This experience normally falls into one of three categories:

1. Winter Blues: this is the most common form. You tend to feel sluggish, have difficulty sleeping, and find yourself a bit down as the days get shorter. It’s not severe enough to be a diagnosable condition, but it sure doesn’t feel good.

2. Seasonal Affective Disorder (SAD): this is another one you may have heard of. It’s a bit more serious than the Winter Blues. You might experience low mood and lack of pleasure along with a number of physical and behavior markers like the urge to sleep more, low energy, isolation, etc. Interestingly, a small minority of people experience SAD in the summer instead.

3. Seasonal Affective Disorder +: the final one is essentially an extreme version of SAD. In the case of SAD+, the deep discouragement of winter is offset by periods of extremely high energy and mood levels in the summer. These extremes can be exhausting for people.

Understanding the cause of our struggles is an important step in helping us address them. However, despite research into circadian rhythms (our body clock), neurotransmitters, genes and other factors, we still don’t know exactly why each person struggles in a particular way when winter comes. The good news is that even if we’re not sure of the cause, we have solid data on solutions that work. As a psychologist who is passionate about behavior change and the role of thoughts and behavior, activation, or our level of engagement with life, is one of those solutions. If we disengage from activities as the temperature drops, our mood tends to drop as well. Not everyone who has winter blues or SAD becomes sedentary in the winter, but our level of activation appears to play a strong role.

Here are three research-based solutions: medication, lights and Cognitive Behavioral Therapy (CBT).

1. The medications usually include some form of antidepressant used for other mood disorders. These are effective for many sufferers.

2. Light therapy involves sitting in front of a light box with bright non-UV lights for an extended period of time. This type of therapy is best done under the care of a provider who can recommend the best light and assess the risk, which is particularly high for bipolar individuals.

3. While meds and lights are very good options, the research points to CBT as the strongest solution. You may already know that CBT involves examining your thoughts and emotions. But many people, including some providers, are unaware that it includes behavioral tools, like activation. When we increase our level of activity despite our rainy-day mood, we nudge ourselves to engage in activities that normally bring us joy.

Activation is incredibly powerful and very simple, but that doesn’t mean it’s easy to do when you’re feeling really down. It still requires some will power. The good news is that the more you do it, the easier it becomes. It’s such an effective tool that we included it as the first lesson in our Learn to Live Depression program. So, if you’re feeling the seasonal pull of the shorter winter days but aren’t at the point where you want to consider outside help, then activation may be a good option for you. Start with something small. Take notes. Jot down your mood before and after. Try to choose recurring activities, like a daily morning walk or a regular bike ride. Make it part of your schedule. Winter doesn’t have to be a season of discouragement. Try activation and see how much different you can feel.

The four most commonly recognized communication styles are:

1. Passive
2. Passive-Aggressive
3. Aggressive
4. Assertive

Passive communication often comes from a place of low self-esteem. Passive communicators frequently don’t speak up for themselves or assert their wants or needs. They may feel as if their feelings and opinions don’t matter, may not look people in the eye, and may even apologize for speaking up. Over time, being passive may lead to built up frustration or anger.

An example of Passive communication:
Sarah disagrees with Mark, but doesn’t want to speak up because she doesn’t like conflict. She looks down and nods her head in agreement, even though inside she dislikes how he is always getting to state his opinion.

Passive-Aggressive communication involves expressing negative feelings in a hidden, or indirect way. The person is still trying to avoid conflict, but the feelings come out in a roundabout way.

An example of Passive-Aggressive communication:
Sarah asks Mark, “Are you wearing that to the party?” triggering hurt and embarrassment for Mark. But rather than tell Sarah that he was bothered by the comment, Mark retaliates by slowing his efforts to get ready for the party, knowing it is important to Sarah that they get there quickly.

Aggressive communication has unfortunately impacted most people at times. The person who has been aggressive often expresses him or herself in a way that hurts others, often in response to their own anger or drivenness. Can you think of such an interaction? You probably ended up feeling hurt or insulted.

An example of Aggressive Communication:
Sarah is upset with Mark’s choice of restaurant for the night: “I can’t believe you chose this place again. You have the worst taste! How could you be so stupid? Why would I want to go here?”

Assertive communication is often the most effective and kind way to communicate. You are able to express your feelings and opinions directly, without deliberately offending or hurting others. This type of communication can be challenging, because you often must be brave (you are sharing your own wishes) and honest (sharing your true feelings can be hard). If you practice, communicating assertively typically becomes easier over time.

An example of Assertive communication:
Sarah wishes that Mark would put down his phone when they are having an in-person conversation: “Mark, I would really appreciate if you would put your phone down when we’re having a discussion. When you are looking at your phone, I have a hard time knowing if you’re listening to what I’m saying, and I wonder if what I’m telling you just isn’t important to you.”

Sarah probably felt a little nervous telling Mark how she felt, but she expressed herself honestly and in a respectful way. Hopefully, Mark will put down his phone and listen to Sarah during their next conversation and they will both feel better about how they are communicating.

Being assertive doesn’t come naturally to everyone. Sometimes it seems easier to give in to others, or more natural to get what you want by ordering people around. If your parents communicated this way, then it may seem normal to you. These types of behaviors are learned. The good news is that we can unlearn unhelpful behaviors. Persisting in problematic communication strategies—communicating passively, passive-aggressively, or aggressively–often leads to feelings of anger, resentment, irritation or isolation. Assertiveness can be learned through repeated use. There’s always time to change…here are some things to think about when you are interacting with someone with whom you have a relatively good relationship:

• Tell the other person what they’re doing.
• Tell them how it’s affecting you.
• Tell them how you feel about it. (Try to use “I” and express feelings rather than thoughts)
• Respectfully, tell them what you’d like them to change.

Each time you’re assertive, it will likely become a little bit easier. Gradually, you may start to notice that you feel better about yourself, and the relationships you have with others will be more satisfying. Change isn’t easy, but being assertive is worth it.

Life can be overwhelming at times. If you’re struggling with depression or anxiety, or feeling stressed by juggling too many things at once, it’s easy to forget about taking care of YOU. For many of us, our jobs, spouses, children, aging parents, or even hobbies take priority. It’s easy to focus on these people and things because you need to or want to, but it’s important to leave room for yourself, even if it’s just 15 minutes a day.

Here are some ways to show yourself a little love during this holiday dedicated to amour:

1. Think of 3 things you love about yourself. We all have flaws, and people struggling with anxiety or depression are usually excellent at acknowledging them. Give a shout out to your strengths instead. Maybe you’re a great friend, or have mad breakfast making skills, or a voice sort of like Adele. Enjoy it, be grateful for it, smile about it, and give yourself a little pat on the back.
2. Move your body. Not because you want to fit into smaller clothes or win a race, but because it’s good for you. Exercise is like a love note to your body and your brain – from you.
3. Practice . Harboring anger and holding on to past grievances can eat you up inside. Letting go of anger is a gift to the other person but also, and more importantly, to you.
4. Have fun. Just because you’re older than 12 doesn’t mean everything has to be serious. Laugh aloud, do karaoke, play a board game, have a dance party in your kitchen.
5. Reward yourself. Maybe you reached a goal you’ve been striving for, or maybe you just made it out of bed this morning (and that may have been a big accomplishment for you). It doesn’t have to be something big or fancy, but go ahead and splurge on the latté, the hot bath or an extra 20 minutes of your favorite show.

We can get hard on ourselves when life gets busy and everyone and everything is competing for our time. It is precisely during those times when those of us struggling with anxiety or depression need to take a step back, breathe and think about our own needs as well. This Valentine’s Day don’t forget to show some love to yourself.

CBT stands for Cognitive Behavioral Therapy and is a form of psychotherapy that has been around since the early 1960’s. (There’s an interesting story about how the two most prominent founders of the model, Aaron Beck and Albert Ellis published their seminal books about the same time in the same year – so there has been some dispute over who was the first to formally present some of the key ideas.) CBT takes into account a person’s thoughts or perceptions, and how those thoughts or perceptions affect emotions and actions. We learn to identify our automatic thoughts or distorted thinking, after which we are better able to change those thoughts to something more logical or more useful. We can then begin changing our patterns of behavior, facing fears and eliminating unnecessary precautions, getting more active, or applying new alternative behaviors in place of the old actions that kept us stuck.

The skills of CBT can be applied immediately to problems we are suffering from in the present. And these skills become a helpful set of tools that can be applied to new situations as the challenges of life arise. CBT can be applied to work, school, relationships, and social situations – almost anything!

Among the most common reasons someone may seek out CBT are depression, anxiety, obsessive-compulsive disorder, social anxiety, and post-traumatic stress disorder (PTSD). What many people don’t realize is that CBT can be applied to a whole host of issues we face in our daily lives: pain conditions, sleep disorders, life stress, eating disorders…the list goes on.

In recent years, we have learned that CBT has another asset – learning how to change our thoughts and behaviors can be done from the privacy of our own homes. Internet-Delivered Cognitive Behavioral Therapy, (iCBT) has been demonstrated to be as effective as face-to-face therapy. The iCBT option means that those of us who may not otherwise choose face-to-face therapy – because of cost, stigma, or lack of options nearby – can still get the benefits of CBT.

CBT may sound like just another acronym in a world full of TLAs (three-letter acronyms). But really, it’s shorthand for a proven strategy for reshaping our unhelpful thinking and changing our unhealthy behaviors. Whether you need help with the stress of a new job, handling college life, or speaking in front of a group, CBT is a tool that can help you change your thoughts, your behaviors, and your life!

It’s a staggering statistic: 1 in 4 adults living in America have a mental health problem, such as anxiety, social anxiety, or depression. Given this, it would be natural to expect that it would be relatively easy to get help for these mental health challenges. But, curiously, it’s not. Here are a few reasons I have observed that help explain why:

1. Stigma or the fear of stigma. Despite the progress made through the #stopthestigma campaign, stigma has been a strong force over the years. Mental health problems have, at times, not been viewed as the real, treatable, health problems they often are. Talking about them has not been the norm. Whispers, awkward glances, and hushed conversations about something “not being right” have historically been commonplace.

We frequently fear being stigmatized when, in truth, we don’t really know if others will accept us or not. None of us wants to be labeled, but sometimes the fear itself—of being judged or labeled—is our biggest foe. Often, the best step we can take is to reach out and get the help we need, regardless of what others think. Often people find that others are compassionate when they learn of these struggles.

2. Cost. Mental health care, like any health care, costs money. Whether it means an office visit and the cost of a monthly prescription or 3 months of face-to-face Cognitive Behavioral Therapy (CBT), mental health care is not cheap. For many years, stigma and cost have prevented a large number of people from seeking help. With the enactment of the Affordable Care Act (ACA), cost has become less of an issue. The ACA has expanded mental health and substance use disorder benefits for 62 million Americans. Most health plans must now cover depression screening and behavioral health assessments at no cost, and plans are no longer able to deny coverage based on a pre-existing mental health condition.

Not all providers participate in insurance plans, but many do, so it is definitely worth looking into.

3. A shortage of mental health professionals. For many people choosing to seek care, distance and waiting lists pose an additional hurdle. While some areas may have a sufficient number of providers, there are many mental health provider shortage areas that continue to face growing needs, especially with the expansion of coverage under the ACA.

Sadly, even when therapists are accessible, they often fail to provide evidence-based care so the impact of the treatment is disappointing.

4. Fear is a pervasive obstacle. Fear of being labeled. Fear of therapists or therapy. Fear of admitting the problem itself.

Fear is a normal emotion with any challenge in life, but in many cases, working through that fear is a step in the right direction, a step toward help and healing. Many people have found that, if they can just take that first step, the fear becomes more manageable.

5. The nature of the beast. Anxiety and depression are, by their very nature, obstacles to finding a solution. In severe instances, many sufferers can hardly get out of the house or even out of bed. Other times people rationalize their thoughts and behaviors as “just my personality.” Coming to a point of acceptance about needing help and having the energy and courage to take a first step of asking for help are all part of the picture.

These factors are complicated and often compound one another. But our hope is that through awareness, accessibility, innovation, and courage, we can start to roll back this beast. Our #mentalhealthmatters.

1. Telling your story draws us together. Whether you are struggling with depression, anxiety, stress, divorce, or another issue, telling your story can help connect you with others who are experiencing the same thing. Just hearing someone else say, “Me too,” can break down feelings of isolation and loneliness. Having one other person, or even a whole community who believes you, understands you and can serve as a support system can be extremely empowering. When you share your story with trusted others, you create a small world around you of openness that could potentially become contagious, spreading in a way that makes all of us grow closer in more authentic relationships.

2. You become an advocate. You don’t need to have a fancy degree, years of experience or other qualifications to be a mental health advocate. By telling your story, you become a supporter and source of encouragement for all those who are going through the same thing and are not yet ready to reach out. In addition to your becoming an advocate, you in turn become eligible for the encouragement they can provide.

3. When you share your story with trusted others, you grow closer to them, having taken a risk. Think of it as a sort of a behavioral experiment in which you hopefully learn that they care and honor that trust. Can you think of a time when you shared something with a friend or family member and ultimately ended up feeling closer to them because of how they responded to you taking a risk and sharing?

4. One of the “tasks” in cognitive behavioral therapy is “facing your fears.” When you share your story with trusted others, you face your fears in a very direct way, often experiencing the fear of rejection or ridicule. Facing those fears is an important part of getting past your anxiety and urge to avoid. Through that process, you may also discover that others have helpful and useful ideas for you as you continue to share your story with others.

It may sound like one of the scariest things you could do, but maybe it’s worth a try. Sharing your story may end up being one of the most important things you could do for yourself. You may end up with a new (or closer) group of supporters, and the satisfaction of facing your fears, taking a risk and coming out of the other side can be exhilarating.

This old saying of unknown origin speaks to the incredible impact of even the smallest insects, over time, on the hardest surface. The constant grinding of small feet wears away even the most solid rock. Sadly, this is also true of our ANTs, those Automatic Negative Thoughts that constantly wear away at even the most confident self and contribute to challenges such as depression, social anxiety, and stress, anxiety and worry.

ANTs are not our personal automatic thoughts, but really types of thinking patterns that may be hidden in our private automatic thoughts. Over the years they’ve been called cognitive errors, thinking errors, cognitive distortions, or “stinkin’ thinkin’, though the latter term has been applied in various ways to various experiences (and why not?) Still, at the risk of confusing a few temporarily, I’m going to use the term ANTs because it sticks in our minds.

We discussed several types of ANTs last month in our blog post on mental health and the holidays. Here are more ANTs that you may recognize in your own life:

Fortune Telling – You possess a crystal ball, but unfortunately it only predicts negative things for you.
– If I go to a party, everyone will ignore me, just like what seemed to happen last time.

Labeling – Instead of calling a failure or unusual behavior a one-time incident, you generalize, and attach a sweeping, permanent label, whether this is about yourself or someone else. When you label, you don’t just observe your shortcoming, you draw general, negative conclusions from them.
– I couldn’t think of anything to say to a couple of people at the party. I’m such a social failure. I’m so awkward. (In truth, you probably do just fine in many other situations)
See also: How Heidi Overcame Her Social Anxiety with Online Cognitive Behavioral Therapy

Focus Only On the Bad – This is exactly what it sounds like. If four out of five people compliment the cake you made, you’ll focus on the fifth, turning a non-comment into a criticism. When you anticipate others opening gifts you’ve given them, for example, you might selectively recall only the image of the one dissatisfied gift opener and predict the same negative response with each gift you give in the future.

Feelings Make Fact – Feelings are complicated. Sometimes they are related to experiences or memories that you have from the past. Feelings are not necessarily truth – they are feelings.
– I am so uncomfortable at this family gathering, and I feel unattractive in this outfit. They must all think I am fat and ugly and unlovable. (Feeling unlovable does NOT mean you are.)

Not Helpful Thoughts – These are thoughts that may or may not be true, but dwelling on them does not serve a positive purpose.
– I’m not as physically fit as I used to be. I’ve gained weight, and I’m getting wrinkles. It’s hard getting older.
These statements may be true, but choosing to dwell on them won’t help you feel good and be in a state of mind where you can easily observe the pleasant things around you.
See also: The Relationship Between Depression and Social Anxiety

I hope these examples help you to better understand the thinking patterns (cognitive distortions, stinkin thinkin, cognitive errors) we refer to as ANTs. It’s a new year – what better time to work on new thought patterns? Get ready to squash those ANTs before they wear you down! Check back soon for a lesson on Data Collection – you’ll learn how to be a super sleuth of your own social situations which may help you address mental health challenges, including social anxiety, depression, or stress, anxiety and worry.

Just this week in California, 2,600 Kaiser Permanente clinicians announced an upcoming Kaiser Permanente mental health clinician strike. The clinicians plan to strike to “protest Kaiser’s chronic failure to provide its members with timely, quality mental health care.” Under question are Kaiser’s alleged failures to appropriately fund and staff their psychiatry department, leading to understaffed clinics and hospitals, unacceptable appointment wait times, and adverse outcomes related to not having access to care. They have been fined $4 million for “failure to provide mental health treatment in a timely manner.” The demand is simply too high and the resources too scarce.

As large and profitable as the Kaiser organization is ($3 billion in profits in 2014), it is not immune to the burden of increased mental health demand. Decreased money being allocated toward mental health, a shortage of trained mental health providers in certain areas, and a very large demand for services pose significant challenges, not only in California, but all across America. We can expect to see more tension in the healthcare sphere, and especially in the mental health space, as more people are given access to covered services through programs like the ACA.

The hope is that difficult situations like this one in California will get us thinking more broadly about innovative solutions in our search for affordable and effective options to meet the pressing needs. Creative solutions like Internet delivered Cognitive Behavioral Therapy, for example have been proven through years of research but remain underutilized. Any solution that addresses the major barriers to treatment to like stigma, cost, and accessibility should be considered.

See also: PsychCentral: Dr. Russell Morfitt Discusses Online Counseling for Anxiety

2,600 clinicians will be striking in order to raise awareness about the situation in California. Let’s hope the strike creates a dialogue about other treatment options as well.

It’s officially here, the proverbial “most wonderful time of the year.” But for some, especially those living with social anxiety, this time of year may be anything but wonderful. Work parties, family gatherings, holiday travel, it can all get stressful in a hurry for a social anxiety sufferer. Cognitive Behavioral Therapy (CBT) is one of the most effective approaches to dealing with stress in our lives. It provides several different techniques to help people, including those social anxiety, depression, or excessive stress, anxiety, or worry. One of the key components of CBT is identifying problems that may exist within our thoughts, those thoughts that are so ingrained in us that we don’t really notice them anymore. The idea is that if we are able to identify flaws in our thoughts, we can change them. We at Learn to Live have a name for those problems– ANTS, for Automatic Negative Thoughts. Below is a list of some of the ANTS a person may detect:

All or Nothing Thinking – “I tried avoid cookies and ended up eating one. See, I have no self-control. I’ll have to give up on my diet now.” These thoughts don’t allow room for mistakes or flexibility.

Should Statements – “I lost my patience with my kids at the Christmas program. I should always be able to control my emotions. What’s wrong with me?” These statements usually involve unrealistic expectations and don’t allow for flexibility.

Mind Reading – “My aunt didn’t smile much during our conversation at dinner. She probably thinks I’m boring and stupid.” Mind reading thoughts make assumptions about another’s feelings or thoughts without any real evidence to support it.

See also: Overcoming Social Anxiety was HARD, but it changed my life…

Disaster Making – “I’m probably going to fail the final test, and if I fail the test, I won’t have any chance of getting into college. I won’t be able to handle it.” These thoughts assume the worst-case scenario in all situations. The imagined outcome is out of proportion and I believe it will be beyond my ability to cope.

Personalizing – “If only I had been at the nursing home, mom never would have fallen. Now she has a broken hip and can’t join us for the holidays…and it’s all my fault.” These thoughts take the blame for all bad outcomes, denying responsibility to anyone else.

You’ve probably all heard the familiar clichés, “Knowledge is power,” and “Knowing is half the battle.” In this case, they are both true – being able to identify these thinking patterns as automatic and unhelpful is the first step in being able to change your thoughts and ultimately your life. After identifying these thinking problems, I’ll tell you about some more ANTS and then move on fear facing. Stop back soon to check out our upcoming posts on these topics.

“The world as we have created is a process of our thinking. It cannot be changed without changing our thinking.”  ~ Albert Einstein

Although Thanksgiving has passed, the tips in our recent post, Take Social Anxiety Off Your Thanksgiving Menu will still apply for your upcoming holiday gatherings.

The good news is that psychological treatment for social anxiety – namely Cognitive Behavioral Therapy (CBT) – has the benefit of addressing not only the primary diagnoses, but the comorbid conditions as well. The tools and fundamentals of CBT, including Thought Inspection, identifying Automatic Negative Thoughts (ANTS), Fear-Facing and others, teach sufferers to identify and change the problem thoughts and behavior patterns that perpetuate the anxiety. These techniques, which focus on behavior, have the potential to address underlying behavior and root causes of other, physical and mental health problems as well.

Some of the most common comorbidities experienced by social anxiety sufferers include depression, bipolar disorder, panic disorder, conduct disorder, avoidant personality disorder, and the use of alcohol and illicit drugs to relieve symptoms.
This is something to keep in mind if you’re feeling overwhelmed by overlapping issues. The tools and fundamentals of CBT can be used to address a broad array of disorders by targeting those thoughts and behaviors at the root of them all.

Read the transcript of this video below:
Social anxiety involves making predictions for the future, predictions about the future, dreading things and then developing patterns of avoidance. And really that’s true for other anxiety problems as well – I dread something, I fear something about the future and then I develop behavioral patterns that keep me stuck.

Usually they’re about avoidance or escape, and so for that reason there is a great deal of comorbidity – that means overlap. If I have social anxiety disorder, I have a 50% chance of having another anxiety problem or depression. And depression is especially likely because when I have social anxiety disorder I’m tempted to avoid meeting new people and going out. And I avoid doing some other things that might give me meaningful significant relationships with other people and important experiences that I could have and enjoy. I start missing out on those experiences because of that avoidance. Then I’m at greater risk above becoming really depressed when I have some kind of setback happen in my life.

So, I’m not out there in the kind of environments that would give me positives, or that would help me bounce back from the setbacks and negative things that might happen to me. So I’m at greater risk of getting really quite depressed.