Tinnitus is a condition characterized by ringing or other noises in one or both ears. Tinnitus can be caused by hearing loss, ear infection, head or neck injuries, certain medications, or symptoms of other health conditions. Tinnitus can also cause other complications from sleep problems, social problems, and other mental health issues.
Tinnitus effects on mental health
anxiety and Stress
Often people pondered the “chicken-or-the-egg” conundrum, does anxiety cause tinnitus or tinnitus cause anxiety? Research continues to try and answer that question. In a longitudinal study examining the correlation between anxiety and tinnitus, the researchers found that those with tinnitus had a high incident rate of anxiety. They further noted that the correlation could be due to anxiety causing tinnitus, tinnitus and anxiety effect each other equally, or that there is another factor affecting both anxiety and tinnitus. Other factors may be genetic or neurological dysfunction (Hou, Yang, Tsai, Shen, Lan, 2020).
There are neurological networks that share commonalities between anxiety and tinnitus. The Limbic System and the Dorsal Cochlear Nucleus (DCN) are thought to be neurological contributors to anxiety and tinnitus. One of the functions of the Limbic System is to manage emotional states. While one of the functions of the DCN converting auditory stimuli in the brain. The proximity of these two neurological networks can possibly affect each other in times of stress.
Regardless of the correlation of anxiety and tinnitus, the end result is still feeling a sense of anxiety and stress. Individuals have noted that they feel more stressed and anxious when they experience increasingly louder ringing in their ears (due to the tinnitus) and in a cyclical fashion they find that the symptoms of tinnitus are further exacerbated, creating significant distress.
Depression
Similarly to anxiety, depression and tinnitus correlation is still being researched. In a scientific review, the researchers arrived to a similar conclusion: depression affects tinnitus, tinnitus causes depression, or depression and tinnitus are symptoms of another condition (Geocze, Mucci, Abranches, de Marco, Penido, 2015). Furthermore, depression and tinnitus can be correlated due to the the neurological proximity and the functionality of the Limbic System and the DCN.
Due to the symptoms of tinnitus being unrelenting, individuals may feel hopeless in achieving relief. These symptoms may also affect sleep, causing fatigue and low energy. Furthermore, it may impact people’s motivation to engage in social activities, resulting in social isolation. All of these secondary symptoms can cause one to become depressed.
Neurofeedback As a treatment for Tinnitus
As previously established, tinnitus has neurological origins. With that understanding, researchers have studied using Neurofeedback as a treatment strategy for tinnitus. In a study, researchers found that Neurofeedback training can assist individuals in controlling their attention to the auditory stimuli, and thusly experienced a reduction in symptoms (Busse, Low, Corona-Strauss, Delb, Strauss, 2008). In another study, researchers found that utilizing Neurofeedback training to modify specific brainwaves, patients with tinnitus has experienced major to complete symptom relief (Dohrmann, Weisz, Schlee, Hartmann, Elbert, 2007).
Neurofeedback is also an affective non-pharmaceutical treatment strategy to treat the aforementioned complications of tinnitus. Studies have shown that Neurofeedback training can reduce anxiety through brainwave regulation. Studies have also shown that Neurofeedback training can assist in establishing normalized neurological activity in individuals experiencing depression.
This month’s post was written by Aarti S. Felder, MA, LCPC, BCN. Aarti is our chronic illness specialist and is a Board Certified Neurofeedback practitioner.
Attention Deficit Hyperactivity Disorder is a complex neurodevelopmental disorder that is characterized by low production of dopamine in the prefrontal cortex. The prefrontal cortex is in charge of what we call executive functions; planning, organizing, decision-making–all of the directing parts of the brain. Emotional regulation and reward pathways in the brain are also affected by individuals with ADHD. The diagnosis is further broken down into three different presentations: primarily inattentive, primarily hyperactive, or the combined type. Here’s a list of some of the symptoms to look for:
The inattentive symptoms (previously referred to as ADD) in the Diagnostic and Statistical Manual 5th edition (DSM-5) are:
Often fails to pay close attention to details or makes careless mistakes in schoolwork, at work, etc.
Often has trouble holding attention on tasks or activities (e.g., easily distracted)
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, gets side-tracked)
Often has trouble organizing tasks and activities; has trouble finishing tasks
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time
Often loses things necessary for tasks and activities (e.g., school materials, wallet, phone, keys).
Often forgetful in daily activities
Often distracted by stimuli (e.g., sounds, movement)
The hyperactive/impulsive symptoms in the DSM-5 are:
Often fidgets with or taps hands/feet or squirms in seat
Often leaves seat in situations when remaining seated is expected (e.g., leaves place in the classroom, in meetings, etc.).
Often runs about or climbs in situations where it is inappropriate. In adolescents or adults, this may manifest as feeling restless
Often unable to play or engage in leisure activities quietly
Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to remain still for any extended time without significant discomfort; others may say that the person is restless, fidgety, or difficult to keep up with).
Often talks excessively
Often completes other people’s sentences or blurts out an answer before a question has been completed
Often has difficulty waiting for their turn (e.g., while waiting in line, while speaking in conversations).
Often interrupts or intrudes on others. For adolescents and adults, may intrude into or take over what others are doing (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission)
The combined type is diagnosed by the presence of an even mix of the symptoms. There are other criteria for this diagnosis which include symptoms lasting for a specific duration and having an impact on various domains of an individual’s life.
What are the Statistics
Approximately 5% of children and adolescents are affected by ADHD globally. In the U.S. 6.1 million children (9.4%) between the ages of 2 and 17 are estimated to be diagnosed with ADHD, with boys more likely to be diagnosed than girls (11.7% compared to 5.7%). The difference in the diagnosis of girls and boys is often due to the presenting symptoms and socialization of children. Girls are more often diagnosed with the inattentive presentation which is often missed in a classroom setting where most referrals for ADHD testing occur.
While ADHD is considered a childhood disorder, 139.84 million adults have persistent ADHD with childhood onset (2.58% of the global population) and 366.33 million adults have symptomatic ADHD regardless of onset (6.76% of the global population) as of 2020. Because ADHD affects brain development, it manifests in all aspects of life and can significantly impair educational achievement, relationships (romantic, familial, friendships), employment, finances, etc. There are many common symptoms of ADHD (inattention, inability to focus, poor time management, weak impulse control, exaggerated emotions, hyperfocus) which are often seen as character flaws or bad parenting when the underlying cause is due to an individual’s specific brain functioning. This is also seen in difficulty with emotional processing.
Emotional dysregulation
One aspect of ADHD that has been recognized as a symptom for diagnosis in Europe and noted in research for at least two decades but is still not considered in the Diagnostic and Statistical Manual version 5, has been the emotional component of ADHD. About 70% of adults with ADHD report emotional dysregulation (ED), which has led to the term, DESR, or deficient emotional self-regulation, popping up in ADHD research, and other mental health conditions in which emotional dysfunction is a major component. This refers to a deficiency in the four components of self-regulation. These four components are the ability to inhibit behavior triggered by strong emotions, the ability to self-soothe and regulate strong emotions, the ability to refocus from events that cause strong emotion, and the ability to organize emotional responses. This emotional dysregulation greatly impacts a person’s ability to recognize and control the emotions that they are feeling which can lead to issues connecting with others, putting feelings aside to focus on something, and processing a difficult situation. This can be seen in rejection sensitive dysphoria.
Rejection sensitive dysphoria (RSD) is a common manifestation of emotional dysregulation that is defined by an extreme emotional sensitivity and pain that is triggered by the idea that someone is being rejected or criticized by important people in their life or by the idea of failing to meet an expectation. While RSD is not caused by a trauma, the pain from it can be felt as a traumatic experience. When these feelings are internalized, they can imitate a mood disorder, and often leads to misdiagnosis of a major mood disorder. When these feelings are externalized, they can be like a sudden rage at the person or situation causing the pain. This can be a devastating ordeal that can lead to feelings of alienation.
Comorbidities with adhd
People with ADHD often have other co-occurring mental health conditions. According to the CDC almost 64% of children with ADHD have at least one other mental health condition: 52% have behavioral health or conduct problems, 33% have anxiety disorders, 17% have depression, 14% have been diagnosed with autism spectrum disorder, and 1% have Tourette syndrome.
In adults as many as 80% of people with ADHD have at least one co-occurring mental health condition. It is estimated that rates of comorbid bipolar disorder in adults with ADHD are between 5.1% and 47.1%, about one-fifth to one-half of adults with ADHD have major depressive disorder/dysthymia, about 50% of individuals with ADHD have some type of anxiety disorder, personality disorders are present in more than 50% of adults with ADHD, and research shows that 25% to 40% of adults with substance use disorder also have ADHD. Having multiple mental health conditions can make it harder to identify the source of a condition and the best way to approach treatment. When talking about ADHD, we expect it to present as primarily hyperactive/impulsive and this can also lead to issues in beginning treatment. Women and girls are often misdiagnosed or underdiagnosed in ADHD because they primarily present in the inattentive type. The classroom setting is most often where ADHD is first noticed, but with the inattentive type it is often less disruptive to the classroom so is less likely to get someone referred for treatment. Also in female students the behaviors that would often get male students categorized as ADHD get labeled as “airheaded” or a “chatterbox” or “flighty.” They also are socialized to behave in ways that more easily mask their symptoms, such as spending more time on school work, which can lead to other problems when they are unable to manage emotionally or socially in the ways they are expected to. This can be stigmatizing when they are unable to perform the way they are expected to and can lead to perfectionism, social withdrawal, low self-esteem, and negative self-talk.
The future of adhd
In current ADHD research there is looking into changing the name to better reflect the complex of the condition. One proposed future name is variable attention stimulus trait (VAST). This name comes from Edward Hallowell, M.D., John Ratey, M.D. who are leading researchers and wrote the book ADHD 2.0. Other areas of research are looking into better understanding the emotional aspects of the condition.
Treatment for adhd
When approaching treatment for ADHD, medication is the most well known and most stigmatized. It is an important treatment approach, because when people are on the right dosage of medication it greatly improves their lives. RSD can be greatly improved by medication management.
Another treatment approach is ADHD/executive functioning coaching. This is a behavioral training that focuses on finding ways to deal with/externalize the executive functioning skills that are lacking.
Therapy is another approach that helps build coping strategies, builds greater understanding of the areas in which a person is struggling, and can help a person learn ways of dealing with the emotional issues of ADHD.
Neurofeedback is another treatment that has been proven effective for ADHD. Neurofeedback, or EEG Biofeedback, is a technique that uses operant conditioning to train the brain to be more efficient (and is a service that we provide).
As we continue to learn more about ADHD and how to improve the quality of life of people who have the condition, we will continue to approach it by looking at the strengths that can be found in it. Here at TriWellness we can help.
When talking about people with disabilities the focus is often put on the disabilities themselves, but what is often overlooked are the mental health concerns that often exist alongside the disabilities. Studies show that those with disabilities experience frequent mental distress nearly five times as often as adults without disabilities. Over 30% of those with disabilities report at least fourteen out of the last thirty days as being mentally unhealthy days. The mental health strain on people with disabilities can come from feelings of isolation, exclusion, financial insecurity, and a lack of personal and professional fulfillment, as well as other distresses relating to specific disabilities. All of these stressors are being exacerbated by the Covid-19 pandemic.
One of the main causes of mental distress in all populations comes from financial insecurity, which is an issue that is prevalent among people with disabilities. On top of the exorbitant medical costs that come with living with a disability, the average income of those with disabilities is only about a third of the income of someone without a disability, indeed only 17.9% of people with disabilities are employed, compared to 61% of non-disabled people, 29% of employees with disabilities only work part time. This is a result of lack of access to education, reliable transportation, discrimination, and a government aid system that often penalizes earned income over a very limited level.
Studies show that employment is often heavily linked to self esteem, self worth, and an overall feeling of purpose. Unemployment can lead to rates of depression that are twice as high as the general population. This rate rises to four times as high in the long term unemployed. With the help of therapy, purpose can be discovered far beyond the confinements of employment. Finding out what in life gives you self value can have extreme effects on your quality of life. Other ways to find purpose other than employment can include volunteering, accessible hobbies, and being a positive presence in your family/community.
Often the sole focus on the treatment of the disability alone can overshadow the mental health concerns of those living with disabilities. The medical and mental health fields can do more to integrate the treatment of physical and mental wellbeing of those with disabilities. More can be done to increase access to both financial and physical freedom as well as growing awareness for the need for greater mental healthcare. This feeling of having no purpose due to unemployment as well as feelings of isolation and exclusion, among other distresses, are areas that counseling can help to alleviate through exploration, collaboration, and education.
Wide range of resources including links and information for SSDI (Social Security Disability Insurance for those who are unable to work due to a disability) and SSI (Supplemental Security Income for those who can only work part time) Able Savings Accounts (allows for people with SSDI or SSI have less limits on their saving amount) Medicare, and Service Animal Support and much more.
Programs to help those with disabilities gain greater access to transportation through reduced cost or in some cases free train and bus transportation through the CTA.
This final resource is a fun one. Qualifying people with disabilities can obtain a free lifetime pass to all national parks. Access to nature can have positive effects on mental health, decreasing negative emotions such as stress and anxiety and promoting more positive feelings. Providing this for people with disabilities increases accessibility to those who might not have been able to visit before.
Within the field of counseling, therapy, and psychology as a whole, there exists a wealth of information that informs our daily practice. This information comes from research studies, controlled experiments designed for the purpose of advancing our understanding of the human mind, and in our case, how to treat the mind for mental illness.
One specific area of research that I particularly find interesting, relates to the realm of emotional regulation. Emotional regulation sounds like some enigmatic concept, but it is actually quite straight forward, contrary to its execution! Emotional regulation is a person’s ability to regulate the emotions they feel in a moment, and their ability to control them in a given situation. An example could be that during a job interview, you are nervous to go in front of the interviewer. Instead of your anxiety continuously ramping up uncontrolled, you are able to take some time to collect your thoughts, calm yourself, and reduce your anxiety.
To further dissect this scene, we might look at how facial expressions affect one’s emotional state. In “The Influence of Visual Context on the Evaluation of Facial Trustworthiness” the authors, Wang, Lin, Fang, and Mo found that one’s emotional, facial expression can affect another’s trust in them. So given that information, if the interviewee is unable to regulate their emotions, they may be perceived as untrustworthy, despite being nervous.
Furthermore, in “Social Judgments from Faces“, Todorov, Mende-Siedlecki, and Dotsch identified the the region of the brain, the amygdala, that is lit up when a person perceives an emotional response on another person’s face leading to a quick judgement. We also know that the amygdala is responsible for detecting whether something is threatening. So it is no wonder that if someone is nervous in an interview, it can lead to them feeling fearful if the interviewer’s stern expression is perceived negatively.
Emotional Regulation and Chronic Illness
Emotional regulation has a lot of applicability when it comes to the therapeutic environment. However, this area needs some more attention in assisting people with chronic illness emotionally regulate. Despite there are some great studies that focus on chronic illness and caregivers (check back in the future for a post on this topic!), this is an important area of focus. It is still part of a broad topic that has many facets from the individual with the illness to their caregivers as well as the different diagnoses. The more research that is done on such a complex topic, the more we can learn to help the individuals with different chronic illnesses.
While the literature surrounding this concept is limited, there are some articles we can look towards, at some level, to inform our practice. In “Motion Regulation in Chronic Disease Populations: An Integrative Review” Wierenga et al. reviewed 14 articles that looked at various variables (gender, age, education, stress, emotional health, etc.) that affect the chronic illness outcome as well as other physical health. After reviewing those articles, the authors concluded that emotion regulation should be included in the treatment process.
Another wonderful, but more specified, article Exploring Emotion Regulation and Emotion Recognition in People with Presymptomatic Huntington’s disease: The Role of Emotional Awareness details the emotional regulation development of those with presymptomatic Huntington’s disease. Due to the neurodegenerative nature of the disease, Zarotti and his colleagues found that emotion recognition and regulation become increasingly more impaired as the disease progresses. This suggests the struggle for those who experience Huntington’s Disease as well as their caregivers becomes intense as the disease progresses, which can further exacerbate the condition and the need for care in a cyclical nature.
Emotion regulation tips and tricks
Distractions- For good!
In these trying times, with the news of the pandemic to the state of our world it is completely understandable the desire to distract oneself. There are ways to distract yourself in a productive matter. Watching Netflix, Tic Tock, YouTube, or doom scrolling on Facebook or Reddit may be distracting, however it may cause for the news to creep back into focus. These methods are also neurologically stimulating at 60 HZ, which is the voltage associated with alertness as well as psychological conditions when exposed externally to for an extended amount of time.
Another method of productive distraction can be engaging in movement. Exercise is a good method to assist your Autonomic System (ANS) in the Parasympathetic Nervous System (PNS) activation in times of stress (please see our previous blog posts about Trauma and Stress Response for further explanation of this process). If you are unable to exercise, walking around the block or at the park can also be a great, productive distractor along with engaging in a walking meditation or mindfulness.
Guided Imagery, Meditation, and Mindfulness
Mindfulness, guided imagery, and meditation are methods of being present in the moment. Guided imagery involves a recorded script or a clinician following a script in vivo. The script engages one’s imagination and breath as a method to be present in the moment. Mediation can be another method being in the present moment through the use of one’s breathe. Mindfulness involves engaging the five senses (sight, sound, smell, touch, and taste) to focus your attention on the present moment.
For example, when being mindful while going for a walk you may notice the greenery or the vibrant colors of the grass, trees, or flowers. You may hear the birds chirping as they pass you playfully through the air or the buzzing of the bees as they pollinate those vibrant flowers. You may also notice the smell in the air, it could be sweet from the fragrance of the flowers, or the Petrichor after a rainy night. You may also feel the warmth of the sun against your skin, or the balminess of the air causing you to perspire. Bonus sense: you may notice the way you feel as you put one foot in front of the other and how your legs connect to your body and how you are put together on this planet in the universe; this is called proprioception.
Neurofeedback
Neurofeedback is another method for regulating one’s emotions through the use of technology. As discussed in a previous blog post, Neurofeedback utilizes technology, neuroscience, and psychology to assist clients in neurological regulation. After assessing your baseline neural activity and identifying areas that can benefit from training, Neurofeedback would assist you in trainingyour brain to operate in a more effective manner.
For example, as many of us may be experiencing anxiety right now, perhaps our prefrontal cortex is overly activated with Beta or Gamma (the higher end of the Beta wave spectrum and into Gamma are 35-60 Hz) brainwaves, which as we know those brainwaves are associated with anxiety and high stress. Neurofeedback would show you in real-time the status of your current brain activity through measurements gather from electrodes placed on your scalp and reward your brain with calming or fun feedback (playing music continuously or seeing a video in full screen mode) when those electrodes read Alpha (8-12 Hz) brainwaves, for example, which is associated with a calm, meditative, or restful state. Eventually, your brain will learn that this is a better state to be in and will know operate at that level when stressed without the need for continuous training or medication!
Aarti S. Felder, MA, LCPC is our Clinical Director who founded TriWellness to help individuals experiencing chronic illness. Aarti is also our chronic illness specialist.
and introducing:
Christian Moresco, BA is an intern here at TriWellness. He chose to study chronic illness and mental health as it is near and dear to him. His sister was diagnosed with a chronic illness and has seen the ravages that it had impacted her life and his. Christian hopes to add to the research, particularly emotion regulation and chronic illness, to further impact our field in helping individuals with chronic illness.
On June 28, 1969, a group of gay customers at a popular gay bar in Greenwich Village, New York, called the Stonewall Inn, who had grown angry at the harassment by police, took a stand and a riot broke out. As word spread throughout the city about the demonstration, the customers of the inn were soon joined by other gay men and women who started throwing objects at the policemen. Police reinforcements arrived and beat the crowd away, but the next night, the crowd returned, even larger than the night before, with numbers reaching over 1000. For days following the event, demonstrations of varying intensity took place throughout the city. On the 1st anniversary of the Stonewall Riots, the first gay pride parades in U.S. history took place in Los Angeles, Chicago, San Francisco, and near the Stonewall Inn in New York.
Common Terminology
The following common terminology, provided by the Human Rights Campaign, can be found here and helps to expand our vocabulary and broaden our understanding of issues related to the LGBTQIA+ community. Having an informed vocabulary, and an openness to learn and understand, allows us to engage appropriately in conversations around LGBTQIA+ issues and connect with people from this community.
Please note: This list of terminology is not intended to be an exhaustive list of all possible terms and phrases related to the LGBTQIA+ community, but rather considered a “stepping stone” in becoming familiar with commonly used words used to refer to people from this community.
Pride Flag
As an allied organization and as a commitment to providing visibility to any folks who identify with this community, it’s important for us to showcase the Pride Flag and provide information on its recent changes. Originally, the well-known symbol for Pride Month is the historic rainbow flag, created by Gilbert Baker in 1978. Each of the six stripes represents an idea that is resonant with the LGBTQIA+ community – red for life, orange for healing, yellow for sunlight, green for nature, blue for peace, and purple for spirit. In 2018, a designer named Daniel Quasar offered a redesign of the official flag called the Progress Pride Flag, which highlights the intersectionality and diversity found within the LGBTQIA+ community. The white, blue, and pink are the colors of the trans flag, and the black and brown stripes represent the marginalized racial and ethnic minorities found within the community. The second flag gained popularity upon its release, and though it hasn’t been labeled as the official pride flag, it’s becoming more widely used due to the increased representation and intersectionality that exists within the community.
Historic Landmarks
June 1969
Stonewall Riots/Gay Liberation Movement
June 1970
First Pride Parades in major cities
December 1973
Homosexuality is no longer considered a mental illness
June 1978
Pride Flag is born
June 1981
First official reporting of what will become known as the AIDS epidemic
September 1982
CDC uses term “AIDS” for first time, definition not limited to gay men
October 1987
AIDS Memorial Quilt is created and displayed during D.C. Pride
May 1991
First Black Pride
October 2009
President Obama signs Matthew Shepard and James Byrd Jr. Hate Crimes Prevent Act in law, expanding legislation on racist hate crimes to include hate also based on sexual orientation, gender identity, and disability
September 2011
President Obama repeals “Don’t Ask, Don’t Tell”, which prevented out LGBTQIA+ community members from serving in the U.S. military
January 2015
President Obama addresses LGBTQIA+ community in State of the Union Address for the first time in history
June 2015
“Sexual orientation” is added to military’s anti-discrimination policy
U.S. Supreme Court rules in favor of marriage for same-gender couples
May 2016
New York City’s Stonewall Inn is recognized as a national monument
May 2019
Trailblazers and activists from the Gay Liberation Movement, Marsha P. Johnson and Sylvia Rivera, are memorialized with a monument in Greenwich Village, Manhattan, New York
June 2020
U.S. Supreme Court rules that the 1964 Civil Rights Act protects gay, lesbian, and transgender employees from discrimination based on sex
Sexual Orientation & Gender Identity
Before diving in specific issues and concerns that the LGBTQIA+ community faces, it’s important to differentialize between a person’s sexual orientation, gender identity, gender expression, sex assigned at birth, and physical and intimate attraction. The Gender Unicorn graphic (shown below) portrays each of these concepts as a spectrum, allowing a person to identify anywhere on each individual spectrum rather than electing one option over the other. For example, a person whose sex assigned at birth is male, but transitions to be a transgender woman, does not automatically mean she is attracted to men, will have sex with men, or expresses her gender in a feminine manner. It’s very much possible that this woman can have a mix of feminine and/or masculine gender expression and physically attracted to men, but is emotionally and intimately attracted to women and women-identified folks.
These concepts are not black and white, and it’s important to never assume someone’s gender identity, sexual orientation, or their physical and emotional preferences.
One’s internal sense of being male, female, neither of these, both, or another gender(s). For transgender people, their own internal sense of gender identity and their sex assigned at birth are not the same.
Sexually attracted to
Whom I am sexually attracted to.
The group of people or genders to which a person can become sexually attracted to, if at all.
Gender expression/ presentation
How I look and express myself.
The physical manifestation of one’s gender identity through clothing, hairstyle, voice, body shape, etc. Most transgender people seek to make their gender expression (how they look) match their gender identity (who they are), rather than their sex assigned at birth.
Romantically/ emotionally attracted to
Whom I am romantically/emotionally attracted to.
The group of people or genders to which a person can become romantically, emotionally, or spiritually attracted to, if at all.
Sex assigned at Birth
The sex classification that I was assigned at birth.
The assignment and classification of people as male, female, intersex, or another sex based on a combination of anatomy, hormones, and chromosomes. This is usually decided at birth or in utero and is usually based on genitalia.
Examples of Genders: We included “other genders” to indicate the many genders that other people might identify as, express themselves as, and be attracted to. Examples of these genders include: Agender, Bigender, Genderfluid,
LGBTQIA+ SPECIFIC ISSUES AND CONCERNS
Our holistic, whole person view takes into consideration the multiple complexities of structural, systemic, and societal issues that affect folks from the LGBTQIA+ community. The following is a list of just some of the current issues that folks face in today’s climate.
Issues and concerns
Aging
Health disparities
HIV/AIDS and STDs
Affirming medical care
Culturally competent mental health care
Racism and discrimination
Coming out and/or being “outed”
Unsupportive friends and/or family
Homelessness
Accessibility to employment, housing, religious, and medical/family/social services
Parenting and family formation
Social alienation
Double alienation (if holding 2 or more marginalized identities)
Bullying
Suppression of self-identity; denial
Homophobia, transphobia, biphobia, etc.
Internalized homophobia, transphobia, biphobia; body dysmorphia; self-hate
Hate crimes and hate speech/rhetoric
Domestic and sexual violence
Mental health
Depression
Anxiety
Self-esteem issues
Substance use
Suicide
Trauma and post-traumatic stress disorder (PTSD)
Navigating relationships and sex
Guide for LgBTQ Youth
This guide from HRC and the Child Mind Institute offers specific tips for LGBTQ youth about the importance of mental health, how to help a friend struggling with mental health issues, and how to find an LGBTQ-affirmative therapist.
Law, Policy, and Human Rights
Discriminatory laws and policies still exist in multiple states in the U.S. The Human Rights Campaign offers a virtual map of all of 50 states’ up-to-date laws and policies affecting LGBTQIA+ people, including but not limited to LGBTQIA+ parenting, relationships, youth, and transgender rights. To access this map, please visit https://www.hrc.org/resources/state-maps and you can select an individual state, or select laws and policies by issue. The issues presented in this map are for:
Employment
Housing
Public Accommodations
Anti-Conversion Therapy
School Anti-Bullying
Education
Transgender Healthcare
Gender Marker Updates on Identification Documents
Hate Crimes
Discrimination in Child Welfare Services
Unsupportive family
Domestic and sexual violence
Tips
Tips if you decide to come out: questions to ask yourself
Pride Month is a time to acknowledge, respect, and honor the lives and experiences of the LGBTQIA+ community. In recent years, Pride Month has become a time of celebration for the community, however it’s important to not overlook those who still unsure of their identity. The Q in LGBTQIA+ can stand for “queer”, but it can also stand for “questioning” for folks who are still trying to make sense of and understand their sexual orientation and gender identity.
Here are some questions to consider if you identify (or don’t) with the term “questioning” and are wanting to “come out” to the people around you:
How long have you been sure about your sexual orientation?
Are you comfortable with your sexuality?
Do you have support?
Are you knowledgeable about queer issues?
What’s the emotional climate at home?
Can you be patient?
Do you have resources?
Are you financially dependent on your parents/people you’ll be coming out to?
What’s your general relationship with the person/people you’re coming out to?
What’s their moral societal view?
Is this your decision?
Tips for Coping at Home with Family and Surrounding Environment
Remember that you’re still you! – Take part in activities and let family/friends know you are the same person as before; focus on common interests.
Coming out – Remember “coming out” is a continual process, you may need to “come out” multiple times with various people and situations.
Set limitations and boundaries – Set clear expectations for how one should interact with you. If communication or situations become too intense, excuse yourself and seek support.
Pronoun slips – If you are transgender or gender non-conforming, be gentle with family’s pronoun “slips” and let them know you know how difficult it is.
Tips for Self-Care
Take care of your body and incorporate healthy eating, drinking, exercising, and sleeping habits into your routine. Your physical health has direct implications on your mental and emotional health!
Arrange time with supportive friends and family members. Oftentimes, folks have a “chosen family” which become their main source of support and connection, and can fulfill many missing gaps not received by their immediate family and friends.
Visit local, safe LGBTQIA+ spaces – bookstores, coffee shops, bars, Pride events, etc.
Don’t wait for your family’s change attitude and approval before you give it to yourself. Others may need time to acknowledge and accept your identity but recognize that it may have taken some time for you to come to terms with yourself, and others may need that time as well, if not more. Remember to affirm yourself!
Inform yourself of specific issues relating to the LGBTQIA+ community. One of the ways to feel connected to others is to educate ourselves on current issues going on in the community. An informed perspective can lead to an empathy and understanding.
A term used to describe someone who is actively supportive of LGBTQ people. It encompasses straight and cisgender allies, as well as those within the LGBTQ community who support each other (e.g., a lesbian who is an ally to the bisexual community).
Asexual
The lack of a sexual attraction or desire for other people.
Biphobia
The fear and hatred of, or discomfort with, people who love and are sexually attracted to more than one gender.
Bisexual
A person emotionally, romantically or sexually attracted to more than one sex, gender or gender identity though not necessarily simultaneously, in the same way or to the same degree. Sometimes used interchangeably with pansexual.
Cisgender
A term used to describe a person whose gender identity aligns with those typically associated with the sex assigned to them at birth.
Coming out
The process in which a person first acknowledges, accepts and appreciates their sexual orientation or gender identity and begins to share that with others.
Gay
A person who is emotionally, romantically or sexually attracted to members of the same gender. Men, women and non-binary people may use this term to describe themselves.
Gender binary
A system in which gender is constructed into two strict categories of male or female. Gender identity is expected to align with the sex assigned at birth and gender expressions and roles fit traditional expectations.
Gender dysphoria
Clinically significant distress caused when a person’s assigned birth gender is not the same as the one with which they identify.
Gender-expansive
A person with a wider, more flexible range of gender identity and/or expression than typically associated with the binary gender system. Often used as an umbrella term when referring to young people still exploring the possibilities of their gender expression and/or gender identity.
Gender expression
External appearance of one’s gender identity, usually expressed through behavior, clothing, body characteristics or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.
Gender-fluid
A person who does not identify with a single fixed gender or has a fluid or unfixed gender identity.
Gender identity
One’s innermost concept of self as male, female, a blend of both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different from their sex assigned at birth.
Gender non-conforming
A broad term referring to people who do not behave in a way that conforms to the traditional expectations of their gender, or whose gender expression does not fit neatly into a category. While many also identify as transgender, not all gender non-conforming people do.
Gender-queer
Genderqueer people typically reject notions of static categories of gender and embrace a fluidity of gender identity and often, though not always, sexual orientation. People who identify as “genderqueer” may see themselves as being both male and female, neither male nor female or as falling completely outside these categories.
Homophobia
The fear and hatred of or discomfort with people who are attracted to members of the same sex.
Intersex
Intersex people are born with a variety of differences in their sex traits and reproductive anatomy. There is a wide variety of difference among intersex variations, including differences in genitalia, chromosomes, gonads, internal sex organs, hormone production, hormone response, and/or secondary sex traits.
Lesbian
A woman who is emotionally, romantically or sexually attracted to other women. Women and non-binary people may use this term to describe themselves.
LGBTQ
An acronym for “lesbian, gay, bisexual, transgender and queer.”
non-binary
An adjective describing a person who does not identify exclusively as a man or a woman. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories. While many also identify as transgender, not all non-binary people do. Non-binary can also be used as an umbrella term encompassing identities such as agender, bigender, genderqueer or gender-fluid.
Outing
Exposing someone’s lesbian, gay, bisexual transgender or gender non-binary identity to others without their permission. Outing someone can have serious repercussions on employment, economic stability, personal safety or religious or family situations.
Pansexual
Describes someone who has the potential for emotional, romantic or sexual attraction to people of any gender though not necessarily simultaneously, in the same way or to the same degree. Sometimes used interchangeably with bisexual.
Queer
A term people often use to express a spectrum of identities and orientations that are counter to the mainstream. Queer is often used as a catch-all to include many people, including those who do not identify as exclusively straight and/or folks who have non-binary or gender-expansive identities. This term was previously used as a slur, but has been reclaimed by many parts of the LGBTQ movement.
Questioning
A term used to describe people who are in the process of exploring their sexual orientation or gender identity.
Same-gender loving
A term some prefer to use instead of lesbian, gay or bisexual to express attraction to and love of people of the same gender.
Sex assigned at birth
The sex, male, female or intersex, that a doctor or midwife uses to describe a child at birth based on their external anatomy.
Sexual orientation
An inherent or immutable enduring emotional, romantic or sexual attraction to other people. Note: an individual’s sexual orientation is independent of their gender identity.
Transgender
An umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation. Therefore, transgender people may identify as straight, gay, lesbian, bisexual, etc.
Transitioning
A series of processes that some transgender people may undergo in order to live more fully as their true gender. This typically includes social transition, such as changing name and pronouns, medical transition, which may include hormone therapy or gender affirming surgeries, and legal transition, which may include changing legal name and sex on government identity documents. Transgender people may choose to undergo some, all or none of these processes.
May 19th was Inflammatory Bowel Disease (IBD) Awareness Day, so I thought it fitting to explore the implications of mental health in South Asian Americans (SAA) this Asian American Pacific Islander (AAPI) Heritage Month.
Symptoms of IBD
There are two types of IBD: Crohn’s Disease (CD) and Ulcerative Colitis (UC) and the following are common symptoms:
Diarrhea
Unexplained weight loss
Bloody stool
Fatigue
Reduction in appetite
Abdominal pain
Fever
Additional Symptoms of CD
Mouth sores
Anal fistula
ADDITIONAL SYMPTOMS OF UC
Rectal pain
Defecation urgency
Tenesmus
In children, failure to grow
Futher complications of IBD
Colon cancer
Side effects from medications
Inflammation in other areas of body
Sclerosing Cholangitis
Blood clots
Addition complications for CD
Bowel Obstruction
Fistulas
Malnutrition
Addition complications for UC
Toxic mega colon
Perforate colon
Severe dehydration
Diet and Lifestyle Implications on Mental Health
In South Asian (SA) culture, people can seek a holistic treatment regimen such as Ayurveda or Homeopathic as an alternative treatment to illness utilizing allopathic therapeutics. The appeal of those treatment modalities is the sense of limited side-effects as opposed to allopathic treatment. Furthermore, Ayurveda and Homeopathic therapies are coupled with lifestyles involving spirituality, diet, and movement. Overall this may be a great way to treat illness when it encompasses several realms to treat the person as a whole, but it is a different challenge to treat IBD as opposed to general gastric distress.
Ayurveda and Homeopathic Treatments
There have been international research done on the use of natural remedies for IBD, however there are several critiques, such as the studies’ procedures or the number of clinical trials. Nevertheless, as with all treatments, ample research must continued to be done to determine effective therapies. In the resources section, there are a few studies that aim to add to the knowledge-base of eastern traditional medicine of IBD treatment. While these studies discussed the efficaciousness of Ayurveda and herbal supplements, some patients following similar regimens as indicated in those studies did not gain remission. The continued active IBD due to ineffective treatment, led to more severe illness. As one can imagine, chronic flares can lead to depression and hopelessness. Some individuals even further expressed frustration and resentment in finding that biologics has a higher efficacious rate in gaining remission, however is not a readily available treatment modality due to availability and financial reasons.
Diet
Although diet change has been found to be factor that assist in the symptom reduction (i.e. the anti-inflammatory diet, a low fiber diet, a gluten-free diet, or a low dairy diet to name a few), it alone cannot treat IBD. When diet is poorly used as a treatment strategy for controlling IBD, it can lead to poor nutrition and weight changes as a result of the of either of the illnesses’ symptoms, as well as lethargy due to the insufficient energy derived from the nutrients consumed. The results of these symptoms can lead to depression and anxiety due to poor performance, cognitive dysfunction, perceived “laziness”, for example.
The social implications on Mental Health
As previously mentioned, symptoms of IBD can be perceived as laziness, however in truth, patients may experience struggle with just getting out of bed due to the symptoms of IBD. In this section we will explore other social factors on IBD and mental health for SAA and SA alike.
Body Type
Having IBD can lead to drastic changes in body size as a result of nutrient absorption, appetite changes, lethargy, and the impact on growth in pediatric patients. Furthermore, the side-effects of cortical steroids, such as weight gain and bloating, and the body’s response to perceived starvation during remission (storing fat) can further exacerbate the changes in body size. Just as in any culture, the changes in body size as a result of IBD can lead to poor self-esteem and body dysmorphia, SAAs thoughts about their bodies are further compounded as a result unobtainable beauty standards and the lack of healthy representation in media. Furthermore, in patients with body size changes as well as with colostomy bags can struggle with desirability and fertility (historical data suggests that a colectomy can effect pregnancy in women). Furthermore, patients with colostomy bags, especially in younger individuals, struggle with visibility of the bags and other’s perceptions of it. These experiences can also lead to depression due to feelings of loneliness or social anxiety, out of fear of the judgement.
Religion
One of the major religions in South Asia, specifically India, is Hinduism. Hinduism is intertwined in the way of life for Indians as well as Indian Americans. Hindus believe in the concept of reincarnation and the role of Karma as well as Dharma. To pray and mediate is to find inner peace. This can be a contradiction to some individuals with IBD, as having IBD can be perceived has having “unclean” Karma, or imply that the cause of IBD is behavioral in nature (not “praying hard enough”). With such powerful implications, a Hindu may not derive inner peace from prayer and meditation leading to further anxiety (“why is this not working?!”) or depression (“I must be a bad person because I have IBD.”)
Closing Remarks
The aforementioned experiences are by no means exhaustive. Individuals with IBD from various cultural backgrounds can indeed affect mental health. IBD as well as IBS (Irritable Bowel Syndrome) are also affected by mental health. Therefore, treatment must involve physical health intervention as well as mental health intervention.
Medical adherence, not to be confused with compliance, is an active involvement in the betterment of one’s health through actionable changes. Compliance, on the other hand, is a passive involvement in one’s wellness journey. Compliance also implies that the individual does not have much control as opposed to adherence, where the individual is in the driver’s seat of their own healthcare. Adherence can have a significant affect on an individual’s prognosis, however adherence may not be enacted. In a study conducted by the World Health Organization (WHO) in 2003, researchers found that in developed countries, 50% of individuals with chronic health conditions adhere to their providers recommendations and therapies for certain health conditions. This statistic is further compounded when faced with other factors and barriers to healthcare adherence discussed in this month’s blog post.
Understanding the recommendation
According to a study looking at English and Spanish- speakers, several individuals misunderstood the directions and recommendations from their physician. Factors contributing to this confusion was language, comprehension of the medical jargon (even if instructions were given in their native language), and age. Several other studies have shown that when given verbal instructions, patients struggle to recall the information at a later time, especially when the physician uses medical jargon. The resulting issues led patients to erroneously take their medication, which could potentially effect the therapeutic value of the medication. Furthermore, the lack of medicinal effect can lead to depression and feelings of hopelessness.
Our clinician’s recommendations:
It definitely can be intimidating when an authority figure is throwing information in what seems like a hefty pile. However, we may forget that we are the authorities of our bodies and we deserve to give ourselves a moment to check in with the information we are getting. I often recommend clients to request a follow-up document, whether their physician uses an Electronic Health Records (EHR) software or can give you a print out at the end of your visit. Sometimes, physicians may not use these methods, so I often recommend clients to take notes either with old school: pen and paper or using their notes application on their phone. Another component to ensuring optimal understanding, maybe requesting a provider who speaks your native language (if that option is available) so nothing is lost in translation, and asking your physician questions to make sure you understand (“If I understand you correctly,…” or “I just want to make sure I got this right,…” are some starters).
The rapport with the PHYSICIAN
It is no surprise that “bedside manners” effect adherence. Research has found that physicians who foster a therapeutic environment through effective communication and support led patients to be more actively involved in their treatment process. The more active patients are in their treatment, the more they are satisfied with their partnership with their provider, and the more cohesive partnership led to better adherence. Another study found that it is imperative that patients feel comfortable with their physician, to ensure that all the important information is shared with the provider. It is also important to have all the needed information for the physician to make an accurate recommendation.
Our clinicans recommendations:
When buying a car, we shop around until we find the car that meets our needs, because this is a decision that can potentially affect us in several areas of our lives (financially, commute, enjoyment, etc.). The same goes for finding the right provider. If you are able to meet with different providers in your area, it is ok to make sure they are a right fit for you. Your healthcare is a partnership, and you can decide if the provider’s style fits with your needs.
Stayed tuned for Part II where we discuss culture and psychological factors to adherence and Part III where we explore how medical adherence affects chronic illness.
This month’s blog post was written by our Chronic Illness specialist, Aarti Felder.
Contact us for more information or assistance in managing your chronic illness.
I remember the first time I was introduced to Acceptance Commitment Therapy (ACT). I do not remember really being taught about it in school. I read it and, on the name alone, thought, “sign me up!” The idea that it was okay to feel what was going on, discuss the feelings, and to learn how to work through those feelings made so much sense to me. Working with trauma for most of my career, I thought this could be something I could incorporate into my daily life.
A major part of what drew me to these interventions was the idea of acceptance. That word is such a huge thing to include because at this point, we are learning so much about how the brain works and have only scratched at the surface.
Dialectical Behavior Therapy (DBT) was something I had learned in school. I felt like the idea was great, DBT works to change thought processes through mindfulness, acceptance, and emotional regulation, but it was too rigid with specific rules and pathways. Due to these strict rules, I felt DBT was missing something that I could use in my practice. I had always gotten ACT as an idea and concept, although in practice it often involved clinicians being passive. On the other hand, DBT was too rigid and required accountability.
I was fortunate enough to participate in a fellowship through University of Chicago and Paul Holmes where I learned about Contextual Behavior Therapy (CBT). This is a third wave of intervention that works to combine both DBT and ACT. For me as a clinician, CBT revealed new opportunities.
Often, in traditional therapy, the emotions related to trauma are overlooked. It becomes more about oversimplifying one’s struggles, i.e. don’t be in an abusive relationship, control flashbacks and triggers. CBT focuses on just not thinking a certain way, it involves work to do and tries to change that thinking. The combination of ACT and DBT works more to accept those thoughts and work on how to identify or improve them. This is different since it does not put the blame on one’s thoughts but works to identify how the thoughts work.
Traditional talk therapy also involves focusing on the trauma in detail. While it is important to understand the trauma, it is also important not to retraumatize. This is the importance of working and practicing mindfulness together.
Treating trauma with act and dbt
Trauma can is it change a person, from how one perceives the world to their relationships. With the combination of ACT and DBT, those changes are examined. The reasons for flashbacks and triggers are examined, as well as their choices are examined through a safe and nonjudgmental lens. The combination of those two modalities lends a more balanced approach.
Trauma can lead to uncertainty, the person experiencing the trauma may not be able to trust others or may feel like they cannot trust themselves. Trauma survivors who do not trust themselves may not listen to their body. This is a protective defense since they feel the one time they were able to trust themselves; something bad happened. Not listening and trusting themselves is their way to protect themselves from another traumatic experience. Although this strategy may appear effective, however it can also lead to many problems. For example, when things go wrong, which is a part of life, they lack the tools and resources to handle the problem. They also protect themselves so much that they miss out on experiences or relationships. In my practice, I have found that the combination of ACT and DBT truly concentrates on listening to your body.
With the use of a combination of ACT and DBT, I have been able to talk to clients about their trauma, discussing how it is affecting them and where it is felt both physically and mentally. We also spend a lot of time discussing the safety and changes that have occurred in order to explain that the situation does not have to repeat itself. Our eventual goal is the ability to be present. I have had clients who discuss how they have a new joy in their “self-care” because they no longer view it as “I’m supposed to be doing this,” but instead “I like this.”
I also incorporate mindfulness, particularly focusing on the tools and the words each person uses, into my practice, which is key for trauma survivors. The nature of trauma is that the person experiencing it loses control over a situation and mindfulness involves regaining control. Clients are empowered by working with their clinician to gain control. It is natural for all humans to play the “What if” game after experiencing trauma, to think about all the things we could have done differently, the signs we could have or should have seen. What we can do with the use of this of treatments to address the truth: nothing can change the past. Using these tools, the focus turns to realize that the past cannot be changed, but the future is still open. This allows the clinician and client to concentrate on accepting current situations and working towards being the best version of oneself now, while realizing that the future is still undecided and filled with possibility.
Trauma happens to all of us as part of the natural circle of life. It is completely normal to spend time in the space of wondering what could have been done differently. The key to effective therapy for trauma survivors is not going through the sordid details, but of acknowledging the feelings, rephrasing thoughts, and focusing on the present. The combination of ACT and DBT allows for openness working with trauma survivors, but also the awareness of and pay more attention to the treatment. I feel this truly empowers people to know what they think and be their true self. These methods allow me as a clinician to serve as a guide in this journey.
Follette, V., Palm, K.M. & Pearson, A.N. Mindfulness and trauma: implications for treatment. J Rat-Emo Cognitive-Behav Ther24, 45–61 (2006). https://doi.org/10.1007/s10942-006-0025-2
Jennings, J. L., & Apsche, J. A. (2014). The evolution of a fundamentally mindfulness-based treatment methodology: From DBT and ACT to MDT and beyond. International Journal of Behavioral Consultation and Therapy, 9(2), 1-3. http://dx.doi.org/10.1037/h0100990
Overcoming Trauma and PTSD: A Workbook Integrating Skills from ACT, DBT, and CBT by Sheela Raja
This month’s blog post was written by our Trauma Specialist, Laura Valiukenas, MSW, LCSW.
“The fact that we are here and that I speak these words is an attempt to break that silence and bridge some of those differences between us, for it is not difference which immobilizes us, but silence. And there are so many silences to be broken”
Audre Lorde
History is important because it connects us to a context greater than ourselves, as well as the larger community that helps us process things better and be greater than the whole. This is part of the reason why Black History Month was created. Black History Month was officially recognized in 1976 as a national event after decades of efforts to recognize the often-neglected accomplishments of Black Americans in United States and global history. This exclusion from history is seen in so many aspects of life, including mental health. Within the African American community there is a lot of skepticism about seeking services, which is a result of years of unethical treatment that continues to the current day. From racial eugenics and forced sterilization, to Henrietta Lacks whose cells were taken without her permission and used (to this day!) for medical research, to the Tuskegee syphilis experiments (which were continued in Guatemala after being deemed too unethical for the United States), to the history of gynecology, to the increased risk of complications and death due tocovid-19, there are many examples of how the medical field hurts Black Americans. Due to this deep history of abuse by the medical field and erasure of the contributions made by these individuals, it makes sense that there is mistrust by the community. Being disconnected from one’s history and contributions can lead to a sense of isolation and not belonging/not being wanted by the culture around you/excluded and exploited by a society that steals from your culture and dehumanizes you.
Connecting to the History of Psychology
Often Black, Indigenous, and People of Color (BIPOC) feel that they are excluded from mental health spaces. Part of that is because of the earned mistrust in the medical and mental health fields, and part of it is because the field often excludes issues that are major concerns for these communities. Psychology and mental health issues are primarily seen as white, Western traditions that do not prioritize the things that are important to people outside of the dominant cultural narrative. But if we look at and understand that counseling is a healing practice, it becomes clear that it includes BIPOC. With that being said, let’s first look at the contributions BIPOC have made in the field of psychology and counseling.
Black Psychologists
“In the future, as in the present, as in the past, Black people will build many new worlds. This is true. I will make it so. And you will help me.”
N. K. Jemisin
Dr. Francis Cecil Sumner, PhD: Father of Black American Psychologists (1895-1954)
The first African American to receive a Ph.D. in psychology in 1920 from Lincoln University
He focused on refuting racism and bias in Eurocentric theory and research of psychology
Dr. Inez Beverly Prosser, Ed.D (1895-1934)
The first African American woman to receive a doctoral degree in psychology in 1933 from the University of Colorado
Her work focused on the education system and the different outcomes of students in integrated vs. segregated schools
Dr. Ruth Winifred Howard Beckham, PhD (1900-1997)
Received a PhD in psychology and child development in 1934 from the University of Minnesota
Dedicated her career to the advancement of women and children in her community
Dr. Herman George Canady, PhD (1901-1970)
Received a Ph.D. in psychology in 1941 from Northwestern University
The first psychologist to examine the role of the race of the examiner as a bias factor in IQ testing
Spearheaded the movement to organize Black professionals in psychology
Dr. Joseph L. White, PhD: Godfather of Black Psychology (1932-2017)
Received a Ph.D. in clinical psychology in 1961 from Michigan State University
Proposed the seven major psychological strengths of African-Americans (2005)
Improvisation
Resilience
Connectedness to others
Spirituality
Emotional vitality
Gallows humor
Healthy cultural suspicion
Dr. Robert V. Guthrie (1932-2005)
Described by the American Psychological Association (APA) as “one of the most influential and multifaceted African-American scholars of the century”
Wrote Even the Rat was White: A Historical View of Psychology
Exposed that long history of racist work in psychology
Profiled overlooked Black psychologists
First African-American to have his papers included in the National Archives of American Psychology
Dr. Robert Lee Williams II, PhD (1930-2020)
Received a Ph.D. in clinical psychology in 1961 from Washington University in St. Louis
Created the Black Intelligence Test of Cultural Homogeneity (BITCH-100) in 1972
Created to demonstrate how cultural content on intelligence tests may lead to culturally biased score results
Set a precedent for the critical examination and rejection of Eurocentric intelligence testing
Dr. William Cross (1940–present)
Received his Ph.D. in Psychology in 1976 from Princeton University
Proposed one of the first models of Black racial identity development in psychology
Dr. Janet E. Helms (present)
Received her doctorate in psychology with a specialization in counseling psychology in 1975 from Iowa State University
Her work focuses on how race, culture, and gender can influence one’s personality and participating counseling styles
Challenged inherent racial bias in construction of assessment tools
Racial Identity Theory
The Association of Black Psychologists (ABPsi)
Established in 1968
Original goal was to have a positive impact upon the mental health of the national Black community by means of planning, programs, services, training, and advocacy
Current goal is to promote social justice, cultural psychology, racial/ethnic identity and multicultural competencies, and addresses challenges facing the black community
Association for Multicultural Counseling and Development (AMCD)
Division of the American Counseling Association chartered in 1972
Part of its mission is to enhance the development, human rights and the psychological health of ethnic/racial populations and all people as critical to the social, educational, political, professional and personal reform in the United States and globally
Since the early days of psychology BIPOC individuals have been present and advocating for the issues that concern their communities.
What are specific needs of BIPOC individuals?
There are many issues that impact communities of color’s physical and mental well-being. These include lack of access to resources such as healthcare, steady employment, nutritious foods due to food apartheids, and housing due to the continued effects of redlining on the housing market. There is also the stress of the continued global pandemic and increased cultural awareness of racial trauma.
Racial trauma, a form of race-based stress, refers to BIPOC reactions to dangerous events and real or perceived experiences of racial discrimination. In the past year, many causes of race-based stress were highlighted, including the continued police brutality and murder of BIPOC individuals, the increased lack of support from the government, and the lack of access to basic needs. This stress can cause many health problems because of what stress does to the body. This can include physical affects like headaches, muscle tension or pain, chest pain, fatigue, stomach issues, and sleep problems; mood issues like anxiety, restlessness, lack of motivation or focus, feeling overwhelmed, irritability or anger, and sadness or depression; or behavioral issues like over- or under-eating, angry outbursts, drug or alcohol misuse, and social withdrawal. There can also be long-term problems like higher rates of diabetes, substance use, high blood pressure, cardiovascular disease, and autoimmune disorders.
So what about mental health?
“All that you touch, You Change. All that you Change, Changes You. The only lasting truth is Change.”
Octavia E. Butler
When dealing with all of these stressors, it is important to find ways of approaching healing. Here are some suggestions to begin in that healing:
Eating healthy and getting 7-8 hours of sleep
Staying physically active and making space for moment in your life
Connect with others who reaffirm your humanity
Practice self-care routines
Seek out healing practices consistent with your beliefs
Take breaks from technology and social media
Explore relaxation techniques such as deep breathing
Learn to understand what you can and cannot control
This process can be difficult but important for one’s wellbeing and functioning. You have the skills to heal, and we can help.
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
