Black/African Americans and Mental Health

Why is it that members of the black community are less likely to seek services for mental health? Is it the mistrust in healthcare professionals? Stigma? Cultural barriers? Lack of access? Or is it the safety nest of relying on family, friends and the religious community? Whatever it may be how do we fix it? What other mental hurdles keep black people from seeking assistance? Believe it or not, the list continues. Many will seek help for physical concerns, but not mental disorders. 

The Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey found that Black and Hispanic respondents had equal or higher rates of depression than Whites. According to The US Department of Health and Human Services (OMH), in 2019, suicide was the second leading cause of death for blacks or African Americans, ages 15 to 24. Black or African Americans living below the poverty level, as compared to those over twice the poverty level, are twice as likely to report serious psychological distress. National Alliance on Mental Illness (NAMI) reports only 1 and 3 black adults with mental illness received treatment.

Stigma comes from the lack of understanding and fear that leads to the reluctance to seek help. It is time to eliminate negative stigmas like only crazy people see shrinks, therapy and sharing your feelings make you weak, it’s a waste of money and the “I can handle it myself” approach. What other negative stigmas associated with black therapy come to mind? Let’s not forget the stigma behind the journey in itself of finding a therapist that can relate culturally. As some stigmas may be more discouraging than others, the time to eliminate them is now.

Knowledge is power. First step to seeking help is to know the signs. Let’s take a stroke episode for an example: You have to know the signs and quickly seek help when the signs first present itself. Signs such as facial droop, one sided weakness and trouble speaking. While mental illness has signs that impact our daily functioning such as poor appetite, loss of interest, feelings of sadness, hopelessness, worthlessness, irritability, increase in risk taking behaviors, racing thoughts and so much more. It is so very important to know the signs.

Let’s change the perspective and encourage ourselves and others to live a happy, positive and successful life. Many black success stories include battles with mental health. Celebrities such as actresses Taraji P. Henson, Jennifer Lewis, hip hop artists Jay Z, Kid Cudi and first lady Michelle Obama – all detailed times in their lives where they sought the help needed and continued to thrive as individuals. 

Treatment is available. Please do not suffer in silence. Acting as if the signs/symptoms are not there will not make it go away. Face the fears and push forward. 

Seek help and reach out to a well-trained mental health professional. Encourage other loved ones to do the same. 

Team work makes the dream work! Each one, teach one! Greatness awaits!


National Institute of Minorities Health and Health Disparities

Constance White, MA, LPC

Constance White, MA, LPC is brilliant clinician who assist clients experiencing general mental health challenges reach their full potential

Finding an Approach in Coping with Trauma

There are many symptoms of trauma. It can be seen as a constant search for a threat that cannot be found, difficulty sleeping, hyperarousal, constriction in the physical body, flashbacks, and disassociation. some individuals experience reduced ability to cope with stress and mood swings.

What is trauma?

The Diagnostic and Statistical Manual Fifth edition – Text Revision (DSM 5-TR), which psychotherapists and psychiatrists use as a diagnostic tool, would suggest that trauma,

“is caused by a stressful occurrence, which is outside the range of usual human experience, and that would be markedly distressing to almost anyone.”

It is a

“serious threat to one’s life or physical integrity serious threat or harm to one’s children, spouse, or other close relatives or friends; sudden destruction of one’s home or community seeing another person who is or has recently been seriously injured or killed as the result of an accident or physical violence.”

While the diagnostic criteria in the DSM 5-TR may not be wrong, some experts would argue that it is vague and that there is more to consider what is trauma. Like any definition, this is subjective to a person’s experience. Several experts would argue that surgeries, falls, a diagnosis, abuse, and shootings are outside the realm of usual human experience. This would suggest that a traumatic event may be more than a feeling than a mere subjective definition on paper. 

Clinicians who use the Trauma Resiliency Model may argue that symptoms of trauma stems from the frozen residue of energy that has not been resolved and discharged. The natural autonomic, defensive, response could be a stuck response. This stuck residue of energy can pop up when a person has a memory of what has happened, leading to a reaction, to a triggering event. In turn, this energy remains trapped in the nervous system if not managed or released. Furthermore, this frozen energy, such as a tight feeling in the chest, a feeling frozen when triggered, or the need to fight or run away from the triggering situation.

What physiologically happens in someone who has experienced trauma?

Research has shown that an excess of cortisol and adrenaline is released into the body. An individual who has experienced trauma takes the excess of cortisol and adrenaline and automatically fights, flights, freezes, or fawns. Furthermore, memories, triggers, or stressful events can create havoc on our minds, bodies, and souls. Due to the resulting release of excess cortisol and adrenaline, it mobilizes resources from the gut, immune system, elimination system, and parts of the brain responsible for cognition, decision-making, and other higher functions. This energy gets placed into muscles to fight or run for one’s life. Other negative impacts of the stress response can be seen in memory, digestion, concentration, as well as the elimination of toxins.

A study conducted at UCLA suggests that when someone is triggered less, it slows the aging process in their brain. Therefore, being triggered more creates more aging in the brain and can compromise the immune system, as stress hormones inhibit the immune system. All of the above can happen when a triggering memory has been brought to the present. Rosenfield concludes that the memory can be misleading, “it is not fixed images that we rely on, but recreations, imaginations, the past remolded in ways appropriate for the present.” 

Consequently, if in a traumatic situation a maladaptive response (fight, flight, freeze, fawn) is never completed in a threatening situation, the nervous system is trying to search for an appropriate response to an inappropriate situation. According to Peter Levine, as we become more desperate to find an appropriate response, we begin to select any image around us at the time of the traumatic situation, which becomes a memory. These images then become related to similar future emotional state but are not useful to one’s survival.

Therefore, a past memory in a current situation can seem more real than life itself. This has been referred to as a trigger, which can cause flashbacks. In healing work, “the relationship that we have with our memories” may be a key to change. Becoming unattached to symptoms, and “release[ing] them from our minds and hearts along with the energy that is locked in our nervous systems” describes the healing process.

When an individual experiences a traumatic or difficult situation, the body releases an excess of stress hormone and reaches for anything as an appropriate response to feel safe, which creates a memory. In turn, the memory creates the future physiological responses that experts call trauma responses.

How do we heal and feel better to deal with these trauma responses?

There are various types of therapies proven to assist in trauma. It is up to the client to do what feels like the right fit for them, while remembering there is no “right” way to heal. Yoga or breath work can slow down the nervous system. Emotional Freedom Technique requires one to tap, access, and release emotions, while speaking the truth. Eye Movement Desensitizing and Reprocessing (EMDR) is used to process the past through the use of techniques to heal the physical and mental state of trauma.

Meditation is just as powerful through the discovery of inner peace. While also, belief can shift biology as in Cognitive Behavioral Therapy (CBT). Neurofeedback and Biofeedback is also another efficacious therapeutic strategy, with the focus on neurological origins of trauma and Heart Rate Variability. Some would go to a shaman or other holistic healers and use energy work or herbal-based medicine. Science continues to explore the aforementioned therapies and healing practices; some practices have more data to support the efficacy while others are emerging in science to determine why these therapies are successful. 

The use of Yoga in Trauma Therapy

In the traumatic state, which has been activated in amygdala and the prefrontal cortex and is inhibited by stress, asking somebody to rationalize or think through their response when they are (in an acute) state is asking them to do something of which they are temporarily, neurologically incapable. Therefore, for some, focusing on breath and movement of the physical body awareness is a way to shift active stress.

One study suggests in an active state of stress, one can learn to calm down by learning a set of skills including Tracking, Resourcing, Grounding and Gesturing, Help Now and Shift and Stay. This study mentions something akin to what in Buddhist terms would be described as mindfulness of the body. This state of mindfulness can help calm and stabilize the nervous system. Yoga Nidra is a specific (still and gentle) type of yoga, which has been used to treat PTSD symptoms such as anxiety, insomnia, and depression.

Programming the autonomic nervous system, changing beliefs, and thus neuropathways in the brain can shift biology to feel better. It is proven that releasing emotional and physical blockages leads to healing. There are many treatments, it is the preference and which therapeutic style fits with the needs of the client. Whether it is practicing yoga, lifting weights, attending counseling, burning old letters, or throwing eggs at trees to release energy, is up to to the client. Finding the approach to healing and coping with the memories, felt-sense, reactions, and held emotion is key to healing and the understanding and releasing the trauma. The client is not the emotion or feelings, trauma is not a life sentence. With the correct tools and support one can feel better and live a life of wellness past the trauma.


Compson, J. (2014). Meditation, Trauma and Suffering in Silence: Raising Questions about How Meditation is Taught and Practiced in Western Contexts in the Light of a Contemporary Trauma Resiliency Model. Contemporary Buddhism15(2), 274–297.

Diagnostic and statistical manual of mental disorders : DSM-5-TR (5th edition, text revision.). (2022). American Psychiatric Association Publishing.

            Levine, P. A., & Frederick, A. (1997). Waking the tiger : healing trauma : the innate capacity to transform overwhelming experiences. North Atlantic Books.

Merriam-Webster’s collegiate dictionary. (Eleventh edition.). (2003). Merriam-Webster, Incorporated.

Miller, R. C. (2015). The iRest program for healing PTSD : a proven-effective approach to using Yoga Nidra meditation & deep relaxation techniques to overcome trauma. New Harbinger Publications, Inc.

Rosenfield, I., & Rosenfeld, A. H. (1988). Rosenfield, Israel. The Invention Of Memory: A New View Of The Brain // Review [Review of Rosenfield, Israel. The Invention Of Memory: A New View Of The Brain // Review]. Psychology Today22(5), 68–. Sussex Publishers, LLC.

Schalinski, I., Elbert, T., Steudte-Schmiedgen, S., & Kirschbaum, C. (2015). The Cortisol Paradox of Trauma-Related Disorders: Lower Phasic Responses but Higher Tonic Levels of Cortisol Are Associated with Sexual Abuse in Childhood. PloS One10(8), e0136921–e0136921.

Van der Kolk, B. A. (2015). The body keeps the score : brain, mind, and body in the healing of trauma. Penguin Books.

<a href="">Rebecca Caliendo, MM</a>
Rebecca Caliendo, MM

Rebecca is a senior clinical intern at TriWellness and has been teaching yoga and mediation for six years. Her clinical focus is on using yoga and evidence-based clinical therapies in her work with clients.

Seasonal Affective Disorder

December is Seasonal Affective Disorder (SAD) Awareness month, and we want to bring more awareness to this aspect of depression. Seasonal Affective Disorder is a type of depression where significant mood and behavior changes happen with the changes in the seasons, usually late fall or early winter and improve in the spring and summer, or vice versa. The seasonal changes in mood are not a full diagnosis, it is s specifier for depressive disorders and it is important to be aware of those changes. Here are some symptoms of depression to watch out for: 

Symptoms of major depression may include:

  • Feeling depressed most of the day, nearly every day
  • Lack of interest in activities you once enjoyed
  • Experiencing changes in appetite or weight
  • Having problems with sleep (too much or too little)
  • Feeling sluggish or agitated
  • Having low energy
  • Feeling hopeless or worthless
  • Having difficulty concentrating
  • Having frequent thoughts of death or suicide

In order for SAD to be diagnosed, the above depressive symptoms have to have a noted relationship with a particular the time of the year for at least 2 years and be more of a presence during that time of the year than any other times of the year. Here are some depressive symptoms that are often characteristic of SAD:

  • Loss of energy
  • Over-sleeping
  • Overeating
  • Weight gain
  • A craving for carbohydrates

An important distinction in the diagnosis of SAD is whether there are external factors that are impacting the change in mood, such as changes in school or seasonal employment status. It has also been noted that winter-type seasonal pattern occurs more in women than in men, in younger people more than older people, and with people who live in higher altitudes; having another mental health condition also increases the likelihood of developing SAD. Treatment for SAD often includes 

  • Antidepressant medication
  • Vitamin D
  • Light therapy
  • Psychotherapy


American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

During this time of year there can be an increase in depressive symptoms which can greatly impact your ability to function, here at TriWellness we can help you develop the skills to manage this low mood. 

This month’s blog post was written by our Chronic Illness Specialist Jessie Duncan, MA, LPC, NCC.

Native americans and HealthCare

Traditional Medicine

Throughout history, different tribes have different rituals for healing following what is called the bio-psycho-social-spiritual model. Tranditional healing practices involve the balance of the physical, mental, social, and spiritual factors in life. Ceremony is an important part of healing as it incorporates the Spirit, Creator, and the Universe. Alaskan Native, Hawaiian Native, and Native American healers utilize indigenous plants to heal conditions from muscle aches to diabetes. Healers of the Nation utilize their tribal Medicine Wheel that represents the four directions along with Father Sky, Mother Earth, and the Spirit Tree. The Medicine Wheel’s four directions connect the life stages (birth, youth, adulthood, and death), life aspects (physical, intellectual, emotional, and spiritual), the seasons (spring, summer, autumn, and winter), along with other factors connecting one to nature. Movement along the Medicine Wheel also is a reflection of one’s connection to nature, as one moves along withe Medicine Wheel in the same direction the Sun moves across the sky, East-West, in a clockwise direction (Native Voice: Healing Ways).

History of American Indigenous People and Healthcare

Native Americans healers would utilize the aforementioned healing practices, however once the western people arrived to the American shores, they also brought diseases that the Natives were not immune. As a result of the lack of immunity, an estimate of 90% of the population, prior to colonization, perished.

The Indian Health Service (IHS) was established on July 1, 1955 under the Public Health Service for the betterment of healthcare for Native Americans. The IHS was responsible for providing healthcare to Native Americans in accordance to the Synder Act of 1921 and the later Indian Healthcare Improvement Act (IHCIA) of 1976 (Baciu et al, 2017). However, the IHS mission was not always realized and had a documented unethical practice. In 1976 the General Accounting Office (GAO) found that in a span of three years, Native women ages 15-44 years old were subjected to involuntary forced sterilizations. This unethical practice and several other clinical misconducts along with genocide, ethnocide, and trauma has fostered mistrust in the American healthcare system (Pacheco, et al, 2013).

Native American Healthcare Today

Despite the advancement and access to healthcare, Native Americans continue to experience disparities. Their average lifespan is 73 years in comparison to the 78.5 years for the rest of Americans. Indigenous people in the US also have higher rates of impact from liver disease, chronic respiratory diseases, and the recent Covid-19 pandemic (Stanley, 2020).

However due to the mistrust in the American healthcare system, the improvement of these disparities are challenging to say the least. The Indian Self-Determination and Education Assistance Act (ISDEAA) of 1976 and the subsequent amendments place the power back to the Native Americans. They have the option to receive or decline healthcare services from the IHS. By placing the power with the people, the leaders of each tribe can determine their need or even desire to contract with IHS. However a factor that continues to impact the efficacy of the IHS is insufficient funds (Baciu et al, 2017).

Many tribes within the Nation have also reintroduced the traditional healing practices their ancestors utilized. In Hawaii, some communities have adopted the Waianae Diet, or the “Pre-Captain Cook Diet”, where the focus on the reduction of preservative, fatty, and high-caloric foods to promote a healthy living. Furthermore, several tribes have also opened up their Powwow to the public and invite non-natives to healing ceremonies to engage in the aforementioned traditional healing practices.


Koithan M, Farrell C. Indigenous Native American Healing Traditions. J Nurse Pract. 2010 Jun 1;6(6):477-478. doi: 10.1016/j.nurpra.2010.03.016. PMID: 20689671; PMCID: PMC2913884.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. Appendix A, Native American Health: Historical and Legal Context. Available from:

Native Voices: Healing Ways (Retrieved Nov. 2022).

Pacheco CM, Daley SM, Brown T, Filippi M, Greiner KA, Daley CM. Moving forward: breaking the cycle of mistrust between American Indians and researchers. Am J Public Health. 2013 Dec;103(12):2152-9. doi: 10.2105/AJPH.2013.301480. Epub 2013 Oct 17. PMID: 24134368; PMCID: PMC3828980.

Stanley, B. ‘Many Years To Overcome’: A Brief History of Native American Health Care Disparities. The Rotation. 2020 Aug.

This month’s blog post was written by our Chronic Illness specialist, Aarti S. Felder, MA, LCPC, BCN.

Breast Cancer and its Impact on Mental Health

Overview of Breast cancer

Breast cancer is a common cancer that impacts mostly women, but has a history of impacting 1% of men. Breast cancer is characterized by the formation of cancer cells in the breast tissue. Some common symptoms of breast cancer are lumps within the breast tissue, changes in size, shape, or appearance, changes in skin around the breast and nipple. Regular mammograms and self-examinations can assist in early detection and resulting better prognosis (Mayo Clinic, April 2022).

Breast surgeon, Dr. Judy C. Boughey, M.D. explains breast cancer.

Types of breast cancer

There are eight types of breast cancer.


  • Cancer cells in the lining of blood vessels and lymph vessels
  • This a a rare cancer

Ductal carcinoma in situ (DCIS)

  • Abnormal cells in the milk duct
  • Earliest type of breast cancer that is noninvasive, and has a low risk of spreading


  • A type of breast cancer that develops rapidly
  • Symptoms include red, swollen, and tender breasts
  • This is a rare cancer

invasive lobular carcinoma

  • A cancer that begins at the lobules of the breast (the milk producing glands)
  • These cancer cells have the ability to spread to the lymph nodes and other areas of the body

Lobular carcinoma in situ (LCIS)

  • Abnormal cell formation in the lobules
  • Not a cancer, however individuals with this diagnosis have an increased risk of developing breast cancer
  • This is an uncommon condition

Male Breast Cancer

  • Cancerous cells in the male breast tissue
  • This is a rare condition

Paget’s Disease of the Breast

  • The disease starts at the nipple and extends outwards to areola
  • This condition is a rare type of cancer

Recurrent Breast Cancer

  • Breast cancer that reoccurs after treatment
  • Cancerous cells evade treatment

Risk Factors that impact Breast Cancer

The following are risk factors that can affect the development of breast cancer. However, having one or more of the following factors, does not necessarily imply that one will develop breast cancer.

  • Physically a female
  • Older in age
  • Personal or family history of breast cancer
  • Genes (BRCA1 & BRCA2 are known genes that increases the risk of cancer)
  • If you have been exposed to radiation
  • Obesity
  • Start of menstruation before 12 years old
  • Starting menopause at a later age
  • Having your first child after the age 30 or not having been pregnant
  • Postmenopausal hormone therapy
  • Drinking alcohol

Prevention and treatment

Breast cancer prevention involves lifestyle changes from diet and movement, and regular self exams and breast cancer screenings. In cases of high risk, your physician may recommend preventive medications or surgery.

Despite risks and prevention, sometimes an individual may still develop breast cancer. Due to intensive research, there are several treatments available.


There are several different types of surgeries which is contingent on the severity of the breast cancer. Lumpectomy is utilized to remove the specific region around the tumor. A mastectomy is the removal of the entire breast, depending on the spread of the cancer it may involve the removal of both breasts. Another type of surgery involves the removal of certain lymph nodes; the amount of lymph nodes removed depends on the spread of the cancer. After the removal of the tissue, some patients may want to get a referral to a plastic surgeon for reconstructive surgery.

Radiation Therapy

Radiation therapy is another treatment strategy used to treat cancer. It involves x-ray or proton energy that targeted to the infected region. These beams of energy can be externally implemented or internally implemented, as in brachytherapy. Common side-effects of radiation therapy are fatigue, swollen or redness around the targeted region


Chemotherapy is a type of cancer treatment that involves utilizing medication to treat the cancerous cells. This treatment may be used prior to surgery to decrease the size of the tumors in the breast tissue. Other times, chemotherapy may be used post-surgery in high risk cases of the cancer returning. Chemotherapy is also used to treat cancer that has spread to other areas of the body. This treatment is known to have several side effects, from hair loss to vomiting, and a compromised immune system.

Hormone Therapy

Hormone therapy blocks certain hormones, mainly estrogen or progesterone, depending on the specific cancer. Much like chemotherapy, this treatment may be used before surgery (to shrink the tumor), during, or after surgery. This treatment have several side effects depending on the type of treatment received. Common side effects are hot flashes, vaginal dryness, or night sweats.


Immunotherapy is a type of therapy that utilizes the patient’s own immune system to attack the cancer cells. This therapy impedes the cancer from hijacking the patient’s immune system. Immunotherapy is effective in cases where the patient does not have receptors for estrogen, progesterone, or HER2.

Targeted Medications

This type of treatment strategy uses specific medications to target specific abnormalities in the infected cells. Through research, scientists have found specific abnormalities called the HER2, this is type of protein that assists the cancer cells to grow and survive. By targeting the HER2, it can attack the protein without harming the healthy cells and restricting the growth of cancer cells.

the impact of diagnosis on mental health

Receiving the diagnosis of breast cancer and the subsequent treatments can understandably impact one’s mental health. From experiencing the stages of grief of what was to the treatments’ side effects as well as the impact of the treatment on the patient, there are several areas that can influence the patient’s and their family’s mental health.

Mood changes

One’s mood can be impacted at any stage of breast cancer. In the initial stage of being diagnosed with breast cancer, it can come as a shock if it was a sudden diagnosis. Some patients and their families noted experiencing The Kübler-Ross Five Stages of Grief or anticipatory grief. Certain aforementioned treatments can impact mood by causing hormonal changes, resulting in fluctuations in mood.

Other treatment strategies can also affect mood as a result of the physical side-effects. Increased fatigue and decreased energy can result in depressed mood due the lack of engagement in previously enjoyable activities, energizing movement activities, or general functionality. Surgery can affect how one view’s themselves which impact their self-esteem and mood.


Anxiety is another common mental health condition connected to the diagnosis and treatment of breast cancer. Patients may experience concern and worry about their prognosis and the impact of treatment. Some people who have experienced recurrent breast cancer or other cancers may feel anxious about the effectiveness of treatment this time.

Some individuals who have experienced recurrent breast cancer or other cancers may also experience medical trauma. Medical trauma is an experiential response to pain, serious illness, and medical procedures. Considering that breast cancer can lead to a person feeling a sense of shock, loss of the sense of control, life-altering or even life-threatening treatments/prognoses, and conditions experienced at the hospital and with clinicians, patients develop medical trauma.

Strategies for managing mental health

As important it is to seek medical treatment for breast cancer, it is also important to take care of one’s mental health. As previously mentioned, there are several factors that can impact a patient’s and their family’s mental health. It is important to seek help.

Community support groups are a great resource for patients’ and their families to support each other and to receive support in difficult times. In the Chicagoland area, Lurie Cancer Center lists several local support groups. The National Breast Cancer Foundation also provides some resources on finding support groups nation-wide. American Society of Clinical Oncology also provides some international resources and support in several languages for several different types of cancers.

Individual or family therapy is another strategy that can assist patients and their families cope with the mental health conditions that impact them. In therapy, individuals will have a safe space to process their diagnosis, prognosis, treatment process, and other aspects that may arise during the process. Therapist also assist individuals in the development of coping strategies to manage whatever stressors may arise outside of therapy.


Breast Cancer

How Breast Cancer can Affect Mental Health

On Death & Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. 50th Anniversary Ed., Dr. Elisabeth Kübler-Ross, Aug 2014.

Elisabeth Kübler-Ross Foundation

Anticipatory Grief: Mourning a Life before it’s Gone, A. Drakulich, 2021.

Public Fact Sheet for Medical Trauma Survivors

Receiving the diagnosis for Breast Cancer can be challenging, however you are not alone. Clinicians at TriWellness are trained in health psychology can provide assistance in this difficult time.

This month’s post was written by our Chronic Illness specialist, Aarti S. Felder, MA, LCPC, BCN.

Benefits of Breathing and Laughing

Over the years, I have seen an increase of individuals burdened with symptoms of anxiety. The feeling of being overwhelmed, hopeless, helpless, with excessive worrying, restlessness, and fearful. These days, we are being met with the daily hustles of balancing work, family/friends and home. We are dealing with the inflation of gas, food and cost of living. Many of us are constantly trying to please others, stay on top of our bills and avoid work burnout. We forget about ourselves. The importance of self-care and taking the time to breathe. Stopping for a few minutes just to take a deep breath can be the most beneficial thing you can do for yourself. You are giving yourself the time to gather thoughts, regain your sanity and relieve stress. The continued overwhelming feeling of anxiety and stress can impact your health, your daily functioning, performance at work and your social interactions in a negative way. That is not what we deserve or want. Take the time, breathe and focus on positivity. 

Think about all those times you had a good laugh to the point you had tears in your eyes. When you were sitting with family and friends, reminiscing about the good old times. Or even spending the night at a comedy show. How did you feel after that? Did it change your mood in a positive way? Were you more relaxed? Laughing is the best natural medicine available. Laughter reduces anxiety, relieves stress, relaxes muscles, improves mood and it is an immune system booster. We are all human and we make mistakes. Avoid feeling down about those mistakes, instead laugh and learn from them. Do not dwell on the little things, life is too short.

If you find yourself feeling overwhelmed; like the walls are closing in on you, your heart is racing, you’re sweating, unable to concentrate, just STOP and if you are able walk away to a quiet room. Close your eyes, inhale deeply through your nostrils, hold for a couple of seconds and slowly exhale through your mouth. Repeat this as long as needed, inhaling the positivity and exhaling the negativity. Afterwards, try to think of something funny, look at a funny video on your phone, check out memes or simply fake laugh. Believe it or not, but fake laughter has the same benefits as real laughter. The body does not know the difference. Like the saying goes, “fake it until you make it!” 

So, the next time you are feeling anxious remember you have the tools to alleviate the situation. Daily self-care is important, do not cheat yourself of it. Utilizing deep breathing and laughter will also provide you with inner peace. The best part about breathing and laughing is that it is FREE at no cost. Remember, you are only one person. Know your limitations, take time for yourself and think positive. At least once a day, set aside a few minutes to take a deep breath and laugh. You would be so thankful that you did. You are worth it. Love yourself.

This month’s blog post was written by Constance White, MA, LPC.

Benefits of Yoga and Movement to Mental health

Close your eyes and notice if you are carrying any stress in your body in this moment. Maybe in the jaw or stomach? Now, try to create space around the tension or stress by sending the energy of the breath around the tension. Breath regulation is beneficial in allowing people to slow down into what is happening right now.

When we experience stress or trauma, it can live in the body and can create a stress response in people of all ages. The stress response may be varying in levels such as clenching your jaw, tensing your body, needing to leave the room, or having a panic attack. 

While it is happening, it can seem scary. There is some good news. Stress response can be controlled using modalities such as mindfulness, yoga, as well as therapeutic touch such as acupuncture or massage along with therapy. 

This gives us the ability to regulate and recalibrate the autonomic nervous system, to control a stress response. In children, similar activity to assist in this release of stress include needing movement, play, and joyful engagement. These are all considered bottom-up methods, which calm physical tensions in the body, and shifts people out of flight/fight to reorganize people’s perception of danger. Basically, it can help you feel better.

Memories of trauma can but not always, lead to physiological symptoms such as autoimmune disorders, or skeletal muscular problems. Why? Because there is a proven mind, brain, and body connection to stress. 

“So how can we help that? I am a busy person and life is hard.” When we practice asana (yoga movements) no matter how modified, gentle, or vigorous, a reconnection and ability to warmly love self exists. This then shifts to other areas of life including but not limited to diet, relationships, energy, etc, which helps us to feel better.

Proven studies exist to show the physiological benefits and shifts in breathing exercises which change when a person becomes upset, is having a trauma memory, or is well regulated. Interpreting physical sensations is called interoreception, which allows people to have a relationship with their interior world and self. To be able to understand what the body needs, allows people the ability to tune into nourishing and healing the self.

Studies exist that show after twenty weeks of one weekly yoga class in people who have experienced stress and trauma, there are increases in activation of brain structures involved in stress regulation. These brain structures include the insula, and medial prefrontal cortex. Does this have to be only yoga? No! For some it could be running, reiki, massage, or even gardening.

Feeling safe in our bodies allows people to communicate previously overwhelmed situations that were not easily felt or talked about.

Children and adults can be taught self-regulation skills. The act of educating about physical sensations and becoming friends with our bodies, can assist in healing. Yoga, therapeutic touch such as acupuncture or massage, and breath work in addition to talk therapy may help you feel better. Contact us to start your journey to wellness.


Chirokas, Dennis, C., & Bradshaw, M. (2021). Phenomenological Reflections of Trauma Survivors on Healing Through Yoga. The American Journal of Occupational Therapy75(S2), 7512505186–7512505186p1.

Gulden, & Jennings, L. (2016). How Yoga Helps Heal Interpersonal Trauma: Perspectives and Themes from 11 Interpersonal Trauma Survivors. International Journal of Yoga Therapy26(1), 21–.

Van der Kolk. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Publishing Group.

This month’s blog post was written by TriWellness’s newest counseling intern, Rebecca Caliendo, MM, who has been teaching yoga from 2016.

mental health and diabetes in asian Americans

types Diabetes

Diabetes or Diabetes Mellitus is a chronic condition that is characterized by one’s body’s inability to convert the glucose (sugar) in food into energy and effects about 537 million adults from the ages of 20-70 around the world, and 1.2 million children ages 0-19 are affected by Diabetes Type I around the world. It is projected to rise to 643 million by 2030 (International Diabetes Federation, 2021). There are four common types of diabetes.


Prediabetes is caused by one’s body not responding to insulin production and resulting in higher levels of blood sugar. A person with prediabetes has an A1C range between 5.7-6.4%, when normally it is less than 5.7%. (A1C is a test that assesses for the percentage of blood that has sugar-coated hemoglobin.) Individuals with Prediabetes commonly exhibit the following risk factors:

  • Overweight
  • +/= 45 years old
  • Immediate familial history of Type II Diabetes (see below)
  • Physical activity less than 3 times per week
  • Polycystic Ovary Syndrome (PCOS)
  • Giving birth to a baby who is more than 9 pounds
  • Gestational Diabetes (see below)

Having Prediabetes can lead to Type II Diabetes (see below) if not managed (CDC).

Prediabetes: Could It Be You? (February 2020, CDC)

Gestational Diabetes

Gestational diabetes is characterized by a pregnant person’s body being affected by insulin production. This can also impact the person’s pregnancy and their baby’s health. Individuals with Gestational Diabetes have a higher risk of developing Type II Diabetes (see below) as well. There aren’t as many symptoms an individual with Gestational Diabetes may experience other than the possibly having increased thirst or more frequent need to urinate. Possible risk factors a pregnant person may be:

  • Overweight or obesity
  • Little to no physical activity
  • Diagnosis of Prediabetes
  • History of gestational diabetes in previous pregnancies
  • PCOS
  • Family history of diabetes
  • History of delivering a baby more than 9 pounds in previous pregnancies

Gestational Diabetes can cause complications in both the pregnant person and the baby. The pregnant person may experience the following complications:

  • High blood pressure
  • Preeclampsia
  • Deliver via C-section
  • Developing Type II Diabetes in the future

The baby of a person with Gestational Diabetes can have the following complications as well:

  • High birth weight leading to complications in delivery
  • Preterm birth
  • Respiratory Distress Syndrome (RDS) which is characterized by experiencing severe breathing difficulties
  • Hypoglycemia (low blood sugar)
  • Developing Type II Diabetes or Obesity in the future
  • Stillbirth

(Mayo Clinic)


Type I Diabetes used to be known as Juvenile Diabetes because it was predominantly diagnosed in children, however it can be diagnosed in adulthood. It is chronic condition that is characterized by a one’s pancreas inability to produce enough insulin. While the causes for Type I Diabetes is still being researched, it is believed that genetics, viral exposure, or environmental factors can cause Type I Diabetes. Treatment is primarily concerned with managing insulin levels, diet, and lifestyle. Common symptoms of Type I Diabetes may be:

  • Increased thirst
  • Frequent urination
  • Unhistorical bed-wetting in children
  • Increase hunger
  • Accidental weight loss
  • Irritability, mood changes
  • Fatigue
  • Feeling physically weak
  • Blurred vision

Individuals with Type I Diabetes can develop further complications throughout their body in the future if blood sugar isn’t managed well:

  • Development of cardiovascular diseases
  • Neuropathy (nerve damage)
  • Nephropathy (kidney damage)
  • Diabetic retinopathy (eye damage)
  • Foot problems
  • Oral complications
  • Dermatological complications
  • Pregnancy complications

(Mayo Clinic)


Diabetes (Type 2) (American College of Cardiology, 2019)

Type II Diabetes is also a chronic condition that is characterized by irregulation of sugar transformation into fuel, resulting in too much sugar in the bloodstream. Type II Diabetes is caused by the pancreas inability to make enough insulin and the body’s cells become resistant to that insulin. While there is no cure for Type II Diabetes, patients can manage the disease with weight loss, proper diet, physical activity, combined with medication. People with Type II Diabetes tend to experience the following symptoms:

  • More thirst
  • Increased urination frequency
  • More hunger
  • Accidental weight loss
  • Fatigue
  • Blurred vision
  • Sores can take awhile to heal
  • Having more infections
  • Numbness or tingling in extremities (hands and feet)
  • Parts of skin are darker than the rest of the skin (often seen on the neck or in the armpits)

Individuals are at higher risk for developing Type II Diabetes if they experience any of these factors:

  • Overweight or obesity
  • Fat distribution is mainly in the abdomen (mens’ waist of 40″+; women’s waist of 35″+)
  • If a person doesn’t use up the sugar through physical activity
  • Other family members have Type II Diabetes
  • High levels of the “bad” cholesterol (triglycerides) and low levels of “good” cholesterol (High-Density Lipoprotein, HDL)
  • The risk of developing Type II Diabetes increases as one ages
  • Prediabetes
  • Gestational Diabetes or giving birth to a baby weighing 9 pounds or more
  • PCOS

Much like Type I Diabetes, Type II Diabetes can lead to complications throughout the body:

  • Cardiovascular diseases, such as atherosclerosis (high blood pressure and narrow blood vessels)
  • Neuropathy in extremities and other areas of the body
  • Nephropathy
  • Retinopathy
  • Dermatological complications
  • Slow healing; when left untreated, sometimes the cure requires amputation
  • Hearing problems
  • Sleep apnea
  • Dementia

(Mayo Clinic)

Diabetes in the Asian American Community

In the Asian American community, 1 in 3 people are diagnosed with a type of diabetes (CDC, 2022) and is the fifth leading cause of death in AAPI (Joslin Diabetes). At the U.S. Department of Health and Human Services Office of Minority Health published the statistical differences of Asian Americans and their other nationality counterparts. They found that they are 40% more likely to have diabetes than non-Hispanic Whites. From 2017-2018 South-Asian Americans were 70% more likely to develop diabetes in comparison to their non-Hispanic white counterparts (OMH, March 2021). Due to the distribution of fat, primarily the visceral fat (fat distributed around organs), Asians can appear to be at a healthy weight and often under diagnosed with diabetes. As a result, it is recommended than Asian Americans have their A1C checked if their BMI is 23 or greater (CDC, April 2022). As the Asian population is quite diverse, it is difficult to identify the specifics of each subgroup and more research is needed (NIH News Releases, 2015).

Diabetes Impact on Mental Health in Asian Americans

The Mind-Body Connection impacts the individual with diabetes. People with diabetes are two to three times more likely to suffer from depression for various reasons and not many of these individuals are diagnosed and treated. Anxiety and stress can also impact diabetes prognosis (CDC, 2021) due to the manner in which the body burns energy. As diabetes is impacted by diet, individuals can develop Eating Disorders(MHA) and perhaps even Body Dysmorphia due to the weight fluctuations one can endure throughout the disease process. Furthermore the difference in BMI standards to adjust to Asian body types may impact the individual’s view of themselves. Research has noted that the implementation of conjoint intervention of medicine and lifestyle changes (i.e. diet, physical activity, and therapy) can greatly improve the lives of individuals with diabetes.


Diabetes Care– ADA’s Standards of Medical Care in Diabetes clinical practice recommendations

Drag ‘n Cook– a resource for Asian food recipes with nutritional information

International Diabetes Federation (IDF)

International Diabetes Federation Diabetes Atlas 10 ed. (2021)

Mayo Clinic The Essential Diabetes Book, 3rd ed., Maria Regina Castro, M.D. (2022)

National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States

Prediabetes– CDC

Prediabetes– Mayo Clinic

Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021–1029. doi:10.1001/jama.2015.10029

Type I Diabetes

Type II Diabetes

This month’s article was written by our chronic illness specialist, Aarti S. Felder, MA, LCPC, BCN.

Trauma Anniversaries

Have you ever felt something wrong?  Maybe out of nowhere you begin to feel heightened sense of anxiety or suddenly are having nightmares of things you thought were in the past.  Oftentimes, when we look at the calendar, we begin to realize there is a reason for this.  The anniversary of a traumatic event is coming up.

When we experience traumas such as death, sexual assault, abuse, assault, car accident, and many others, our bodies store the trauma and in this same way remember it.  Exposure to trauma results in our bodies “being stuck” in fight, flight, or freeze mode.  Repeated exposure to trauma or the memories results in our bodies remaining in this mode.  Triggers come from the reaction our body and brain has seeing a threat, whether real or perceived. If you have ever had the feeling of something being off and then seen an anniversary date approach, this is what we refer to as Anniversary trauma, still in its early days of research. A common example used that was experienced by vast numbers of people are the attacks in the United States on September 11, 2001.  For those of us who were alive that date, we felt trauma to various degrees and most of us have heightened awareness and perhaps even trauma and triggers as we approach that date every year.

But what we do not spend nearly enough time on is how our bodies react to our own personal traumas. I have often spoken to clients who discuss how they are having a hard time and not sure why.  As we process through this, we often find that there was something traumatic that had happened around this time of year. In a similar way to how certain places or experiences trigger us, particular calendar dates, seasons, and holidays can have a similar reaction.  These triggers around anniversary trauma include things such as depression, restlessness, increased or decreased appetite, insomnia, outbursts of anger, panic attacks, and hypervigilance.

These are just a few of the responses to triggers.  These responses to triggers often feel like they are just adding to an already stressful situation, they are really our body trying to protect itself and warn us of danger.  A traumatic event can seem like our body failed and the retriggers are our body trying to protect ourselves the second time around. 

So how do we deal with this?

As cliché as it sounds, one of the most important things is self-care.  We hear this term a lot and most people immediately think of journaling or mediation, but in reality, it is anything that creates a feeling of peace.  This is different for everyone, but can be activities like exercise, puzzles, reading, knitting, gardening, or any other healthy hobbies or activities.  Self-care lets us teach our bodies how to be at peace which lets them have something to recenter themselves when those triggers arise.  Self-care can help our minds and body relax and to learn strategies on how to lower our high levels of vigilance.

Secondly, working with a trained professional is also important to have support, but more importantly to learn skills to help with coping, awareness of ongoing retraumas or potential retraumas, and then the establishment of a toolbox to manage these emotions.  When it comes to anniversary trauma, creating awareness around the potential triggers as well as how to manage expectations, avoid particular situations and triggers, and how to best equip yourself for those particular dates and times is key.  


A., V. der K. B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

Hamblen, J., Friedman, M., Schnurr, P. Anniversary Reactions: Research and Findings. U.S. Department of Veteran Affairs. (

Texas A&M University. (2016, December 9). Can you unconsciously forget an experience?. ScienceDaily. Retrieved April 21, 2022 from Veterans Affairs. Trauma Reminders: Anniversaries. (2018, August 7). Retrieved April 22, 2022, from,the%20time%20of%20the%20event.

This month’s post was written by our Trauma Specialist, Laura Valiukenas, MSW, LCSW.

Neurofeedback and Tinnitus

What is tinnitus

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.


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.



Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study

Systematic Review on the Evidences of an Association between Tinnitus and Depression

Depression in Patients with Tinnitus: A Systematic Review

Tinnitus and Hearing Loss in 15–16-Year-Old Students: Mental Health Symptoms, Substance Use, and Exposure in School

Neurofeedback by Neural Correlates of Auditory Selective Attention as Possible Application for Tinnitus Therapies

Neurofeedback for Treating Tinnitus

Alpha Suppression and Symmetry Training for Generalized Anxiety Symptoms

A Review of EEG Biofeedback Treatment of Anxiety Disorders

Clinical Use of an Alpha Asymmetry Neurofeedback Protocol in the Treatment of Mood Disorders: Follow-Up Study One to Five Years Post Therapy

Neurofeedback with anxiety and affective disorders

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.