. 1987; 144:201–204). I didn’t always understand this the way I do now. For most of my life, I just thought I didn’t know how to sleep like a normal person. Was it something they taught you in nursery school that I had somehow missed? I remember looking around at all the other kids during nap times, wondering how they managed to drift off into dreamland upon the teacher’s command, while I was still tossing and turning and fretting about being awake. Sleep either evaded me completely or drowned me into unconsciousness, depending on what mood state I was in at the time. In periods of hypomania, I would feel a heightened sense of wakefulness—an acute alertness to sounds and stimuli I usually overlooked. I was like a dog let loose for a romp, and the world was one big joyous wonderland of sensory input known only to me. But once that hypomania escalated into full-blown mania, the input overwhelmed me. There was no escaping it—too much light, too much noise, too much tactile information; I couldn’t tune it out for a millisecond. If I tried to close my eyes against the searing brightness, they’d only flutter open again. It was pointless even to try to sleep, so I’d spend days whirling around in a manic spin, my body exhausted but my mind cruelly, savagely awake. One would think the inevitable ensuing depression would come as a relief, but it didn’t. Depression is never welcome, no matter how much one longs for mania to end. True, my world would slow way down then, but the slowness came at an unbearable price: an intense paralysis of thought and action. The lethargy seeped into my very bones until it became nearly impossible for me to do anything but lie motionless in my bed. Sleep became my only escape, and I’d spend days, even weeks, trapped under my covers, haunted by the memory of movement. Thank God, those too-awake days and nightmare-soaked nights are mostly behind me now. Medication, therapy, mindfulness, and years of education have rewarded me with mood stability. But even though I’m now what’s called “euthymic”—meaning my bipolar symptoms are in remission—sleep remains an absolute priority in my life. I know that it’s one of the linchpins of my recovery, and that I could easily backslide if I don’t care for it the way I would care for a treasured possession. That’s why I guard it so fiercely. As I emphatically told my poor boyfriend this morning, nobody and nothing—and certainly not a mattress app!—gets between me and a good night’s sleep. The truth is, bipolar disorder often makes me feel like my mind is not my own. Sleep is one of those rare things that gives me a modicum of control. It would be foolhardy not to treat it like the precious resource it is. Terri Cheney - Book -

Mood shifts in bipolar disorder linked to disrupted neural reward circuits. Mood and emotion affect both what and how we learn and how we adapt to the environment. Disrupted neural activity in reward (striatum) and mood (insula) centers characterize bipolar disorder. Further exploration of the link between mood momentum shifts and RPEs might lead to new targets for therapy. How would you define learning? When we learn something, there is a relatively permanent change in our behavior that comes about because of our experiences with the world around us. Learning allows us to adapt to the environment we find ourselves in successfully. So something that affects learning can affect how well we adapt. Studies have shown that there are a number of factors that affect learning, ranging from what we have already learned (stored in our memories), to the environment we find ourselves in when we learn something new, to our social interactions, and even our socioeconomic status. An important factor that can affect how we learn, and even what we learn, is our emotions and our moods. Paul Eckman, noted for his studies of human emotion, characterizes emotion and mood as differing along five dimensions. They differ in duration (moods last longer than emotions and can be difficult to get rid of), moods can make us more susceptible to experiencing a matching emotional response (a happy mood lowers the threshold needed to trigger the emotion of joy for example, and joy is more easily experienced when we’re already in a happy mood), moods tend not to have non-verbal expression while emotions are universally identifiable through facial expression, and finally, it can be difficult to identify the trigger for a mood, but usually easy to point to a trigger for an emotion (Eckman, 2024). It's this last characteristic that had researchers Moningka and Mason (2024) interested in particular. They wondered about a question that has dogged clinicians and lab scientists alike for quite a while. This question has to do with bipolar disorder and the shifts in mood that characterize this emotional issue. Biopolar disorder results in extreme shifts in mood, cognition and sleep, from emotional pole to emotional pole, extreme lows ( depression ) to extreme highs (mania). Luckily, bipolar disorder responds well to treatment and there are a number of effective treatments available. The question that has persisted has to do with what triggers the shift from one emotional pole to the other, and where in the brain this shift might be happening. Finding answers to these questions would be incredibly helpful in treating the disorder. In their review of the literature, Moningka and Mason reported that there are many studies that have found that individuals suffering from bipolar disorder may be sensitive to rewards in a way that differs from that of non-sufferers. However, they also point out that there are as many studies showings a decrease in reward sensitivity in bipolar patients as there are suggesting an increase in reward sensitivity. They noted that this disagreement in the results might stem from two problems. The first is that making a decision based on the reward received is recursive, involving anticipation and expectation of reward, evaluation of the outcome of behavior, as well as other signals that affect the decision that will be made. One of these other signals that needs to be taken into account is the effect of mood on reward decision making. When we learn something new, we make predictions about the reward we might receive. If the reward we get is better than our prediction, then we create positive reward prediction error (Positive RPE) and our mood improves. This is, after all, what we wanted a better-than-expected outcome. Our confidence increases, and we look for ways to repeat that rewarded behavior. If the reward is worse than our prediction, a negative RPE is created, which impacts mood in a negative direction. We lose confidence and will try to avoid the behavior that led to the disappointing outcome next time. These positive and negative RPEs can accumulate over trials in a learning task, pushing our mood up or down as we succeed or fail. Eldar, Rutledge, Dolan and Niv (2016) say that “Experiences affect mood, which in turn affects subsequent experiences. …First, mood depends on how recent reward outcomes differ from expectations. Second, mood biases the way we perceive outcomes (e.g., rewards), and this bias affects learning about those outcomes” (page 15). This bias is referred to as mood momentum. Moningka and Mason examined fMRI recordings from participants with bipolar disorder and compared them to controls without the disorder. Recordings were made during a roulette task, under two different reward conditions. In the first condition the probability of reward was low (25%). The second had a 75% chance of reward. In addition, the recordings were made at three distinct time periods; making the choice about placing the bet, anticipating the outcome (while the wheel was spinning) and at the outcome itself. They found that the change in mood created by the outcome of the spin of the wheel affected brain activity in reward and mood centers (ventral striatum and anterior insula) more strongly in participants with bipolar disorder than in controls. The connectivity between the ventral striatum (reward) and the anterior insula (mood) was also found to be disrupted in participants with bipolar disorder, suggesting that the momentum of mood might excessively bias the way the striatum tracks RPEs in bipolar participants in particular. Further exploration of the link between mood momentum shifts and RPEs might lead to new targets for therapy. Barbara Blatchley, Ph.D., References Ekman, P. (2024) Mood vs. Emotion: Differences & Traits. Eldar, E., Rutledge, R.B., Dolan, R.J., and Niv, Y. (2016). Mood as representation of momentum. Trends in Cognitive Sciences, 20(1), 15-24. Moningka, H., and Mason, L. (2024). Misperceiving momentum: Computational mechanisms of biased striatal reward prediction errors in bipolar disorder. Biological Psychiatry: Global Open Science, 100330

A Personal Perspective: What some people do once they get over the shock. My friend in Mexico unexpectedly lost her husband. She was inconsolably consumed by grief . It was an enormous effort to sort through important papers and bills. She thought she was imagining things when she found that her husband had been withdrawing large sums of money from their joint account. She had no idea of where the money had gone until one of her husband’s friends told her that he had a gambling problem. She said she felt like someone had punched her in the heart. How could they have been together for 26 years and he kept his gambling a secret? “I felt naïve and stupid and was ashamed to betray him by telling anyone what I discovered about him and how devastated I was,” she confided. “My therapist helped me to see that the problem was my husband’s and not mine. He was too ashamed to tell me about his gambling problem, and his goal was not to deceive and hurt me, but to hide his dark side from me and maybe from himself too. I could certainly tell the truth to a few close friends. They were compassionate and helpful, and they encouraged me to focus on my husband’s good qualities, of which there were many. I am starting to heal.” Another friend in Pennsylvania discovered that his live-in boyfriend of five years had another lover who was 20 years his junior and poor. The boyfriend had been borrowing money from my friend over the last six months, and he had used it to splurge on meals and clothes for his new lover. The revelation led to my friend uncovering the way his partner had lied to and manipulated him the whole time they were together. He raged and swore he would never get suckered into a long-term relationship and would be fine with just hookups. I smile as I write this because despite his initial rage and vow, he is now in a new relationship and seemingly quite happy. Rebecca, who recently relocated to France, divorced her husband in the USA before she moved because he was unaffectionate, unappreciative, and unhappy. It was an amicable divorce which he did not contest. The last time he came to her house to pick up his belongings, he handed her a letter. “When I opened the envelope and read it,” she said, “I almost fell to the floor. It was a profound profession of love and caring, and he told me how much he valued the 13 years we spent tother.” He wrote that it was the happiest he had ever been in his life. He revealed to her for the first time that his father had been in prison for most of his childhood, and his mother railed about what a mistake she made by marrying him. He had a longing to see his father but his mother didn’t let him visit. When he tried to tell his mother how much he missed his father and loved him, he was slapped. His mother became cold and distant, and he realized that he had become that way too. “I have started therapy and learned that my behavior with you was trauma re-enactment,” he wrote to Rebecca. “I reproduced the most painful part of my childhood, and the shock of your leaving snapped me back to the present and the reality of my own behavior.” Rebecca and her ex are now friends, and she said it’s a mutually supportive relationship. If I ever wondered how people can live together for many years and not know that they are being lied to or that their partner harbors terrible secrets, my own life taught me how easily this can happen. Many years ago, when I lived in Switzerland, a friend of mine was having an affair with my first husband. She was so laden with guilt that when I divorced my husband, she offered to testify and tell the truth in a Swiss courtroom. Frankly, my choice of a husband was my own trauma re-enactment, and I wanted nothing more to do with the man I had married, or with the friend who had slept with him. At the time, I wondered how I could ever trust anyone again. But after the shock had passed, I decided that it is detrimental to generalize when someone lies and betrays you. All men are not cheaters and neither are all women or all friends. Shutting down and becoming distrustful is not a good way to enter into future relationships or spend the rest of one’s life. Being observant and present is important, but having a closed heart is detrimental to happiness. It was one of the best decisions I ever made and it led to my long-term marriage which is a blessing in my life. Judith Fein - Psychology Today Article - Book

Mental health is a critical aspect of our overall well-being, yet it is often overlooked or stigmatized. In recent years, there has been a significant increase in the awareness and acceptance of mental health issues. As a result, more individuals are seeking support. But what exactly are the benefits of this support, and how can it lead to improved mental health outcomes? This blog post aims to uncover the importance of mental health support and the various ways it can enhance our lives. The Importance of Mental Health Mental health affects how we think, feel, and act. It's essential for handling stress, relating to others, and making choices. According to the World Health Organization (WHO), 1 in 4 people will be affected by mental disorders at some point in their lives. Understanding mental health is crucial because it forces us to acknowledge that many individuals may be struggling around us. By prioritizing mental health, societies can foster environments of compassion and support. A peaceful space promoting mental well-being This shift towards improved mental health awareness includes recognizing the value of support services. Many people find themselves struggling, whether due to anxiety, depression, or other mental health conditions. The availability of mental health support, in the form of therapy, counseling, or support groups, can have positively transformative effects on people's lives. Types of Mental Health Support Mental health support can take multiple forms, each offering different benefits. Common types include: Therapy and Counseling: Professionals provide guidance on coping strategies and emotional well-being. Many licensed therapists use evidence-based approaches that can lead to improved symptoms and personal growth. Support Groups: These are often peer-led gatherings where individuals share experiences. They create a sense of belonging and connection, helping people feel less isolated. Hotlines and Crisis Services: These provide immediate assistance and support during times of crisis, ensuring individuals can access help when they need it most. Educational Resources: Workshops, seminars, and online materials can be invaluable for individuals seeking to learn more about their mental health and strategies for improvement. Each type of support is designed to meet individuals at their current mental health level and can significantly enhance their coping skills, emotional resilience, and overall quality of life. What are therapy services called? Therapy services can be referred to by various names, depending on the approach and the professional providing the service. Some common terms include: Psychotherapy: This is often used interchangeably with therapy and generally refers to talking therapies that are intended to treat various mental health conditions. Counseling: Counseling tends to be shorter-term and focuses on specific issues or challenges. Cognitive Behavioral Therapy (CBT): A specific type of therapy focusing on changing negative thought patterns and behaviors. Group Therapy: A format where individuals with similar problems come together to share experiences and learn from each other, facilitated by a trained therapist. Exploring these various terms can help demystify the process of finding the right mental health support for each individual. The Benefits of Engaging with Mental Health Support Engaging with mental health support unlocks numerous benefits. Here are some of the most notable ones: Enhanced Emotional Regulation One primary benefit of mental health support is improved emotional regulation. Whether through therapy, counseling, or support groups, individuals learn to identify and express their emotions healthily. This process can lead to: Better decision-making during emotional upheaval. Improved relationships with family and friends. A greater understanding of one's triggers and how to manage them. Increased Resilience Mental health support can significantly boost an individual’s resilience. Resilience refers to our ability to adapt and recover from adversity. By addressing mental health issues head-on, individuals learn coping mechanisms and strengthen their emotional toolkit. Those who regularly engage with support services often report feeling more equipped to handle life's challenges. Resilience training can help decrease the likelihood of experiencing mental health crises in the future. Supportive Relationships One of the greatest benefits of mental health support is the development of a supportive network of relationships. Through group therapy, workshops, or support meetings, individuals often form meaningful connections with others facing similar experiences. This sense of community can alleviate feelings of isolation and loneliness. Networking offers compassionate support, mutual understanding, and encouragement. Individuals frequently find that others experiencing similar struggles feel comforting validation. Tools for Self-Discovery Mental health support encourages exploration and self-discovery. Individuals learn about their emotional state, values, and motivations, leading to greater self-awareness and personal growth. This journey can promote: Improvement in overall self-esteem and self-acceptance. Clarification of values and personal goals. A more profound understanding of how past experiences shape present behaviors. Easier Access to Professional Help As more people seek mental health support, the stigma around it decreases, leading to institutional improvements in availability and access. Many people who may have previously shied away from seeking help now find it easier to approach therapy or counseling services. By utilizing the resources available through therapy services , individuals can access the help they need on a timely basis, reducing the risk of escalating mental health challenges. Building a Support System Creating a robust support system is one of the most empowering steps you can take for your mental health. Here are some actionable tips for building that network: Reach Out: Don’t hesitate to contact friends, family, or colleagues. Express your need for support and share your mental health journey. Join Groups: Search for local or online support groups focused on specific communities or experiences related to mental health. Explore Professional Help: Consider reaching out to a therapist or counselor to understand the options available to you. Participate in Workshops: Engage in mental wellness workshops or educational classes within your community. Be Open to Dialogue: Foster open conversations about mental health with those around you to encourage understanding and support. Gathering for group support can enhance mental wellness outcomes Engaging with these steps not only reinforces your support system but also inspires others to prioritize their mental health. Moving Forward with Mental Health Support Understanding the benefits of mental health support is essential for individuals at any stage of their mental health journey. Accessible resources, be it therapy, counseling, or peer support, can profoundly impact one's quality of life and emotional well-being. Incorporating mental health into our everyday lives creates a community-centric approach that nurtures compassion, understanding, and support. Everyone can play a role in this transformative journey by advocating for mental health awareness and celebrating each other's progress. Making the first step toward mental health support can be daunting; however, the rewards are immeasurable. Prioritize your mental health today and explore the various resources available to fuel your journey toward well-being.