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.


“You are not lucky to be here. The world needs your perspective. They are lucky to have you.”

– Antonio Tijerino, President & CEO of the Hispanic Heritage Foundation

Each year from September 15th to October 15th, National Hispanic-Latino Heritage month is recognized. This month is to celebrate the rich histories, cultures, and contributions of people whose ancestors come from Mexico, the Caribbean, Central and South America, and Spain. This month originally started as Hispanic Heritage Week in 1968, and was expanded to a full 31-days in 1988. The month begins on September 15th because that is the anniversary of the independence of Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua; Sept 16th is the anniversary of Mexico’s independence, Sept 18th
is the anniversary of Chile’s independence, and September 21st is when Belize declared its
independence; also Día de la Raza is on Oct 12th falling within the month.

Now the terms Hispanic and Latino encompass 62.1 million people (18.7% of the population in 2020) and has been steadily increasing for the past few decades. Originally the term “Hispanic” came from United States census’s need to categorize people and the term was used for “Americans who identify themselves as being of Spanish-speaking background and trace their origin or descent from Mexico, Puerto Rico, Cuba, Central and South America, and other Spanish-speaking countries.” This excluded Brazil as it is a Portuguese-speaking country even though it is part of South America. There is a lot of discourse about the term “Hispanic” because of the fact that it highlights the colonial legacy of these diverse countries, especially with the emphasis being on Spanish-speaking. There is also discourse around the term “Latinx” when used to describe this community because of how gendered terms are in Spanish, and because Latinx came from academia and not the community; Latine or Latin are often preferred, but there is no consensus because this community is full of different people with different opinions.

It’s easy to see how this diverse group is often lumped into one by the dominant culture, because that’s easier than having to learn the histories and cultures of 45 countries in the Caribbean and Latin America. There are many cultural strengths seen in this community, but that implies that the whole community is a monolith. Each of these countries has a culture, history, and people groups that existed before colonization, was impacted by colonization in different ways, and have developed into their modern way of being in different ways.

These things can lead to vastly different experiences in the United States that can impact mental health. For example, the stress and/or trauma of immigrating to the U.S. would be different for a person coming from Honduras seeking asylum at the southern border compared with someone coming from Puerto Rico which is a U.S. territory. For either of these people, if they were Spanish-speaking, wherever they ended up it would often be assumed that they are a Mexican immigrant, a common microaggression. There are also the impacts of other forms of discrimination such as colorism and racism. The stresses of these experiences can cause psychological and physical harm. 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 higher risk for issues such as diabetes, substance use, high blood pressure, cardiovascular disease, and autoimmune disorders. This can also impact interpersonal relationships and the ability to have strong social support. Often in communities of color, it is seen as a weakness to be dealing with mental health struggles which can lead to further isolation and further issues.

“Acknowledge and embrace the person you are, imperfections and all. That’s the highest service we can achieve: to give back and give to ourselves in the best way we know.”

-Dr. Paul Bonin Rodriguez

Living in a society that ignores your needs and piles stressors on makes it hard, but there are ways to approach healing despite that. First looking at the strength that is to be found within many cultural values such as family connections, community connection, respect, trust, and dignity.
Here are some suggestions to begin individual healing:

  • Take care of your physical health
    • Eat healthy and get 7-8 hours of sleep
    • Stay physically active by making space for joyous movement in your life
    • Explore relaxation techniques such as deep breathing
  • Connect with a community that will reaffirm your humanity in a society that dismisses it
  • Seek out healing practices consistent with your beliefs
  • Take breaks from technology and social media

This process can be difficult but important for one’s wellbeing and functioning. You have the skills to heal, and we can help.

Adames, H.Y., & Chavez-Dueñas, N.Y. (2017). Cultural foundations and interventions in Latino/a mental health: History, theory, and within group differences. New York, NY: Routledge Press.

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

Sleep and neurofeedback

Come Sleep! O Sleep, the certain knot of peace, 
The baiting-place of wit, the balm of woe, 
The poor man's wealth, the prisoner's release, 
Th' indifferent judge between the high and low. 
With shield of proof shield me from out the prease 
Of those fierce darts despair at me doth throw: 
O make in me those civil wars to cease; 
I will good tribute pay, if thou do so. 
Take thou of me smooth pillows, sweetest bed, 
A chamber deaf to noise and blind to light, 
A rosy garland and a weary head: 
And if these things, as being thine by right, 
Move not thy heavy grace, thou shalt in me, 
Livelier than elsewhere, Stella's image see.
-Sir Philip Sidney

The importance of sleep

Sleep is an important function of all living creatures, everyone in the animal kingdom has some variation of a sleep wake cycle. However why is sleep so important in humans? Research has shown that sleep has many functions.

Sleep helps us to consolidate what we have learned into memory through acquisition (information introduced to our brain), consolidation (the process of memorizing the information in the brain), and recall (information being brought up in any mental state). Those who have impaired sleep, can have impacts on memory and learning (Healthy Sleep, 2007).

Another example of the importance of sleep is its impact on mood. Having a good night sleep can lead to feeling energized, motivated, and content. In the reverse, impaired sleep or insomnia can lead to irritability, increased stress, or even the development of a mood disorder (Get Sleep, 2008).

Sleep also has an impact on body restoration. Certain hormones are released during sleep that is responsible for tissue repair and muscle growth. Another restorative factor sleep can assist in cognitive functioning, which may impact in learning and memory. Recent research has also found the importance of sleep on Neuroplasticity.

We previously believed in the idea that if we don’t use certain neurons through practice our brain loses the capacity to use it in the future (use or lose it principle). We now know that it isn’t true, as our brain has what is called Neuroplasticity, which the brain’s ability to form new neurological connections. We do this in everyday life, from learning something new (even if it is small), to sleep, to psychotherapy. We are making new neurological connections without realizing it! Proper sleep helps strengthen and these newer neurlogical connections.

Conditions that effect sleep

Knowing that sleep is very important and its impact that it can have on our brain, mind, and body, what happens when certain conditions impair sleep?

Mental Health CONDITIONS

There are several mental health conditions that can impact sleep. Anxiety, for example, can severely impact sleep. During the first part of the pandemic, many people were experiencing fear, uncertainty, stress, and many other emotions that naturally turned into anxiety. When one is feeling anxious their mind can race, especially while laying in bed trying to fall asleep. As a result of the anxiety, many individuals struggled to get enough sleep which could also further impact their mood.

Another symptom of anxiety that impacts sleep is hyperarousal, the state of being excessively alert. Therefore, when one is trying to sleep while also experiencing hyperarousal, they may be quick to awaken from even the smallest of stimuli (hearing a small thud from the apartment above, for example) and ready to react. 

Certain types of anxiety can also lead to nightmares. Post-Traumatic Stress Disorder and other anxiety and stress disorders can cause night terrors and nightmares that can impact a person’s relationship to sleep. Due to the fear of having night terrors or nightmares, one can also experience anticipatory anxiety.

Depression is another mental health condition that can impact sleep. Depression can impair sleep as well as sleep can impact depression. Due to this relationship, it can be difficult to know which condition caused which symptom. Depression is characterized by experiencing sleep-related symptoms of insomnia, hypersomnia, as well as having abnormal levels of Serotonin, a neurotransmitter that is important for regulation of sleep as well as other bodily functions. 

Medical conditions

There are also several medical conditions that impact sleep. In fact, there are several sleep disorders that can be treated with medication or devices, such as Sleep Apnea, a disorder that is related to breathing disruptions, and Narcolepsy, a sleep disorder related to regulation of the sleep-wake cycle. These are just a few types of sleep disorders, however there are many more conditions that fall under the umbrella of sleep disorders. There are also several chronic medical conditions that impact sleep.

Inflammatory chronic conditions such as, Arthritis, Fibromyalgia, and Inflammatory Bowel Diseases, can impair one’s sleep leading to the symptom of fatigue. Sleep disturbances can be a result of pain impacting one’s sleep, as pain is common in areas of inflammation. When someone is experiencing pain it can lead to mood dysregulation resulting in sleep disturbance conjointly with the the physical discomfort. Furthermore, research has shown that sleep disturbance can result in higher levels of C-Reactive Protein (CRP), a marker of inflammation, suggesting that sleep impairment and inflammation are directly correlated. 

Much like the aforementioned inflammatory conditions as well as cancer can impact one’s immunity. Our immune system is very important in our ability to fight off infections, and for those with a compromised immune system, contraction of infections can be regular occurrence or fear of contraction. Research has also found that sleep impacts immunity; when one has impaired sleep their immune system has difficulty fighting off infections. This also can further compound an already compromised immune system, leading to increased infections and overall feeling of being unwell, increased inflammation, and the cyclical nature of impaired sleep. (Simpson & Dinges, 2007).

Sleep Hygiene

Sleep hygiene is defined by the healthy habits one practices on a regular basis to promote restful sleep. The Sleep Foundation lists some great steps to improve sleep hygiene that is summarized below.

Setting a consistent sleep schedule

  • Go to bed and wake up at the same time everyday, regardless of weekend day
  • If you want to change your bedtime/wake up routine, make changes gradually
  • Try not to take as many naps; if you do take naps, have short 10-20 minute naps in the early afternoon

Have a bed time routine

  • Having a consistent bedtime routine can prep your mind for bedtime
  • Take 30 minutes to wind down before going to bed by doing something relaxing and not stimulating
  • Refrain form using electronics 30-60 minutes before bed, as the screens can be overstimulating to your brain
  • If you haven’t fallen asleep within 20 minutes of lying in your bed, get out of bed, do something relaxing, and then try again

Have healthy daily habits

  • Try and get some sunlight exposure to promote healthy circadian rhythm
  • Build a exercise/movement routine that is right for your ability
  • Limit smoking and alcohol consumption
  • Skipping on caffeinated beverages in the afternoon and evening
  • Try to eat and drink 2 hours before bed (be mindful of heaving/spicy meals); if you need to eat or drink something before bed try to make it small to not wake you up in the middle of the night
  • Regulate activity in bed to only sleep and sex

Having a restful and Relaxing environment

  • Having a bedpillow, and sheets that matches your comfort needs
  • Have a cool and dark sleeping environment
  • Have devices that block or drown out noise (i.e. ear plugs, noise cancelling machines, etc.) to not wake you in the middle of the night

Neurofeedback as a treatment strategy for sleep impairment

Now we know why sleep is important, what can affect sleep, and how we can improve sleep with proper sleep hygiene. But what if sleep hygiene isn’t enough to get a good night’s rest and there are more underlying issues that impact sleep. Therapy can be very helpful if the underlying symptom of sleep impairment originates from a mental health condition. However if there is a neurological reason for sleep challenges (either from mental health or medical conditions) a treatment strategy must address the neurological source of the disturbance. 

Neurofeedback is a form of biofeedback that encourages healthy neurological connections through the use of training one’s brain to effectively operate in specific conditions. Therefore, in regards to sleep, Neurofeedback training promotes healthy brain activity during the sleep state by regulating one’s brainwaves. 

In some cases, sleep and brain activity can be effected by the situation. In one study looking at college students with sleep onset insomnia, they found that poor sleepers had difficulty regulating their alpha brainwave. This suggested the use of neuro-regulating therapies to promote neuroflexibility (Buckelew et. al., 2013).

In another study that focused on the Central Nervous System, researchers studied the effects of electromyography tele-biofeedback versus tele-neurofeedback in subjects with insomnia. They found that not only does neurofeedback improved the amount of sleep in subjects, but also the efficacy of remote neurofeedback (Cortoos, 2010).

As previously mentioned, chronic health conditions can impact sleep, such as fibromyalgia, a condition where a patient experiences pain throughout their body and experience several other symptoms (including sleep disturbance and fatigue). In a study that researched the efficacy of neurofeedback in patients with fibromyalgia, researchers found that neurofeedback protocols that focused on alpha brainwave and sensorimotor rhythm regulation in an 8-week program produced significant results. Patients experienced sleep improvement and pain severity reduction (Wu, Fang, et al., 2021).

Neurofeedback is an evidence-based treatment strategy that does not utilize pharmaceutical intervention to treat sleep problems. In some cases, neurofeedback conjoint with behavioral modifications can drastically improve, if not alleviate, symptoms of fatigue due to sleep impairment.


Anxiety and Sleep, Suni, E., Sleep Foundation (March 2022).

Buckelew et. al, Neuroflexibility and Sleep Onset Insomnia Among College Students: Implications for Neurotherapy, Journal of Neurotherapy (2013). doi

Cortoos, A., De Valck, E., Arns, M. et al. An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary InsomniaAppl Psychophysiol Biofeedback 35, 125–134 (2010).

Get Sleep– Harvard Medical School

Gorgoni et. al., Is Sleep Essential for Neural Plasticity in Humans, and How Does It Affect Motor and Cognitive Recovery?. Hindawi, 2013. doi: 10.1155/2013/103949

Healthy Sleep– Harvard Medical School

Sleep Disorders, Rehman, A., Sleep Foundation (December 2020)

Sleep and Inflammation, Simpson & Dinges, Wiley (December 2007)

Yu-Lin Wu, Su-Chen Fang, Shih-Ching Chen, Chen-Jei Tai, Pei-Shan Tsai, Effects of Neurofeedback on Fibromyalgia: A Randomized Controlled Trial. Pain Management Nursing, Volume 22, Issue 6 (2021).

This month’s blog post was written by Aarti S. Felder, MA, LCPC, BCN, our Chronic Illness Specialist and Board Certified in Neurofeedback Therapist.

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.

Chronic pain and mental health

It has been said that time heals all wounds. I don’t agree. The wounds remain. Time – the mind, protecting its sanity – covers them with some scar tissue and the pain lessens, but it is never gone. 

Rose Kennedy

Pain is something that everyone experiences. It is a signal that there is something wrong in the body. According to the CDC, 20.4% of adults had chronic pain and 7.4% of adults had chronic pain that frequency limited life or work activities. This data also found that chronic pain increased as people got older. And while we are still recording data, we have preliminary reports about long-term effects of Covid-19, we find that different types of pain is one of those effects.  This study found that chronic pain was highest in women at 21.7%, and that women are less likely to be believed about pain by their doctors. This is something that is also seen in physician’s responses to people of color, as they are often acting on unconscious bias about how minoritized individuals feel less pain or feel pain differently than white people. 

What is Pain?

There are many ways to define pain, and how you define it impacts how you approach it. Do we consider physical pain? What about emotional pain? Social pain? Psychological pain? Here are some common types of pain:

  • Acute pain
  • Chronic pain
  • Neuropathic pain
  • Psychogenic pain

Acute pain is a sudden pain that has a limited duration, usually a few minutes to three months, sometimes up to six months. Chronic pain is more long-term pain that can be constant or intermittent, even after healing is complete. Neuropathic pain is pain caused by nerve damage and is often described as shooting or burning pain. Nociceptive pain is pain caused by tissue damage. Psychogenic pain is pain that might have started physically, but is prolonged by fear, stress, depression, anxiety, or is caused by a psychological condition. Often psychogenic pain is a type of pain that doesn’t match the symptoms a person is experiencing, and is diagnosed after everything else has been ruled out.

How is Pain Processed

The gate-control theory of pain was developed to look at three systems involved in the perception of pain. These systems are the peripheral nerves that first receive pain signals, the spinal cord which receives the signal and sends it to different areas of the brain. In the brain there are different areas that can be impacted by pain such as the limbic system developing a memory of pain, and some emotional areas. This process can be inhibited at different points in the pathway, and through other pathways that responds to deep touch and inhibits the release of pain signals. While this is an abstract look at how pain is processed by the body, it is important to look at how pain affects everyday life. 

How pain impacts life

Pain can have a profound impact on a person’s life; from limiting the things a person can do, to decreasing the quality of sleep, to leading to mental health issues, pain can bring about a lot of changes. Chronic pain specifically can impact physical, psychological, and social functioning. Often pain management is primarily handled through pharmaceuticals, but we are now seeing how that overmedication is leading to increased substance abuse. Studies have shown that people with chronic pain are four times more likely to have depression and anxiety than those without pain. 

Common chronic pain conditions

There are many different things that can cause chronic pain, but some of the most common are: 

  • Arthritis/joint pain
  • Back pain
  • Cancer pain
  • Headaches/migraines
  • Muscle pain
  • Nerve damage

This pain can lead to what is known as the “terrible triad.” The terrible triad happens when pain interferes with the normal activity of life leading to depression and irritability, which can lead to insomnia. This state of being in pain, being depressed and being sleepless create a triad of suffering.  

Another thing that is often not considered is how pain affects younger people. In a study from 2016, it was conservatively estimated that 20-35% of children and adolescents are affected by chronic pain worldwide. In children, pain is often under-recognized and under-treated, especially when they might not have the language skills to express what they’re experiencing. Common causes of pediatric chronic pain include: 

  • Headaches
  • Recurrent abdominal pain
  • Limb pain
  • Back pain
  • Pain without any known cause

In children this pain can impact their development because it can lead to the inability to participate in age-appropriate social activities, missing school, isolation, difficulty forming interpersonal relationships, and mental health issues.

Treatment for pain

So as stated above medication the the primary treatment for pain, and should be continued but there are other treatments to keep in mind, that should be monitored by a medical professional. This includes:

  • Physical therapy
  • Acupuncture
  • Transcutaneous electrical nerve stimulation (TENS) therapy
  • Hypnotherapy
  • Behavioral Therapy
  • Biofeedback
  • Neurofeedback
  • EaseVRx virtual reality system

Some therapeutic modalities, specifically Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to help relieve some in managing the pain and discomfort. 

Neurofeedback and pain

So what is neurofeedback. Neurofeedback is a kind of biofeedback that has been in use for decades based on direct, behavioral training of the brain using an electroencephalograph (EEG). We place electrodes on the scalp to observe the different brainwaves and learn different information based on where, the frequency of, and when certain brainwaves occur. This technique allows us to observe the brain in action as the brain learn to function more efficiently. 

For pain management, the theory is that neurofeedback works by teaching self-regulation. Studies suggest that neurofeedback can be used to affect the processing of pain perception, such as in the gate-control theory discussed above. Some chronic pain conditions neurofeedback has been used to treat before include: 

  • Trigeminal Neuralgia
  • Headache and migraines
  • Fibromyalgia 


Ibric, V. L., and Dragomirescu, L. G. (2009). “Neurofeedback in pain management,” in Introduction to Quantitative EEG and Neurofeedback. (New York, NY: Elsevier Inc.), 417–51. doi: 10.1016/B978-0-12-374534-7.00016-2

Here at TriWellness we do offer neurofeedback and a pediatric chronic illness support group.

This month’s blog post was written by Jessie Duncan, MA, LPC, one of our trained specialists in Neurofeedback and chronic illness specialist.

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.

Emotional Regulation and Chronic Illness

Emotional Regulation At A Glance

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 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 training your 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!

Additional Resources

Social Attributions from Faces: Determinants, Consequences, Accuracy, and Functional Significance (Todorov, Olivola, Dotsch, Mende-Siedlecki, 2015)

Emotion Regulation

Psychological Effects of Chronic Exposure to 50 Hz Magnetic Fields in Humans Living Near Extra-High-Voltage Transmission Lines (Beale, Pearce, Conroy, Henning, Murrell, 1997)

This month’s blog post was a joint effort

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.

Factors in Medical Recommendation Adherence: Part I

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.

Interesting studies

Article from the WHO

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.

Chronic Illness Burnout

Managing a chronic illness can be exhausting! There are so many components that need to be addressed in the management of a chronic condition from appointments, to procedures, to medication, to life in general, with the added stressors of today simultaneously all the while managing the physical sensations that the condition may cause. In my practice I like to use the following metaphor:

In video games we start out with a few hearts and as we go through the game and defeat a boss, we gain more hearts. Now, lets just say that each person starts the day with ten hearts. A person with chronic condition(s) may have had a bad night and didn't sleep well, that knocks out possibly one-two hearts. Then they may wake up in pain (minus one-two hearts), attempt to do their morning routine while experiencing pain (minus another one-two hearts), perhaps they have kids and have to help them get ready for school (minus two or more for each child). Now they have to head to a big boss battle, perhaps it's a big presentation at work, at this point, however, they may have half to no hearts left to go into this battle. How are they supposed battle that big boss? 

This is how it can be for someone with a chronic condition, and of course they feel exhausted after their morning routine, needing a way to replenish their energy. However, life can be demanding and may require one to operate with little to no energy. It is completely understandable the difficulty one may endure in the attempt to comply with their medical team’s recommendations. With competing demands how does one manage their chronic condition and whatever life throws at them without experiencing burnout?

Acceptance and commitment Therapy

Acceptance and Commitment Therapy Hexaflex

In my practice I utilize the Acceptance and Commitment Therapy (ACT) Hexaflex points to assist clients to find direction and travel towards a person that they value. Using the Values point of the Hexaflex, I encourage clients to identify their values to facilitate a direction between the competing demands.

Another contribution to burnout, could be a consequence of having thoughts of past that could lead to depression which can further take a few hearts. Or perhaps it is a consequence of thinking about the future, resulting in freezing anxiety, and therefore consuming another few hearts. However, in placing one’s awareness in the Present Moment, can be energy replenishing. I encourage clients to practice present moment awareness by turning their focus to their five senses and how it can relate a sense of calm:

TasteWhat does the air taste like? Is it cool and refreshing or energizing?
SmellWhat does the air smell like? Is there a sweet floral scent, or does it smell clean and fresh?
SoundWhat do you hear? Is there birds that you can hear chirping or the wrestling leaves in the wind?
SightWhat do you see? Does the sun sparkle between the leaves wrestling in the wind?
FeelWhat do you feel? Do you feel the warmth of the sun on your face or chill of the wind as blows across your face?
Questions that I asked myself to engage five of my senses in the present moment to achieve a sense a calm.



ACT Made Simple

ACT Extra Bits

This is a portion of energy replenishing exercises to combat chronic illness burnout. To learn more strategies or to discuss other demanding life stressors, contact us and we can assist you on your journey to wellness.

This month’s blog post was written by Aarti Felder, our specialist on managing Chronic Illness and Mental Health. To learn more about her, please check out her bio.

Dealing with a Chronic Illness During a Pandemic

It’s difficult enough to cope with a chronic illness as well as coping with the stressors of a pandemic, however it can be even more challenging to manage both concurrently. During the pandemic we are faced with many unknowns: Who has the virus? Do I have the virus? When will this all be over? What’s next after this? These questions can cause anxiety, fear, confusion which can further exacerbate a chronic condition especially if the condition is particularly susceptible to the more severe symptoms of the virus. If this describes you, what can you do? As a Licensed Clinical Professional Counselor, I have found some of these strategies to be helpful in alleviating some distressing feelings and thoughts in my clients through the focus of mind, body, and spirit.


Thoughts, emotions, and the things we do are all interconnected and can impact our bodies. For example, if one has asthma and is experiencing tightness in their chest because they are fearful of catching the virus further intensifying their asthmatic symptoms and ultimately arriving to the decision to not engage in any activities, even in activities that are considered low risk. They can then feel frozen by their fear, leading to more feelings of anxiety and even depression in a vicious cycle.

In order to impact the cycle, one must examine their thoughts through different forms. Some of my clients find it helpful to journal their thoughts to allow a space to keep their thoughts rather than in their head. Others find it therapeutic to mediate and place themselves in a calm space to examine those thoughts.


The body and mind are connected. As previously mentioned, in our mind we may have thoughts and emotions that affect our bodies. Whether it’s an individual with asthma who experiences anxiety in their chest and lungs or an individual with gastric issues experiencing that same anxiety in their gut, their emotions and thoughts impact their body.

This is another cycle that can be affected with physical activity. It can be difficult to get out of the house to go to the gym or maybe it’s impossible to socially distance yourself at the beach. However, clients have found the therapeutic impact of getting some fresh air by going for hikes in the forest where they can maintain social distance while also wearing a mask, if possible. Other clients found a sense of serenity in doing yoga on their balcony in their high rise.

Here is a guided walking meditation by Headspace that can provide a sense of tranquility through engaging the mind through mindfulness, body through walking, and spirit through the connection with the Earth.


Each person may define their spirituality differently and may find different ways to incorporate their spirituality through rituals, gatherings, or any other way. Spirituality often involves the connection with someone or something outside ourselves. Engaging spiritual activities can be difficult during the pandemic, especially if you have a condition that makes you vulnerable to the virus.

We live in the age of spectacular technology with devices that allow us to connect with people all around the world in many different forums right at our finger tips! Utilizing such devices to connect with loved ones or to a community of like-minded individuals can be an effective way to connect with other people and embolden the spirit.

If you are introvert, perhaps the idea of connecting with people is not as appealing. However, taking notice of your connection with the earth beneath your feet, the air you breathe, and the beauty all around you and the universe can give you a sense of serenity in your heart.

The cosmos is within us. We are made of star-stuff. We are a way for the universe to know itself.

Carl Sagan describes our connection with the universe.

You may also find other helpful strategies in our previous blog posts, check it out!

Some of the strategies that were discussed here can be difficult to engage without some guidance. These skills can be utilized as training activities in the gym where you are training to be your optimal self. If you find yourself needing assistance or interested in developing more skills, please reach out to us through the Contact Us page or give us a call.

This article was written by Aarti S. Felder, MA, LCPC, to learn more about her you can find her bio here.

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