All Posts in Category: General Anxiety

Darbi Miller, MS, LMFT – Consult The Expert On Increasing Relational Self-Awareness

For this month’s Consult The Expert interview, we spoke with Darbi Miller, MS, LMFT, one of the marriage and family therapists here at The Center For Treatment Of Mood And Anxiety Disorders. Although she likes working with all ages, she enjoys the dynamic surrounding family and relationships.

“One of my favorite things to work with is increasing clients’ relational self-awareness,” she said. “I also enjoy exploring peoples’ Families of Origin, which is connected to self-awareness from my perspective.” 

What Is Relational Self-Awareness?

I asked her to explain what she means by relational self-awareness. “Family of Origin and self-awareness are related,” she said. “In any experience with another person, relational self-awareness can look like asking ourselves, “What is mine? What is yours? What is ours?”

“We each have our own stories, beliefs, and experiences,” she continued. “Relational self-awareness looks at what each person brings to the table and how this affects the interaction between us. If we are self-aware, we have a compass for ourselves which translates into tolerance. We are able to share our personal values and beliefs and hear the other person’s.”

“If we are not self-aware, our interactions are based in fear. We begin looking for approval or we get defensive because we may feel we will “lose” in some way if we are vulnerable with the other person. When you have self-awareness, however, you can be vulnerable and can create more intimacy in all of your relationships.”

Ms. Miller cited a Harvard study that has followed individuals over an eighty-year period. It found that the quality of our relationships has more impact on our health than even our cholesterol levels. “It turns out that surrounding ourselves with positive, close relationships creates a better sense of community within ourselves, which in turn, has a better health impact,” she said.

We discussed how relational self-awareness can help with anxiety treatment. “With anxiety, behind that is usually fear on a basic level. Our thoughts are powerful. If you can get to the core and understand the fear (how can I feel more connection with myself?), connecting to your body and grounding yourself, allows this to be part of the healing process.”

How Does Family Of Origin Fit In?

Ms. Miller explained how Family of Origin fits into treatment of mood disorders. “We come from our own system that was learned in childhood. This is the Family of Origin,” she said. “This system has patterns, beliefs, and values that we can sometimes see, but sometimes aren’t aware of. We all have a family role – maybe we’re the funny one, the responsible one, or the nurturing one. This role can carry into our adult lives and play out between couples.”

“Sometimes people go into a relationship expecting it to heal their Family of Origin wounds. Although it can happen that a new relationship can be good and healing, if we enter it expecting our partner to instinctively know what we need to heal, that may not be the case and we’re disappointed,” she said. “If you are expecting your partner to heal you, where is this coming from? The answer leads back to relational self-awareness.”

How Do These Concepts Help With Therapy?

I asked how knowing what we bring with us from our Family of Origin can be used to improve our own mood disorders.

“Knowing what you have “inherited” and what you can change can be very empowering,” Ms. Miller said. “You don’t have to operate out of same system you inherited. You have control. The realization that you don’t have to follow the same patterns – and you get to decide – can help with anxiety and trauma.”

“I mainly use this work for people who feel stuck in their life, work, and relationships,” she explained. “During therapy, my approach is always to start at the top. We begin with something action-focused, like behavior organization, and getting back into routines that can have a positive effect on the person’s mood and decrease anxiety.”

“I also use cognitive behavioral therapy to challenge negative thoughts. Taken together, these give people some relief. But if they are still looking for more, this is when we explore other things like Family of Origin and relational self-awareness.”

“When we look into Family of Origin, we can choose to do the work for ourselves and also within the family roles, with siblings and parents. I typically go three levels up within the family to look at the generational dynamic,” she continued. “Doing this work can uncover patterns that influence a person’s mood, narratives, and the core beliefs that influence mood, which can be healing.”

“People want to explore these concepts, but in a safe space,” Ms. Miller said. “So, we balance a safe space with these tools, allowing them to go deeper to uncover the aspects that may be underlying their anxiety, depression, or trauma.”

Have Further Questions?

If you or someone you love have questions or would like further information about treatment for anxiety disorders, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

About Darbi Miller, MS, LMFT

Darbi Miller is a Licensed registered Marriage and Family Therapist. She has extensive training in Integrative Systemic Therapy however, does not believe one model fits all. Her approach is strength-based, collaborative, holistic, and geared to meet her client’s specific needs and goals. She works to truly understand each client and the systems that surround them. She believes therapy is a courageous step and feels privileged to bear witness to their journey. Through her authenticity, empathy, and compassion, she provides a safe space for exploration. Darbi works to integrate her knowledge into meaningful and collaborative sessions with individuals, couples, and families. Her areas of interest include walk/talk therapy, the mind/body connection, increasing relational self-awareness, high-conflict couples, and full family work. 

She holds a Bachelor of Arts in Psychology from Michigan State University and a Master of Science in Marriage and Family Therapy from Northwestern University, where she received academic distinction. She is also certified as an Eating Psychology Coach and a Prepare/Enrich Facilitator. Darbi has worked in a variety of settings including schools, hospitals, university clinics, and in-home. She also published an article in the Encyclopedia of Couple and Family Therapy on conjoint sex therapy.

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young girl in mask

Covid Stress And The Pandemic’s Effects On Society: A Psychologist’s Observations

As a psychologist who treats anxiety daily, I’ve been in a unique position during the pandemic. I can distinctly see the difference the last two years have had on individuals, families, and society in general.

Right now, we are seeing so many kids in our Children’s Center, it is mind-boggling. Children have been struggling with online teaching, loss of contact with friends and peers, and the disruption of everyday routines – and it shows.

We are also seeing many more adults in our Anxiety Center. Parents are trying to juggle lost incomes, kids learning virtually at home, relationship challenges, and the illness or loss of loved ones. The family/children aspect is also a big concern for parents right now. They are very worried about their kids and the schools are, too.

I remember when the pandemic started. At the time, I told colleagues that this virus would have two parts to it. Of course, the first and most apparent part would be the medical aspect, because we knew some people would get sick from it.

The second part, however, was the mental aspect, because every one of us would be affected by it in some way. This could be due to personally contracting the virus, or a lost job, the death of a loved one, the stress of shut downs, or the upending of our normal lives. Even if we have somehow managed to escape the virus’ direct impact, we have become aware of this bigger force looming over and all around us, over which we have no control.

Pandemic Trauma Effects

The pandemic is malignant. It is evil, malicious, and malevolent. The virus infects indiscriminately. It sickens or kills the young, the old, the rich, and the poor. Knowing this does not sit well with us.

Usually, we have an inherent coping mechanism that helps us distance ourselves from a traumatic event. We are capable of feeling sad or upset about a tragedy, while being able to go on with our usual day-to-day lives. But, this virus, this pandemic, is so big and so menacing, it is impossible not to pay attention to it.

In my opinion, one of the best stories ever written about life and how we ultimately deal with tragedy’s fallout is the Wizard of Oz. In the story, the bad, malignant force is the Wicked Witch. Dorothy needs the wizard to protect her from the witch and send her back to her normal world.

After many challenges, she finds there is no all-powerful wizard, just a mere man hiding behind a curtain. Her hopes are dashed. She has to manage on her own. Like Dorothy, we are on our own as we try to cope with the upheaval of the pandemic, both as individuals and as part of society.

We entered this crisis relying on authority figures (our governmental leaders, the CDC, the World Health Organization, etc.) to help us navigate through the unknown, but this hasn’t turned out as well as we had hoped. The problem is that humans have dependency needs. As children, we relied on our parents to keep us safe. Today, our needs are not being met by those in authority.

No Escape From Covid Stress

Because we feel fearful and unsafe, we’ve begun lashing out at other targets – and finding them in our fellow sufferers.

Think of it like this: If you were lost in the forest, you’d want to be with others instead of alone. But if the group couldn’t find their way out within a reasonable time, its members would begin turning on one another. “It’s your fault we didn’t turn right, instead of left,” someone might say. Soon the group would be fighting amongst themselves and people would start doing their own thing in an effort to feel like they had some control.

This is being reflected in the infighting we’re seeing amongst ourselves lately. Unfortunately, it will continue to be a long term effect of the pandemic. Indeed, as we emerge from this crisis, we won’t suffer as much from the medical aspect of the virus, but from the societal and psychological factors that are the result of it.

I can’t stress enough how essential it is to get your head out of the news headlines. They are almost always negative, shocking, and upsetting, and that is not good for your emotional health. Dealing with so much trauma in the news and in our personal lives creates chronic stress and disillusionment. This is much like the battle fatigue we see in military personnel during a war. It wears you down.

In this case, though, we have no battlefield to come off of.

The fact that we literally have no escape only adds to the mental fatigue, apathy, anxiety and depression the world is dealing with. As in my forest analogy, it seems that no authority figure can make things better, so we’ve become defiant. As a result, there are fights on airplanes, vaccine mandate protests, trucker blockades, and mask and vaccine refusals.

Resiliency And Moving Forward

There is no easy answer for managing the emotional stress of the past two years. As we move forward and the pandemic recedes, however, the resiliency we have as humans will allow us to bounce back. People can basically recover from anything. I’ve seen it happen over and over during the past three decades as a practicing psychologist.

That doesn’t mean we’ll develop amnesia or that there won’t be long term negatives from the pandemic. Doubtless, some people will come out of this feeling kinder towards each other, while some will feel more entitled, selfish, and rebellious. Nature has a way of correcting itself, though. It is like a pendulum swinging: for every reaction, there is an opposite reaction. I am hopeful that our innate nature will help humanity to better cope going forward.

Clearly, we need to take care of ourselves during this time. As the pandemic drags on, many people have begun reevaulating their priorities. This is contributing to The Great Reset we’ve been hearing about. We’re examining the things that are important to us. We want something new in our lives, something better – be it a new career, a new relationship, or a new hobby.

So, I encourage you to take the time to do the things that make you happy. Spend time with family. Look deep inside yourself to figure out what you want going forward. Take what has happened and learn from it.

Become more spiritual in a way that is meaningful to you. Be more aware of time and how quickly it passes: use your time well. Go out and live, but don’t be irresponsible. Instead, use this experience to make your life meaningful.

Remember that the Japanese symbol for ‘crisis’ is the same as the symbol for ‘opportunity.’ So, find your opportunity and turn this crisis into something positive!

If You Are Struggling…

We can help. Whatever the difficulties you are facing, we are here to listen and offer effective solutions. For more information, contact us or call us today at 561-496-1094.

About Andrew Rosen PH.D., ABPP, FAACP

Dr. Andrew Rosen received his doctoral degree in clinical psychology from Hofstra University in New York in 1975 and completed an additional six years of psychotherapeutic and psychoanalytic training at the Gordon Derner Institute in New York, where he earned his certification as a psychoanalyst in 1983. In 1984, Dr. Rosen founded the Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, where he continues to serve as Director and to work as a board-certified, licensed psychologist providing in-person and telehealth treatment options.

Dr. Rosen is Board Certified by the American Board of Professional Psychology (ABPP). He is also a Clinical Fellow of the Anxiety and Depression Association of America (ADAA) and a Diplomate and Fellow in the American Academy of Clinical Psychology (FAACP). He is an active member of the American Psychological Association (APA), the National Register of Health Service Providers in Psychology, the Florida Psychological Association (FPA), and the Adelphi Society for Psychoanalysis and Psychotherapy. Dr. Rosen was appointed a Clinical Affiliate Assistant Professor at the FAU College of Medicine in November, 2021. He is a Board Member of the National Social Anxiety Center. He has previously served as president of both the Palm Beach County Psychological Society and the Anxiety Disorders Association of Florida.

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child wearing mask in school

Help For School Anxiety During Covid

School is starting up again and many school districts have gone back to in-person learning. While back to school anxieties are typical during any given year, COVID-19 is still with us, which has added more uncertainty and stress for everyone involved.

Since virtual, at-home learning took place during the previous school year, many kids may now find it difficult to adjust to being away from the safety of their home and parents. Add to that the fear that others around them may unknowingly be sick and you may find that even well-adjusted children are experiencing heightened stress. For children who already suffered from anxiety, however, the return to physical classrooms may mean their anxiety worsens when they return for the first day of class.

What Signs Of Stress Can Be Observed In Children During The COVID-19 Pandemic?

In general, children are resilient. Many kids will manage this transition just fine with help and support from their parents. Those who already struggled with anxiety or emotional problems or who had behavioral or developmental concerns before the pandemic may need additional assistance, though. It’s important that you keep a watchful eye on them, as they might be at risk for increased or severe depression and anxiety.

Signs of stress to watch for include (by age group):

Preschool age – Children in this age group may be more whiny or clingy than usual. They may have problems sleeping, have nightmares, or become afraid of the dark when they weren’t before. You may also find that they withdraw or their behavior may regress. They may lose their appetite or become picky eaters.

5 – 9 – Children who are in elementary school also may be clingier. They may be angrier or more irritable and cry or otherwise resist to going to school. They might have nightmares and sleep problems, along with poor concentration. In addition, your child may stop showing interest in friends or activities they used to enjoy.

10 – 19 – Adolescent children may show everything from sleeping and eating disturbances to agitation or arguments with others. They may have physical complaints such as headaches or stomach aches. They may also exhibit poor concentration or engage in some type of delinquent behavior.

Parent Anxiety About School During Covid

The uncertainty surrounding the pandemic makes in-person schooling nerve-wracking for some parents. Obviously, they are apprehensive about their child’s health and well-being, but they also have to address their child’s concerns and reassure them that they will be safe in school. For many, it’s a balancing act of trying to be supportive while also telling the child to be careful, wear their mask, and social distance. Talk about stressful!

It is important to keep in mind that your children look up at you for guidance on how they should react during times of stress. You want to show them that they need to take the situation seriously, but without panicking.

We all do better when we have a sense of control over something that worries us. Children are no different. Discuss their fears and help them find positive ways to deal with their stress.

Ensure they know how to wear a mask correctly (it should cover their nose and mouth). Teach them to carry and use hand sanitizer and how to wash their hands (wash for the time it takes to sing the birthday song). Make sure they understand how social distancing helps to reduce the spread of the virus. Teach them to cough into their elbow or a tissue and to throw a used Kleenex away immediately.

Lastly, protect your child’s health by encouraging them to eat well, get plenty of sleep and exercise daily. This will help build their immunity so they can fight off illness in the future.

Helping Students Return To School After Covid

Going back to in-person learning is a transition and, as with any big change, there will be upset and stress for a couple of weeks until the child settles into the new routine. This is particularly true during the pandemic, when kids are having to adjust to so many new things.

You may find that your child is overly tired during the first few weeks of school. They may be more emotional than usual or act out more often. But if there are major shifts from their normal behavior – such as withdrawing from friends or refusing to take part in things they usually enjoy – and this behavior doesn’t go away after a couple of weeks, this could signal problems and you should consider seeking help.

This is the time to sit down and talk to your kids. Encourage them to tell you what’s bothering them; acknowledge their concerns even if you don’t agree with them. When you know what is concerning your child, work with them to come up with a plan for addressing it. What can you, as the parent, do to help? What can the child do? Does the school need to get involved?

Remember that you also need to take care of yourself. What helped you before the pandemic? Was it calming to work on crafts? What about yoga or engaging in exercise? Maybe listening to calming music or reading reduced your stress? Whatever worked in the past should help you now, but you must take the time for self care.

Keep in mind that even just taking a small break can help you mentally regroup and make you feel less overwhelmed. Take a short walk around the block or indulge in some deep breathing exercises. You don’t have to take a long break – a little bit goes a long way!

Pandemic Anxiety? We Are Here For You

If you are experiencing pandemic fatigue and anxiety, we are here to help. Contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 or email Dr. Andrew Rosen and The Center today.

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What We Have Learned From 2021

No one can deny that 2021 has been a momentous year. It has had a mixture of the good, the bad and the ugly for sure. It has at times been frightening, confusing, comforting and educational. We have witnessed a very unusual presidential election, a subsequent denial by some of the validity of the election and an unheard of polarization of our peers and lawmakers. Most critically, we have endured a gift that keeps on giving; the novel coronavirus that has killed countless people world-wide and more fellow Americans than we would have ever anticipated. We have had to learn the meaning of the word epidemiology as it relates to health and wellness. Unfortunately, we now know explicitly what a spike protein is and looks like. More than ever before we have been influenced (for good and bad) by the internet and social media. Although we have been witness to conspiracy theories in the past, but this year has certainly been a boon time for them.

So it is important for us to sit back and take stock of the emotional and psychological impact of these events. A major fallout has been the confusion over what is fact and what is fiction. We have seen the major news networks disagreeing on many important issues. Who to believe? Proponents of networks that broadcast their unique take on the news may be diametrically opposite of the proponents of the “other” networks. To avoid getting into trouble I will leave the network names blank, but I am sure you know what I am talking about. There was a time in the 1950s and 1960s when veteran newscasters like Walter Cronkite, Huntley and Brinkley, Douglas Edwards educated us nightly on national and world events. Marshall McLuhan’s “the medium is the message” conveyed the power and influence of the media. Somewhere during the subsequent decades all this has changed. It became apparent to television and radio that communicating news is basically a form of entertainment. Like most popular entertainment venues it becomes essential to be able to sell the programs to the masses. Media outlets have always been for profit businesses (exceptions being Public Radio and Public Television) but it seems that profitability became linked to the entertainment value of their shows. Newscasters and news commentators became the entertainers that we see today. Walter Cronkite would not succeed as a newscaster in 2021.

Along comes the world wide web and internet bringing to us the 24/7 experience of social media. Humanity has not been the same since. Due to the openness of social media to anyone with internet access, a huge amount of content has appeared on the screens and podcasts of this world. An interesting paradox has developed. Most social media participants should realize that what they see and hear reflects subjective information. However, at the same time, we are witnessing the tremendous influence of social media on the minds of attendees. It is as if misinformation has become the norm. Conspiracy theories have had a heyday. Part of the problem is that human beings have a strong tendency to be voyeurs. They like to be entertained. We are drawn to the unusual, fantastic and bizarre. Hence the success of reality TV no matter how strange or sensationalistic it can be. Consider the popularity of horror movies going back to the days of black and white silent films. It does appear that what we have been witnessing is the natural evolution of multimedia fueled by both the profit motive and the change in its audience. 

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Our Search for Meaningfulness

The human brain is a curious organ. It is programmed from birth to actively search the world around us. As we get older and mature this search gets fine tuned and focused. We pursue education, friendships, hobbies, sports. Our quest for life experience allows us to learn about the world around us and just as importantly develop a better sense of our own identity. We progress from a period of knowledge acquisition (“knowing”) that can last decades into a prolonged journey that requires that we utilize what we have learned and productively participate in life. This “doing” often includes pursuing gainful employment and careers, raising a family, involvement in spiritual endeavors, development of hobbies, political involvement and altruistic pursuits.

Is there a common thread throughout the stage of knowing and the stage of doing? Both stages involve the presence of meaningfulness. Knowledge, employment, raising a family, friendships all invest humans with a sense of value and worthiness. Curiosity without meaningfulness leads to emptiness. Curiosity requires the attainment of goals and real-time accomplishments. Otherwise curiosity ceases and is replaced with apathy and malaise.

All of us need day-to-day meaningfulness to replenish and sustain our souls. A healthy sense of self thrives on it. The covid 19 virus has created an overwhelming challenge to life’s meaningfulness. Our pandemic world has led to anxiety, an overarching sense of helplessness, and problematic hypervigilance as we worry about getting infected. Covid 19 imposed social isolation has led to depression, hopelessness, helplessness and family stress.

How to cope with a world that none of us have control over? It is natural to experience anxiety in this scenario. Besides day-to-day meaningfulness, human beings have a need to be in control. The pandemic has brutally interfered with our belief that we have control. Social media, news outlets and politicians have contributed to our sense of helplessness by providing confusing messages and advice as we have tried to navigate this new world.

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Getting to Know Anxiety Book Cover

Getting to Know Anxiety

Without a doubt, today’s world is stressful. The end result is that anxiety and mood concerns are now common worldwide and the numbers are skyrocketing.

Written by two mental health experts with nearly eight decades of patient treatment between them, Getting to Know Anxiety describes the basics of anxiety and anxiety disorders in down-to-earth language. In it, Drs. Rosen and Gross offer readers an overview of today’s challenging mental health issues and the most current treatment methods available, as well as practical strategies for mental and emotional self-care.

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Coronavirus Anxiety In The New Normal

Life during the pandemic is slowly returning to a “new normal.” Here in Florida, we’ve reopened just about everything as long as certain rules are followed and masks and social distancing is used.

While many welcome these new freedoms, some people are either wary of going out or are finding their coronavirus anxiety levels are still too high to consider it. Although the prospect of reopening is both welcomed and scary, there are ways to help reduce your anxiety.

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If, And How, Does Covid Shift The Themes, Styles And Goals of Psychotherapy?

One of The Center’s founders, Andrew Rosen, Ph.D. was recently a guest on The Experts Speak, a free podcast series from The Florida Psychiatric Society, to discuss some of the changes, themes, and pivot points that telemedicine and the Covid crisis have produced, and how it may modify – or not — the styles and goals of psychotherapy.

Listen to the full podcast here.

Professional Help For Anxiety

We offer both virtual / online and in-office treatment options.

For more information, please contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 today. 

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back to school separation anxiety

Back To School Separation Anxiety During The Pandemic

As the 2020 – 2021 school year begins, many parents and children are experiencing a form of separation anxiety over sending kids back into the classroom during the pandemic. The beginning of the new school year can be threatening to a child during normal times, but the prospect of going into a situation where the coronavirus is likely to be present has raised anxiety levels in many families.

For parents who live in school districts that offer a choice between virtual or in-person learning, it can be overwhelming to make a decision over which is best for their child. Being safe at home means that kids who have special needs or who learn better in person will lose out on many learning opportunities, while children who are fearful of being in a classroom will struggle if they have to go back into the school.

All this stress can bring up separation anxiety and school refusal in kids, not to mention heightened school anxiety in parents.

Separation Anxiety And In-Person Schooling During Covid-19

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