Causes for Anxiety

Trauma and Disaster: Helping Teens Manage the Impact of Hurricane Sandy

Listen to my interview on The Mary Waldon Show on the emotional impact and how to cope with Hurricane Sandy. Hurricane Sandy has had a tremendous impact on countless families up and down the east coast of the United States. Such an event can leave even the most well-informed parent with questions and concerns.What is the potential impact of natural disasters and other traumas on teenagers? What can parents do to help mitigate the impact of Hurricane Sandy? What is an expected reaction to such extreme events, and what kinds of reactions indicate a need for professional intervention? For answers to these and other related questions, please tune in to The Mary Waldon Show to hear the insight and expertise of Dr. Nerina Garcia-Arcement, an expert in the treatment of Post Traumatic Stress Disorder.

Link to radio show

Hurricane Sandy: Coping with the Emotional Aftermath

By Nerina Garcia-Arcement, Ph.D. Natural disasters, such as Hurricane Sandy, remind us of our vulnerability. The closer the impact of the hurricane to you the more intense your reaction can be. Surviving a natural disaster such as Hurricane Sandy can bring about stress, anxiety, depression and post traumatic stress symptoms. If you have experienced emotional distress in the past, then a major stressor such as Hurricane Sandy is likely to exacerbate a pre-existing condition.

Typical emotional reactions include disbelief, feeling confused or helpless, irritability, sadness, fear, difficulty focusing and making decisions, feeling preoccupied and ruminating about what happened during/after the storm, worrying about what future negative things could occur, and re-experiencing events from the disaster. Common physical reactions are sleep problems, nightmares, feeling jumpy and being easily startled, racing heart, trouble breathing, headaches and trembling.

If you notice you are experiencing these problems there are actions you can take to feel better:

  1. Do not isolate yourself: Seek out support from loved ones, friends and neighbors that know what you are going through.  This will help you realize you are not alone in your pain.
  2. Talk to friends and loved ones about how you are feeling: Expressing your worries, fears, anxieties, sadness, disbelief and confusion can be healing and cathartic.
  3. Limit your news watching: Seeing the images of destruction simply reminds you of your traumatic experience and reinforces your feelings of fear and vulnerability.
  4. Donate or volunteer your time through relief efforts: This will help you feel more in control and that you can make a difference. Aiding others through their pain helps reduce your own.
  5. Engage in hobbies or life affirming activities: Doing things you enjoy will help distract you from your distress and remind you that there is beauty and creativity in the world, not just destruction.
  6. Stay Active: Exercise or go outside for walks. These activities will get your mind off of your problems.  Getting your body moving will help release hormones that relieve stress.

If you find you are still distressed after trying these suggestions, consider talking to a mental health professional or a faith based adviser. Surviving a natural disaster can have a lasting negative impact on how you see the world and how you feel. Addressing your emotional pain now can reduce the chances of your stress, anxiety, depression or PTSD symptoms lasting for years into the future.


Money matters

This article touches on the stressor of money and its impact on marriages.  Money is a leading cause for separation, this article addresses the importance of dealing with it in therapy.

Psychologists are helping young couples stay afloat financially in increasingly turbulent economic waters.

By Rebecca Voelker

October 2012, Vol 43, No. 9

Print version: page 48

Psychologists are helping young couples stay afloat financially in increasingly turbulent economic waters

Troubled young couples who see Brad Klontz, PsyD, in his Kapaa, Hawaii, psychology practice often end up talking about more than their relationship with each other: They find themselves discussing their relationship with money, too.

"Some of the symptoms bringing them in—feeling depressed, feeling anxious, having panic attacks—they may not know how much the role of money is playing in those symptoms," says Klontz, a clinical psychologist and certified financial planner.

Unprecedented levels of student debt, high credit card debt and a dismal job outlook have presented some young couples with financial challenges their parents and grandparents didn't have to face. These days, more psychologists are stepping in to help couples tackle their financial burdens. Money stresses are nothing new for couples just starting out, but trying to resolve them in therapy is.

"There is a much greater awareness now among general psychologists that this is a very important issue to explore," says Philadelphia psychologist Maggie Baker, PhD, also an expert in financial issues.

To respond to the growing need for psychologists to talk to their clients about money management, Atlanta financial psychologist Mary Gresham, PhD, is spearheading an effort to launch an APA division of financial psychology. She's circulating a petition supporting its creation, and financial planners welcome her efforts.

"A trained, educated psychologist is a necessary component in certain financial planning relationships," says Paul Auslander, president of the Financial Planning Association. Some couples can benefit from behavior modification techniques to curb runaway spending or make spending compromises, he says. "But I suspect that there aren't enough financially trained psychologists to help couples coping with recession repercussions."

Combining households, combining money

A common scenario that brings on financial turmoil for newlyweds is that although they may have lived together before marriage, they failed to discuss their financial union before they said "I do," says Gresham. "They had operated under the roommate plan, where each one pays half of the expenses or one pays one set of bills and the other pays another set," she explains. But as they settled into married life, neither spouse knew what was going on with their partners' money. "Then they can't figure out how to collaborate, how to mix the money together."

Gresham looks at four issues with every couple: "math," values, emotions and process. To begin helping couples work through these issues, Gresham asks the couple to take an objective look at how they spend their money, using tracking software so they can see how their income is distributed among rent or a mortgage and other commitments. Baker takes a similar approach in beginning her work with couples. "It's important to get facts into the room," she says.

Seeing how much cash disappears in a $4 latte or a meal out can be a sobering experience. "The emotions start to come in all through this process," says Gresham. That's when she probes more deeply, asking couples about how their perceptions of money growing up affects them as adults. For example, children of cash-careful families may hoard their money as adults, while free-spending families may have kids who later on can't hang on to a paycheck. The reverse can happen, too.

"If a spender marries a hoarder, over time there's bound to be conflict," says Baker. "The spender loves the immediate gratification of spending, but for a hoarder it's almost painful to spend money."

A generational change

In Hawaii, Klontz is conducting research to understand couples and their finances, surveying 422 adults ages 18 to 80, with varying levels of income, education and net worth. His research, published last year in the Journal of the Financial Therapy Association, shows that younger adults are more likely than their parents or grandparents to have potentially damaging "money scripts"—subconscious beliefs that drive their financial behaviors. He found that adults 30 years old and younger were most likely to be "money avoiders" who become anxious, fearful or even disgusted when the conversation turns to money. Younger adults also were more likely to equate net worth with self-worth and to believe that the more money they have, the happier they will be.

These beliefs, Klontz says, are linked with lower income and net worth. People with these views may set themselves up for financial failure by simply ignoring money issues, giving assets away, gambling excessively or compulsively buying things they want but can't afford. "Very often in my work with couples, conflicts over money are really the result of conflicting money scripts," he says.

He uses a psychodynamic approach to examine clients' experiences with money in childhood. Living with a workaholic parent who pursued an ever-bigger paycheck but never was at home or being in a family that neglected life's necessities because parents hoarded cash could trigger present-day money troubles. "The more emotional the experience, the more rigidly these beliefs become locked in place," Klontz says.

Healing begins, he says, when a couple can open up to each other and be empathetic. "They may have very different attitudes about money, but if they can hear each other and respect each other, then they can come to a compromise" about sound money management.

"They become a money team instead of money adversaries," Gresham adds.

Link to article

Organizing Your Life

I was recently on the Colin Lively Show, discussing how to declutter your mind.  The entire show was filled with helpful tips on how to better organize your home, office and mind. The description for the show is below:

Oh lord, if this show wasn’t sent from on-high, than it was Hildamae’s dying wish coming true: get Colin to clean his room! So, there it is, the cat is out of my Birkin bag: I can be rather messy. But aren’t we all? Whether it be in mind, life, schedule, desk, purse, closet, or your inbox, somewhere you are a little messy; and a little messy can lead to a great deal of stress. It is, as Dawn Falcone put it, “stuck energy.” For me, Consuelo un-sticks my stuck energy four times a week, but that doesn’t cover all my bases: I still need to go to Dr. Feldheim, my therapist, and Dr. Koplowitz, my psychiatrist, to get my mind in order.

I was stunned to learn that our outer world is very much a reflection of our inner world. For instance, a messy desk can be a sign of a stressful work environment or chronic work overload. It is important to create systems that keep our lives orderly and neat. We do not need to be neat freaks, but organization is one of the keys to happiness. Growing up, we polished the silver under the iron fist of Hildamae, she said the harder we scrubbed the more we would feel her love. Boy was she right! Three hours of polishing spoons made my wrist feel so loved that they were practically stuck in an arthritic state until my mid-40s. “Sheets tight enough on which to bounce a quarter,” she would demand. By the time I went to college, I had had enough Old Dutch Cleanser, Clorox and Bon-Ami running through my blood that I vowed never to clean again. And I have not touched a mop since!

This week I will be speaking with three personal organizers and a psychologist, and we are going see how we can change our state of mind with a Swiffer, or two, or forty-seven.

This week I will be speaking with three personal organizers and a psychologist, and we are going see how we can change our state of mind with a Swiffer, or two, or forty-seven.

Dawn Falcone is not only passionate about organization, she knows it has a HUGE impact on personal sanity, success, and overall stress level. She emphasizes the point that reducing clutter and chaos will ultimately bring reward in the form of clarity, serenity, and time. She works closely with her clients to design spaces that reflect their personality and spirit. Dawn is a proud member of the (National Association of Professional Organizers) and is a certified interior environmental coach. Her work has appeared in many publications including: Real Simple, Woman’s World, Home And Garden Television, and Apartment Therapy.

Bonnie Joy Dewkett is the founder of The Joyful Organizer and is an organizing expert, author, motivational speaker, and radio personality – oh and she is an expert in time management! Boy oh boy does she know how to block-out a day!

Andrea Brundage of Simple Organized Solutions (S.O.S.) offers personalized hands-on organizational solutions to help small-to-medium sized business owners and homeowners function in efficient and organized environments. In partnership with its clients, S.O.S. creates “sensible solutions for your organizational needs.”

Dr. Nerina Garcia-Arcement is a licensed Clinical Psychologist and a Clinical Assistant Professor, in the Dept. of Psychiatry, at NYU School of Medicine. She specializes in challenges associated with life transitions, stress, anxiety, and depression.She provides a holistic therapeutic session by using a combination of Cognitive Behavioral Therapy and insight oriented/psychodynamic techniques to identify current problems, develop individualized strategies to ease stress, and gain insight into understanding one’s patterns in behavior. Dr. Garcia strongly advocates the act of self exploration, which helps us understand the way we think and act, it will also help shed light on our behaviors that worked in the past but are not effective any longer.

Link to podcast/show

Organizing Your Life

Can Social Anxiety Be Caused by a Nutritional Deficiency?

I was quoted on the topic of social anxiety and its causes. by Rheyanne Weaver |

If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria:

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books: The Mood Cure by Julia Ross Depression-Free Naturally by Joan Mathews-Larson Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

Link to article

Social Anxiety Can Be a Hidden Problem in College

I was quoted on the topic of social anxiety, its causes and how to cope or treat the symptoms. by Rheyanne Weaver |

Public speaking is generally not a favorite activity of most people—in fact many people seem to fear public speaking or at least avoid it when they can. But most people are also not crippled with embarrassment or anxiety when they have to present in front of a class or when they are called on to answer a question. For students with social anxiety, being put into the spotlight occasionally during class presentations or participation is enough to make them avoid those classes altogether.

New research from the University of Plymouth and University of the West of England (UWE) Bristol looked at the impact of social anxiety in higher education, and psychologist Phil Topham estimates that “10 percent of university students experience significant social anxiety,” according to a news release from UWE Bristol.

Social anxiety disorder or social phobia is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as “a marked and persistent fear of social or performance situations in which embarrassment may occur.” There are several other diagnostic criteria, including that “the social or performance situation is avoided, although it is sometimes endured with dread.” People are only diagnosed with the disorder if their life is significantly negatively impacted.

Out of over 1,500 students who were surveyed, some students experienced “frequent anxiety in learning situations that involved interacting with students and staff.” To cope with this anxiety, students would not participate in lectures and presentations or would even skip class. Other students wouldn’t take any classes that involved presenting at some point, according to the news release.

The researchers conclude that students who experience social anxiety “could be missing out on learning opportunities and may be distracted from attending to academic information by excessively focusing on their anxieties.”

Although the researchers don’t believe students should be treated as potentially fragile and coddled, there needs to be more support available for students with social anxiety without further stigmatizing these students or making them feel like their “flaws” are exposed. The researchers even give some suggestions for support in the university, including “not singling out students for questioning in lectures or setting assessed presentations in their first term,” and “sensitive appreciation of the shame and conflict caused in students by the desire to succeed and the fear of failure.”

Basically, college professors need to take into consideration the styles of all college students—some love the spotlight, others have social anxiety, so it’s best to ease students into participating and presenting during class.

Mental health experts have some tips on how to succeed in high school and college despite having social anxiety.

Nerina Garcia-Arcement, a clinical assistant professor at NYU School of Medicine and a licensed clinical psychologist, gave one major suggestion in an email to help students who are experiencing social anxiety.

“Do not avoid what you fear,” Garcia-Arcement said. “The more you avoid, you are creating evidence that it is more comfortable to not do something. Instead, if you face what you fear you can slowly prove that your worst fears will not be realized.”

She also suggests that students follow these four steps to take control of their anxiety:

  1. Stop and evaluate what you are feeling (i.e., butterflies in your stomach, sweating, trouble breathing, heart racing).
  2. Stop and evaluate what are you thinking (i.e., “people will laugh at me,” “I will fail,” “I will look ridiculous.”)
  3. Practice activities that will reduce the physical symptoms, such as deep breathing, muscle relaxation exercises and imagining yourself in a safe place.
  4. Challenge your negative thoughts by stopping the critical belief and instead replace it with a positive thought such as “people have never laughed before,” “I can do this,” “looking silly is the point of this activity, and if I do look silly so what.”

There are effective treatment options for students who have access to a mental health professional.

“Talk therapy is extremely effective for social anxiety, especially cognitive behavioral therapy. Medication can be taken in severe cases, Garcia-Arcement said. “Learning to manage the physical anxiety symptoms and stopping and controlling the negative thoughts is essential to controlling social anxiety. Sometimes people can do it on their own, sometimes they need help with monitoring thoughts and feelings and figuring out what gets in the way of using these new skills.”

She has three other tips for students who are trying to decrease their social anxiety:

  1. Practice deep breathing, meditation, yoga, and exercise. These help manage and control anxiety.
  2. Ease into social activities, first with smaller groups and eventually, as you feel comfortable, with larger groups.
  3. Practice what you fear in a controlled environment. First practice the presentation or talking to a stranger in front of a mirror, later practice in front of someone you trust such as a friend or parent, then go into the real situation.

Scott Carroll, a child psychiatrist who works at the University of New Mexico, said that part of the problem can be that some students don’t realize they have an issue that needs to be worked on.

“Many people with social phobia … often just think they are shy and don’t realize they may have a treatable condition,” Carroll said. “Also, if someone has been anxious their whole life, they may not realize they are significantly more anxious than other people.”

Once students do realize they have a disorder, they have a variety of treatment options available to them, including individual psychotherapy (such as cognitive behavioral therapy), social skills therapy groups, and multiple types of medications.

Carroll has two other coping methods for college students who have social anxiety disorder: positive self-talk, in which you reassure yourself that it’s okay to talk or say hello, can be helpful with milder forms; and repeated exposure, which leads to decreased anxiety, like joining Toastmasters to get comfortable with public speaking.

Jeffrey Gardere, a contributing psychologist at, said in an email that it’s beneficial for students with social anxiety to have friends they can rely on to come along with them in situations that could cause more anxiety.  Sometimes self-help books can be useful as well.

“The young person with social anxiety may also want to stay away from stimulants such as energy drinks and caffeine in order to avoid becoming even more nervous,” Gardere said. “And certainly [try] to avoid liquor, marijuana or any other chemical that is a self medication in order to feel relaxed, simply because they may be more at risk for possible addiction.”

Link to article

How to Quell the Fears of Childbirth

Anxiety can influence a woman's experience during labor. I was quoted in this article regarding how stress and worry can impact a woman's delivery and how to manage their anxiety. by Rheyanne Weaver |

It’s common to fear to some extent painful experiences we aren’t familiar with yet, such as childbirth for soon-to-be mothers. However, a new study found in BJOG: An International Journal of Obstetrics and Gynaecologysuggests that women who fear childbirth tend to actually be in labor for longer than women who aren’t fearful of giving birth.

A news release on stated that 2,206 women were included in the study. These women were only giving birth to one child vaginally, and 7.5% of these women were determined to be fearful of childbirth at 32 weeks into their pregnancy. The report estimated that between 5% and 20% of pregnant women generally fear childbirth.

For women who feared childbirth, the average labor time was about 1 hour and 32 minutes longer than in women without as much fear. When other factors were considered, the women with fear of childbirth still took 47 minutes longer for labor than women without the same amount of fear. Women who feared childbirth were also more likely to need intervention during labor, such as instrumental vaginal delivery and emergency Caesarean section. However, most women who feared childbirth were still able to have a successful vaginal delivery.

The study added that there are different factors that cause women to fear childbirth, such as having a baby for the first time, being a young mother, having little social support, having a history of abuse, and suffering from psychological issues.  Other experts share their professional opinions on the causes of fear of childbirth and what women can do to decrease that fear.

Julie Hanks, a licensed clinical social worker, the owner and executive director of Wasatch Family Therapy, LLC, and a mother of four children, said in an email that she believes fear of childbirth is actually quite common in our society. “I think it is common for women to fear childbirth because it has become so medicalized in our society,” Hanks said. “Instead of viewing childbirth as a natural process that women’s bodies were created to do, it is viewed as a scary, painful, ‘out of control’ experience that needs medical intervention.”

She said that some women who have gone through specific painful experiences before might be more likely to have a fear of childbirth. “In my clinical practice I have seen a link between childhood sexual trauma and fear of childbirth,” Hanks said. “Since childbirth and sexual abuse involve the same organs, it is often emotionally tied together. Additionally, feelings of helplessness and of being controlled by a man may emerge during the childbirth process (often a male OB).”

General anxiety could also lead to fear of childbirth. “Certain mental illnesses, like anxiety disorders, may predispose certain women to anxiety about the childbirth process, especially with first-time moms,” she said.

The stories of other women who have had bad experiences with childbirth could also add to the fear for first-time moms. “Women may fear childbirth because of family stories surrounding their mother or sister’s childbirth experiences,” Hanks said. “Additionally, women tend to share their birth ‘horror stories’ more frequently than they share uncomplicated birth stories, playing into a cultural fear of childbirth. I think this can impact mental health in general.”

The whole concept of becoming a mother can bring up a lot of issues, not just childbirth itself. “Taking on the new role of becoming a mother is also emotionally loaded and may bring up a woman’s own fear of inadequacy and self-doubt about whether or not she will be able to provide the nurturing that this helpless baby requires,” Hanks said. “If a woman has emotional neglect, abuse, or other unresolved issues with her own mother, those ‘left over’ emotions may surface as a woman now faces becoming her mother.”

There are even more mental health issues that can be associated with pregnancy and childbirth. “Hormonal fluctuations may impact emotional health relating to childbirth,” Hanks said. “Also, family pressures, relatives coming into town to celebrate the birth of a new baby may add to the overall stress of childbirth experiences.”

If physical health is impacted, then mental health is also not far behind. “Eating disorders or distorted body image may play into mental health issues, anxiety, and obsessions around childbirth,” Hanks said. “The physical changes that often accompany pregnancy and childbirth are often frightening to women who have built their self-worth around their appearance.” Hanks shared her thoughts on helping women overcome any fear they may feel in relation to childbirth. She said, “I believe that a cultural shift in viewing childbirth as a normal, natural process that generally doesn’t require intervention would really help women embrace the process without fear. Also, sharing positive childbirth stories openly may help shift women’s views.”

Dr. Ingrid Rodia, an OB-GYN and associate professor of obstetrics and gynecology at Geffen School of Medicine at UCLA, said in an email that some women are more anxious in general, and others do have a higher risk in regard to childbirth, so these can both lead to issues with fear.  She added that the most common fears women have in relation to childbirth are pain, concerns about the baby coming out “normal,” and concerns about surviving childbirth. “Women might fear childbirth because they are already overwhelmed and wonder how they are going to deal with the additional demands,” Rodi said. “Women who did not plan the pregnancy, and especially those who did not want to be pregnant, are particularly at risk for anxiety and depression. Those women with a pre-existing mood or anxiety disorder are at increased risk of anxiety and depression, not only during the pregnancy, but also post partum … Psychological issues before the pregnancy can lead to more fear of childbirth.”

Financial issues, a poor relationship with the father, and psychological issues can add to fear of childbirth as well. “Basically, in order to decrease the fear of childbirth, the pregnancy should be desired, the woman should feel financially and personally supported, and she should have medical and psychiatric problems identified and treated prior to pregnancy,” Rodi said.

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at NYU School of Medicine, said in an email that pain and negativity associated with childbirth tends to be exaggerated in the media and among family and friends, adding to a fear of childbirth. “The media’s portrayal of childbirth with women screaming in agony makes it understandable why women might fear childbirth,” Garcia-Arcement said. “Rarely are stories of childbirth portrayed as calm and peaceful, where women are in control of the experience and the pain. Some women have heard negative stories of long and difficult labor from family and friends. If this is their first child, fear of the unknown is common. Women worry about what might happen, what might go wrong and how they will react to the pain of childbirth. This is an experience perceived as out of their control, which can be scary.”

Women who have mental disorders and have certain personality types might fear childbirth more than others. “Women that are already experiencing anxiety and depression symptoms prior to pregnancy are likely to have those symptoms exacerbated by things like a difficult pregnancy or worry about what to expect during childbirth,” Garcia-Arcement said. “Individuals that like to be in control of their experiences will likely worry about childbirth, an experience that cannot be dictated by a mother but can be managed.”

Women do have real concerns in regard to pregnancy, because each pregnancy and childbirth experience is different, and some women do require C-sections, endure more pain, and have complications with delivery, adding to that fear. However, Garcia-Arcement does have several tips for women who may fear an upcoming childbirth experience.

  1. Become informed about what will happen during labor and childbirth. She said, “Childbirth itself might not be within a woman’s control, but how she reacts to it is. Being informed can be empowering. Avoidance of what is feared will only make it worse.  Becoming an informed consumer will help women feel they can make better choices during childbirth. Women ought to learn about what typical labor medical procedures and medications are used.”
  2. Choose the doctor or midwife who is right for you, and plan to use the hospital or birthing center that matches your beliefs about childbirth.
  3. Create a birth plan and discuss concerns and wishes with your medical provider. This is your baby and your body, so don’t be afraid to ask questions before and during labor.
  4. Learn how to use deep breathing techniques, muscle relaxation exercises, and imagery of a safe peaceful place to reduce anxiety.
  5. Plan to use distraction with positive self-care activities.
  6. Seek support from other women, whether in a group setting or online.

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Coping While You Wait For Medical Test Results

In this article I am quoted on typical reactions to the unknown, such as stress and anxiety, and how to manage your feelings and cope with the uncertainty. By Rheyanne Weaver  |

Waiting for the weekend to come or a long-desired vacation can bring excitement, but what happens when you’re waiting for something nerve-racking, like medical test results and a potential diagnosis?

Experts explore the connection between fearing the unknown (which can happen when you’re waiting for medical test results), and provide tips for how you can keep positive in a potentially negative situation.

Nerina Garcia-Arcement, a licensed clinical psychologist and a clinical assistant professor at the NYU School of Medicine, said in an email that fearing the unknown is something we all experience at some point in life.

“Fear of the unknown (especially when [the] outcome can be negative) is a normal human reaction,” Garcia-Arcement said. “That is why many avoid going to the doctor to begin with. They fear hearing that they are ill or whatever they imagine.”

Besides the common fear and anxiety that can be associated with waiting for medical test results, there are other emotions and thoughts that people can experience.

“Other common emotions are numbness ... worry, sadness and guilt (that they didn't go sooner and now might be ill) and concern about how this might impact their lives, plans and families,” Garcia-Arcement said.

So now that you’re waiting for medical test results, how can you cope with some of these negative emotions you may be experiencing?

“[The] best way is to acknowledge what they are feeling, normalize it/know that it is normal to feel that way, and then use healthy coping strategies to deal with what they are feeling,” Garcia-Arcement said. “If they are anxious and worried, do breathing exercises, distract themselves with activities and people they enjoy, do visualization exercises or any other type of self-care activity that will help them ‘get through’ until they receive their diagnosis.”

If you’re almost positive that the medical test results you’re waiting for will lead to a diagnosis of some kind, there are some ways you can prepare yourself for this potentially devastating situation.

“I have my patients imagine worst case [scenarios],” Garcia-Arcement said.

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How Are Diabetes And Mental Health Connected?

I am quoted in a discussion of how Diabetes impact mental health and ways to cope. By Rheyanne Weaver |

Diabetes is a growing health condition that affects 25.8 million people of all ages in the United States, according to 2010 statistics from the Centers for Disease Control and Prevention website.

These most recent statistics also state that 8.3 percent of the U.S. population has diabetes. While the number of people with diabetes increases, there are not only concerns for how diabetes impacts physical health but also mental health.

The American Diabetes Association website suggests that some people living with diabetes can experience some mental health issues due to having diabetes. These can include anger toward having a diagnosis in the first place, denial toward the diagnosis, and in more severe cases depression can result.

Living with diabetes can be stressful as well, according to the American Psychological Association website. For example, people with diabetes might stress over their eating options at restaurants, so it’s important to develop coping methods for stress and to make sure to plan ahead for some situation.

People with diabetes can also learn to recognize negative feelings they have toward diabetes, and then learn how they can treat their diabetes. Mental health professionals can help people with diabetes develop intervention and treatment plans, and they can help with coping strategies.

The American Psychological Association website also stated that according to different studies, diabetes can lead to mental health issues like depression and slow mental processing. People with depression may also in general be more prone to type 2 diabetes.

The website emphasizes that a very small percentage of people who are diagnosed with diabetes actually follow a treatment plan involving changes in diet, exercise and taking medication, suggesting that people with diabetes are having issues with lifestyle changes.

Another study found that people who did work with a mental health professional on behavior change along with making lifestyle changes decreased their chances of getting diabetes.

Some experts share even more information about the link between diabetes and mental health.

Sujatha Ramakrishna, a clinical psychiatrist, said in an email that people with mental illnesses can be more prone to diabetes and other health problems because they are more likely to make unhealthy choices related to overall health, such as poor eating and exercise habits.

People with mental illnesses who take medication can also unknowingly increase their risk of getting diabetes.

“Antipsychotic medications, also known as mood stabilizers, are associated with an increased risk of diabetes,” Ramakrishna said. “It's recommended that patients who take these medications have their weight and blood sugar levels checked regularly by their physician. Other psychotropic medications, including SSRIs such as Prozac, can also cause weight gain, which in turn increases the chance that patients might develop diabetes.”

Nerina Garcia-Arcement, a licensed clinical psychologist and a clinical assistant professor at the NYU School of Medicine, said in an email that there are many mental health issues to consider that are connected to diabetes.

“If someone has diabetes, this impacts and limits their physical abilities and diet,” Garcia-Arcement said. “This often leads to people experiencing sadness, anxiety, frustration and loss. If there are [amputations] due to complications from the diabetes, this often negatively impacts mental health.”

There are also many contributing factors related to diabetes that can lead to depression.

“The stress related to managing a chronic illness, plus fear/worry about a negative prognosis are excellent causes for depression,” Garcia-Arcement added.

Taking diabetes medication can lead to mental health issues indirectly, in addition to psychiatric medication leading to diabetes in some cases.

“Having to monitor sugar levels and take insulin is stressful, limiting of everyday activities and can lead to worry, stress, anxiety and sadness,” Garcia-Arcement said.

In general, especially if you have a mental illness, it’s beneficial to talk to a mental health professional so they can help with motivation, behavior changes and understanding the link between mood and health so you can maintain good health, she said.

“Research has shown that people with mental illness have shorter life spans, often because they neglect their health,” Garcia-Arcement said.

“For example, if you are depressed, you are less motivated to engage in pleasurable activities, get out and socialize, eat healthy ... and exercise. Many don't take their medication as prescribed, often forget doctor’s appointments, or don't have the motivation to make appointments and keep them. This in turn worsens their diabetes. As they get sicker, they often get more anxious and depressed.”

Elizabeth Mwanga, who was diagnosed in 2007 with type 1.5 diabetes (latent autoimmune diabetes), used to be morbidly obese and was close to death due to her diabetes. However, she made major changes in her eating and fitness routines, and since 2009 she hasn’t needed to take medication for diabetes and has even kept off the 100 pounds that she lost.

She definitely sees a connection between mental health and diabetes, especially because many diabetics have high and low blood sugar levels that tend to affect mood.

“Blood sugar lows and highs can cause mood swings, which can be very disruptive,” Mwanga said in an email.

She said low blood sugar levels can lead to anger and minimal energy, and sometimes hallucinations and delirium. With high blood sugar levels, depression and mood swings can be a result.

“Diabetes requires 24/7 self-care management,” Mwanga said. “Sometimes this can be frustrating, overwhelming and depressing.”

“Food and fitness is linked to better physical health and diabetes management, which in turn effects mental health,” Mwanga added.

“I find myself feeling a lot more energetic and happier when I eat a diet full of fresh fruit and vegetables. I have also begun doing research on foods that raise serotonin levels. For example, I drink green tea (for the energy boost/antioxidants) during the day, and chamomile at night (for the calming effect, also full of antioxidants and anti-inflammatory properties). I eat whole raw almonds a lot, and lean turkey.

All of these foods are low GI ([low] glycemic foods are best for diabetics) and studies have shown that all aid to the process of serotonin.”

There is never a better time to make health your priority. Proper exercise, healthy diet and sleep routines are all key to the best overall health, and at least paying special attention to these areas of life will most likely decrease your risk of developing diabetes, other physical and mental health issues.

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