Attention Deficit Hyperactivity Disorder

What is Adhd?

Attention Deficit Hyperactivity Disorder is a complex neurodevelopmental disorder that is characterized by low production of dopamine in the prefrontal cortex.  The prefrontal cortex is in charge of what we call executive functions; planning, organizing, decision-making–all of the directing parts of the brain. Emotional regulation and reward pathways in the brain are also affected by individuals with ADHD. The diagnosis is further broken down into three different presentations: primarily inattentive, primarily hyperactive, or the combined type. Here’s a list of some of the symptoms to look for:

The inattentive symptoms (previously referred to as ADD) in the Diagnostic and Statistical Manual 5th edition (DSM-5) are:

  • Often fails to pay close attention to details or makes careless mistakes in schoolwork, at work, etc.
  • Often has trouble holding attention on tasks or activities (e.g., easily distracted)
  • Often does not seem to listen when spoken to directly
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, gets side-tracked)
  • Often has trouble organizing tasks and activities; has trouble finishing tasks
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time
  • Often loses things necessary for tasks and activities (e.g., school materials, wallet, phone, keys).
  • Often forgetful in daily activities
  • Often distracted by stimuli (e.g., sounds, movement)

The hyperactive/impulsive symptoms in the DSM-5 are:

  • Often fidgets with or taps hands/feet or squirms in seat
  • Often leaves seat in situations when remaining seated is expected (e.g., leaves place in the classroom, in meetings, etc.).
  • Often runs about or climbs in situations where it is inappropriate. In adolescents or adults, this may manifest as feeling restless
  • Often unable to play or engage in leisure activities quietly
  • Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to remain still for any extended time without significant discomfort; others may say that the person is restless, fidgety, or difficult to keep up with).
  • Often talks excessively
  • Often completes other people’s sentences or blurts out an answer before a question has been completed
  • Often has difficulty waiting for their turn (e.g., while waiting in line, while speaking in conversations).
  • Often interrupts or intrudes on others. For adolescents and adults, may intrude into or take over what others are doing (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission)

The combined type is diagnosed by the presence of an even mix of the symptoms. There are other criteria for this diagnosis which include symptoms lasting for a specific duration and having an impact on various domains of an individual’s life.

What are the Statistics

Approximately 5% of children and adolescents are affected by ADHD globally. In the U.S. 6.1 million children (9.4%) between the ages of 2 and 17 are estimated to be diagnosed with ADHD, with boys more likely to be diagnosed than girls (11.7% compared to 5.7%). The difference in the diagnosis of girls and boys is often due to the presenting symptoms and socialization of children. Girls are more often diagnosed with the inattentive presentation which is often missed in a classroom setting where most referrals for ADHD testing occur. 

While ADHD is considered a childhood disorder, 139.84 million adults have persistent ADHD with childhood onset (2.58% of the global population) and 366.33 million adults have symptomatic ADHD regardless of onset (6.76% of the global population) as of 2020. Because ADHD affects brain development, it manifests in all aspects of life and can significantly impair educational achievement, relationships (romantic, familial, friendships), employment, finances, etc. There are many common symptoms of ADHD (inattention, inability to focus, poor time management, weak impulse control, exaggerated emotions, hyperfocus) which are often seen as character flaws or bad parenting when the underlying cause is due to an individual’s specific brain functioning. This is also seen in difficulty with emotional processing.

Emotional dysregulation

One aspect of ADHD that has been recognized as a symptom for diagnosis in Europe and noted in research for at least two decades but is still not considered in the Diagnostic and Statistical Manual version 5, has been the emotional component of ADHD. About 70% of adults with ADHD report emotional dysregulation (ED), which has led to the term, DESR, or deficient emotional self-regulation, popping up in ADHD research, and other mental health conditions in which emotional dysfunction is a major component. This refers to a deficiency in the four components of self-regulation. These four components are the ability to inhibit behavior triggered by strong emotions, the ability to self-soothe and regulate strong emotions, the ability to refocus from events that cause strong emotion, and the ability to organize emotional responses. This emotional dysregulation greatly impacts a person’s ability to recognize and control the emotions that they are feeling which can lead to issues connecting with others, putting feelings aside to focus on something, and processing a difficult situation. This can be seen in rejection sensitive dysphoria. 

Rejection sensitive dysphoria (RSD) is a common manifestation of emotional dysregulation that is defined by an extreme emotional sensitivity and pain that is triggered by the idea that someone is being rejected or criticized by important people in their life or by the idea of failing to meet an expectation. While RSD is not caused by a trauma, the pain from it can be felt as a traumatic experience. When these feelings are internalized, they can imitate a mood disorder, and often leads to misdiagnosis of a major mood disorder. When these feelings are externalized, they can be like a sudden rage at the person or situation causing the pain. This can be a devastating ordeal that can lead to feelings of alienation. 

Comorbidities with adhd

People with ADHD often have other co-occurring mental health conditions. According to the CDC almost 64% of children with ADHD have at least one other mental health condition: 52% have behavioral health or conduct problems, 33% have anxiety disorders, 17% have depression, 14% have been diagnosed with autism spectrum disorder, and 1% have Tourette syndrome. 

In adults as many as 80% of people with ADHD have at least one co-occurring mental health condition. It is estimated that rates of comorbid bipolar disorder in adults with ADHD are between 5.1% and 47.1%, about one-fifth to one-half of adults with ADHD have major depressive disorder/dysthymia, about 50% of individuals with ADHD have some type of anxiety disorder, personality disorders are present in more than 50% of adults with ADHD, and research shows that 25% to 40% of adults with substance use disorder also have ADHD. Having multiple mental health conditions can make it harder to identify the source of a condition and the best way to approach treatment. When talking about ADHD, we expect it to present as primarily hyperactive/impulsive and this can also lead to issues in beginning treatment. Women and girls are often misdiagnosed or underdiagnosed in ADHD because they primarily present in the inattentive type. The classroom setting is most often where ADHD is first noticed, but with the inattentive type it is often less disruptive to the classroom so is less likely to get someone referred for treatment. Also in female students the behaviors that would often get male students categorized as ADHD get labeled as “airheaded” or a “chatterbox” or “flighty.”  They also are socialized to behave in ways that more easily mask their symptoms, such as spending more time on school work, which can lead to other problems when they are unable to manage emotionally or socially in the ways they are expected to. This can be stigmatizing when they are unable to perform the way they are expected to and can lead to perfectionism, social withdrawal, low self-esteem, and negative self-talk. 

The future of adhd

In current ADHD research there is looking into changing the name to better reflect the complex of the condition. One proposed future name is variable attention stimulus trait (VAST). This name comes from Edward Hallowell, M.D., John Ratey, M.D. who are leading researchers and wrote the book ADHD 2.0. Other areas of research are looking into better understanding the emotional aspects of the condition.

Treatment for adhd

When approaching treatment for ADHD, medication is the most well known and most stigmatized. It is an important treatment approach, because when people are on the right dosage of medication it greatly improves their lives. RSD can be greatly improved by medication management. 

Another treatment approach is ADHD/executive functioning coaching. This is a behavioral training that focuses on finding ways to deal with/externalize the executive functioning skills that are lacking. 

Therapy is another approach that helps build coping strategies, builds greater understanding of the areas in which a person is struggling, and can help a person learn ways of dealing with the emotional issues of ADHD.

Neurofeedback is another treatment that has been proven effective for ADHD. Neurofeedback, or EEG Biofeedback, is a technique that uses operant conditioning to train the brain to be more efficient (and is a service that we provide).

As we continue to learn more about ADHD and how to improve the quality of life of people who have the condition, we will continue to approach it by looking at the strengths that can be found in it. Here at TriWellness we can help. 


The Prevalence of Adult Attention-Deficit Hyperactivity Disorder: A Global Systematic Review and Meta-Analysis

Emotion Dysregulation in Attention Deficit Hyperactivity Disorder

Emotion Dysregulation in Adults with Attention Deficit Hyperactivity Disorder: a Meta-Analysis

Attention Deficit Hyperactivity Disorder (ADHD)

Data and Statistics About ADHD

Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach

Does the Continuous Performance Test Predict ADHD Symptoms Severity and ADHD Presentation in Adults?


This month’s blog post was written Jessie Duncan, MA, LPC, a specialist in Chronic Illness and Neurological Treatment modalities.

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.

Black History in Psychology

“The fact that we are here and that I speak these words is an attempt to break that silence and bridge some of those differences between us, for it is not difference which immobilizes us, but silence. And there are so many silences to be broken”

Audre Lorde

History is important because it connects us to a context greater than ourselves, as well as the larger community that helps us process things better and be greater than the whole. This is part of the reason why Black History Month was created. Black History Month was officially recognized in 1976 as a national event after decades of efforts to recognize the often-neglected accomplishments of Black Americans in United States and global history. This exclusion from history is seen in so many aspects of life, including mental health. Within the African American community there is a lot of skepticism about seeking services, which is a result of years of unethical treatment that continues to the current day. From racial eugenics and forced sterilization, to Henrietta Lacks whose cells were taken without her permission and used (to this day!) for medical research, to the Tuskegee syphilis experiments (which were continued in Guatemala after being deemed too unethical for the United States), to the history of gynecology, to the increased risk of complications and death due tocovid-19, there are many examples of how the medical field hurts Black Americans. Due to this deep history of abuse by the medical field and erasure of the contributions made by these individuals, it makes sense that there is mistrust by the community. Being disconnected from one’s history and contributions can lead to a sense of isolation and not belonging/not being wanted by the culture around you/excluded and exploited by a society that steals from your culture and dehumanizes you. 

Connecting to the History of Psychology

Often Black, Indigenous, and People of Color (BIPOC) feel that they are excluded from mental health spaces. Part of that is because of the earned mistrust in the medical and mental health fields, and part of it is because the field often excludes issues that are major concerns for these communities. Psychology and mental health issues are primarily seen as white, Western traditions that do not prioritize the things that are important to people outside of the dominant cultural narrative. But if we look at and understand that counseling is a healing practice, it becomes clear that it includes BIPOC. With that being said, let’s first look at the contributions BIPOC have made in the field of psychology and counseling.

Black Psychologists

“In the future, as in the present, as in the past, Black people will build many new worlds. This is true. I will make it so. And you will help me.” 

N. K. Jemisin

Dr. Francis Cecil Sumner, PhD: Father of Black American Psychologists (1895-1954)

  • The first African American to receive a Ph.D. in psychology in 1920 from Lincoln University
  • He focused on refuting racism and bias in Eurocentric theory and research of psychology

Dr. Inez Beverly Prosser, Ed.D (1895-1934)

  • The first African American woman to receive a doctoral degree in psychology in 1933 from the University of Colorado
  • Her work focused on the education system and the different outcomes of students in integrated vs. segregated schools

Dr. Ruth Winifred Howard Beckham, PhD (1900-1997)

  • Received a PhD in psychology and child development in 1934 from the University of Minnesota
  • Dedicated her career to the advancement of women and children in her community

Dr. Herman George Canady, PhD (1901-1970)

  • Received a Ph.D. in psychology in 1941 from Northwestern University
  • The first psychologist to examine the role of the race of the examiner as a bias factor in IQ testing
  • Spearheaded the movement to organize Black professionals in psychology

Dr. Joseph L. White, PhD: Godfather of Black Psychology (1932-2017)

  • Received a Ph.D. in clinical psychology in 1961 from Michigan State University
  • Proposed the seven major psychological strengths of African-Americans (2005)
    • Improvisation
    • Resilience
    • Connectedness to others
    • Spirituality
    • Emotional vitality
    • Gallows humor
    • Healthy cultural suspicion 

Dr. Robert V. Guthrie (1932-2005)

  • Described by the American Psychological Association (APA) as “one of the most influential and multifaceted African-American scholars of the century”
  • Wrote Even the Rat was White: A Historical View of Psychology
    • Exposed that long history of racist work in psychology
    • Profiled overlooked Black psychologists 
  • First African-American to have his papers included in the National Archives of American Psychology

Dr. Robert Lee Williams II, PhD (1930-2020)

  • Received a Ph.D. in clinical psychology in 1961 from Washington University in St. Louis
  • Created the Black Intelligence Test of Cultural Homogeneity (BITCH-100) in 1972
    • Created to demonstrate how cultural content on intelligence tests may lead to culturally biased score results 
    • Set a precedent for the critical examination and rejection of Eurocentric intelligence testing

Dr. William Cross (1940–present)

  • Received his Ph.D. in Psychology in 1976 from Princeton University
  • Proposed one of the first models of Black racial identity development in psychology

Dr. Janet E. Helms (present)

  • Received her doctorate in psychology with a specialization in counseling psychology in 1975 from Iowa State University
  • Her work focuses on how race, culture, and gender can influence one’s personality and participating counseling styles 
  • Challenged inherent racial bias in construction of assessment tools
  • Racial Identity Theory

The Association of Black Psychologists (ABPsi)

  • Established in 1968 
  • Original goal was to have a positive impact upon the mental health of the national Black community by means of planning, programs, services, training, and advocacy
  • Current goal is to promote social justice, cultural psychology, racial/ethnic identity and multicultural competencies, and addresses challenges facing the black community

Association for Multicultural Counseling and Development (AMCD)

  • Division of the American Counseling Association chartered in 1972
  • Part of its mission is to enhance the development, human rights and the psychological health of ethnic/racial populations and all people as critical to the social, educational, political, professional and personal reform in the United States and globally

Since the early days of psychology BIPOC individuals have been present and advocating for the issues that concern their communities. 

What are specific needs of BIPOC individuals?

There are many issues that impact communities of color’s physical and mental well-being. These include lack of access to resources such as healthcare, steady employment, nutritious foods due to food apartheids, and housing due to the continued effects of redlining on the housing market. There is also the stress of the continued global pandemic and increased cultural awareness of racial trauma. 

Racial trauma, a form of race-based stress, refers to BIPOC reactions to dangerous events and real or perceived experiences of racial discrimination. In the past year, many causes of race-based stress were highlighted, including the continued police brutality and murder of BIPOC individuals, the increased lack of support from the government, and the lack of access to basic needs. This stress can cause many health problems because of what stress does to the body. This can include physical affects like headaches, muscle tension or pain, chest pain, fatigue, stomach issues, and sleep problems; mood issues like anxiety, restlessness, lack of motivation or focus, feeling overwhelmed, irritability or anger, and sadness or depression; or behavioral issues like over- or under-eating, angry outbursts, drug or alcohol misuse, and social withdrawal. There can also be long-term problems like higher rates of diabetes, substance use, high blood pressure, cardiovascular disease, and autoimmune disorders. 

So what about mental health?

“All that you touch, You Change. All that you Change, Changes You. The only lasting truth is Change.” 

Octavia E. Butler 

When dealing with all of these stressors, it is important to find ways of approaching healing. Here are some suggestions to begin in that healing:

  • Eating healthy and getting 7-8 hours of sleep
  • Staying physically active and making space for moment in your life
  • Connect with others who reaffirm your humanity
  • Practice self-care routines
  • Seek out healing practices consistent with your beliefs
  • Take breaks from technology and social media
  • Explore relaxation techniques such as deep breathing
  • Learn to understand what you can and cannot control

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

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

Audre Lorde


This month’s post was written by Jessie Duncan, BS.

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.

Politics and Mental Health

Politics is a very exhausting, ever changing field. The current American election seems to be the most high stakes event with no way to escape hearing about it. We are in a state of media oversaturation where very few places are free from the looming spectre of the political machine. This adds to the stress of the continued global pandemic due to covid-19. The compounding of this stress can have many effects on the mind and body including nausea, chest pain, weight gain, anxiety, and depression.

So where to start?

A place to begin is understanding why politics are so stressful. To begin let’s understand the stress response. When you encounter a perceived threat or fear, the amygdala reacts. The amygdala is a part of the limbic system that is responsible for anxiety, aggression, fear conditioning; emotional memory and social cognition. The amygdala leads to the activation of the hypothalamus which activates the sympathetic nervous system leading to the release of adrenaline and cortisol which regulates the flight, fright, or freeze response. This response is the reason for most of the physical symptoms of anxiety and fear. These include short-term symptoms like racing heartbeat, fatigue, upset stomach, spikes in blood pressure, and shortness of breath; or long-term symptoms like decreasing the immune response, memory issues, increased signs of aging, changes in personality, and cardiovascular disease. 

© 2015, Korean Society for Biochemistry and Molecular Biology

So what is it about politics that causes such an intense response? Well, part of it has to do with how the information is presented. Politics is a highly changed topic because personal is political. The things that a person values are directly related to the policies that they would be willing to endorse. This means that people often view political policies as directly relating to their identity which makes them more likely to have an emotional reaction to anyone who opposes a policy.

Another way politics are tied to emotions is how a policy is presented. An example of this is how Proposed Amendment to the 1970 Illinois Constitution is framed. This amendment, referred to as ‘Fair Tax for Illinois,’ proposes to change the flat rate income tax rate to a graduated rate similar to federal tax rates. When looking for information on this amendment how it is framed depends on the bias of the website discussing it. For example, certain sources against the amendment mention that while it is proposed that it will decrease taxes for 97% of people in Illinois, the elected politicians cannot be trusted with the money and will continue to increase tax rates when this fails. This is an example of catastrophizing, which is when there is a prediction of a negative outcome for a situation and then jump to the conclusion that if that outcome happened it would be a catastrophe. These websites use catastrophizing to look at the ways in which this amendment could fail to increase the fear response of the people that read their information. This framing of the situation in a way that elicits fears about specific things prevents people from critically examining other concerns that they may have about the new amendment.   

Political journalism, including the news, is intended to present political information in an unbiased manner, that is thoroughly fact-checked. However, many opinion-based websites and tv shows frame themselves as if they are political journalism and it is hard to tell the difference. There is also the bias often pops up on different news sources based on the parent companies and other sources of income from the source (this information can be found by searching through the About Us section of a website). All of this happens in politics before addressing the 24-hour news cycle, social media, increasingly partisan politics, racial tensions, and the continued global pandemic. Politics are often framed as an individualistic system where everything that can happen or go wrong is based on the decisions of individual people without looking at the systems that are in place to perpetuate this system. This is a compex, intersectional topic that is multifaceted and affects Black, Indigenous, and People of Color (BIPOC) disproportionally more than other populations, and leads to a lot of stress, anxiety, and depression. Mental health needs cannot be forgotten when approaching politics. 

So what can you do?

When it appears that the system is set up in a way to exhaust us physically and mentally, how can we approach this seemingly unending political season. 

Here are some suggestions to take care of yourself. 

  • Be mindful and aware of how you’re affected by politics is to acknowledge and take steps to adjust as you need
  • Accept whatever feelings are brought up in you when politics are brought up 
  • Unplug from the 24 hour news cycle and social media
  • Good sleep hygiene
  • Eat healthy
  • Exercise
  • Journal
  • Practice meditation 
  • Find spaces that validate your humanity
  • Get involved (if you can)

“Our democracy cannot be left in the hands of those who would rather watch or participate in a train wreck than stop it.”  

–Kimberlé Williams Crenshaw

Stress can be debilitating, here at TriWellness our clinicians are skilled in assisting each individual in managing stressors. Contact us today to start your journey to wellness.


This month’s post was written by Jessie Duncan, the TriWellness intern. You can learn more about Jessie here.

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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Healing in a Difficult Time

Understanding what is going on

To begin taking care of your mental health, you need to understand the things that are affecting it. The two biggest events happening right now are the Black Lives Matter protests and COVID-19, and it is important to understand why these factors are affecting the mental health of many individuals.

The current protests began due to the murder of George Floyd in Minneapolis, MN on May 25, 2020, after a police officer kneeled on his neck for 8 minutes and 46 seconds. George begged for his life and pleaded that he was in pain, could not breathe, and could not move, but the police officers ignored his pleas. The recent protests seem to be much louder and more widespread than they have been in the past and as a result, many are confused as to why there has been such a large worldwide response. This is because of a combination of factors, including the social isolation due to COVID-19 and the continued unjust deaths of Black and Brown individuals during the stay-at-home order (Ahmaud Arbery, Breonna Taylor, Nina Pop, and others).

It is worth noting that COVID-19 disproportionately affects people of color according to preliminary data released by the CDC. A couple of the reasons for this is the disparity in economic and social conditions that primarily affect people of color. This is due to how systems of education, government and the media celebrate and reward some cultures over others in ways that are often invisible. An example is how bandages come in “flesh-color” as pink/beige and this was unquestioned by a majority of people because white is the assumed default. A less benign example is the history of medical experimentation and poor treatment of black, indigenous, and people of color (BIPOC) that lead to higher rates of diabetes, substance use, high blood pressure and maternal death during pregnancy.

Years of this injustice, along with social media as a means to reach others and organize, have led to the development of the Black Lives Matter movement. This movement began as a hashtag on Twitter in response to the acquittal of Trayvon Martin’s murderer George Zimmerman in 2013. This organization, started by Alicia Garza, Patrisse Cullors, and Opal Tometi, developed into a global movement that is spearheading our current protests. The purpose of the organization is to connect communities, intervene when there is violence against Black communities, and provide a space for women, queer, and trans people to be recognized for their leadership in the work of liberation.

Now how does this relate to mental health?

Due to everything that is happening, some people might be experiencing retraumatization from centuries of intergenerational trauma, especially Black individuals. This retrauamtization can have a significant negative impact on the mental health of those in the BIPOC community. Others may be affected by compassion fatigue or burnout when dealing with the grief and shared pain of other’s suffering. This can lead to shutting down or avoiding any distressing information or news. It is especially important that BIPOC take care of their mental health to be strengthened as a community and continue the fight for liberation. It is just as important that others who are sharing in the grief and pain felt by the Black community also find ways to manage their mental health to effectively be allies in the fight for liberation. This is a challenge, and many may feel lost and have no idea where to start. Here are some useful tips that can help with finding where to start your mental health journey.

So how can I approach mental health?

“You may not control all the events that happen to you, but you can decide not to be reduced by them.”

-Maya Angelou

In this challenging time it is important to find ways to practice self-compassion and allow yourself to find moments of peace. Some suggestions for approaching this are:

  • Cultivate hope, love, compassion, and joy
  • Listen to your emotions and accept what is there
  • Examine the greater cultural context and how your fit within it
  • Connect with others
  • Reconnect with your mind-body connection through healing practices

Another approach is through radical healing. Radical healing is a form of healing for people of color that recognizes that true healing happens when we are connected and aim for wellness at the individual, family, community, and societal levels.

Here are suggestions of ways to utilize radical healing to build connection and community:

  • Learn more about the issues that are affecting your mental health
  • Work on self-care and individual healing/Engage in Mind-Body Healing/Nurture your spirituality and practice self-compassion
  • Connect to others and be affirmed in your humanity and increase emotional intimacy
  • Connect to the deeper roots of your identity and culture
  • Learn more about your cultural and become curious about other cultures
  • Take action and actively work towards social justice; Take action to address racism and inequities when you can

By staying psychologically and physically healthy during this time we are able to direct our focus where it is truly needed without distraction. You have all the pieces, we are here to give you the tools to connect to them. Contact us today to begin your journey to wellness.

Helpful Resources

This month’s post was written by Jessie Duncan, the TriWellness intern. You can learn more about Jessie here.