How Can You Tell if Someone You Love is Suicidal?

As a mental health professional, it is not uncommon for people to ask me this question.  Given the recent, very public news of the suicide deaths of Kate Spade and Anthony Bourdain, this question seems to be at the forefront of many peoples’ minds.  Hearing family and friends of a suicide victim talk about being completely shocked by the suicidal act is a scary reminder that it is hard to detect suicidal ideation.  You might think that those loved ones that are closest to a person suffering from depression might easily recognize the warning signs, but that’s not always the case. The truth is that while there are typically warning signs, they do not always take the form that we expect. 

Certainly, things like the loss of interest in activities, an increase or decrease in sleep or food intake, withdrawal from social support, lack of basic self-care, and extreme sadness or hopelessness are often present in suicidal individuals.  However, other warning signs could include increases in substance use, uncharacteristic irritation and anger, reckless behavior or a noticeable peace and happiness after a long bout of turmoil.  While the signs are not always easy to spot, you should pay attention to any large marked shifts in mood.  Verbalized feelings of helplessness and hopelessness or feelings that the individual is damaged and will never recover should also raise red flags.  In addition, the giving away of prized possessions or a reconnection with a lot of important people from the past, as if to resolve relationships, are major indicators of suicidal ideation.

So what should you do if you suspect that someone you love may be suicidal?  Some people say that talking to someone about suicide “puts the idea in their head”.  That’s a myth.  My advice is to be direct and ask your loved one if they are thinking of committing suicide.  Express your concern and your sincere desire to help.  Approach the conversation with as much empathy as possible, even if you do not understand the desire to end their life.  A person who you suspect of being suicidal should not be left alone.  If you cannot stay with them, try to arrange for someone else to stay with them.  You cannot assist a suicidal loved one alone.  Seek professional help to get them through this crisis.  The National Suicide Prevention Lifeline is 1-800-273-8255 (TALK).  They have the resources and suggestions to help your loved one and you in an immediate crisis.  It is always better to call for help and potentially anger your loved one than to do nothing and potentially lose them forever.



Techniques to Battle Anxiety

I find myself talking about anxiety nearly daily both in my personal and professional life.  Everyone seems to have some form of it impacting their lives.  While I could talk for a very long time about what I think the underlying societal causes are, the thing that people are most interested in is how to manage their worrying.  I do not believe that there in a “one size fits all” solution to the problem.  Anxiety is a sneaky foe that takes many forms and often, when one trigger is neutralized, another emerges.  Therefore, I believe it is important to be confident that you have a toolbox full of techniques for managing your anxiety that will allow you to find relief in any situation or circumstance.  Some of the reliable tools that you should always be aware of are physical elements I have discussed at length in previous blogs: proper sleep, nutrition and exercise.  However, there are plenty of mental tools that you can use as well. 

One such technique is worry restriction.  Anxious feelings often associate themselves with particular experiences or places.  Did you know that you can actually cause insomnia by creating an association between your bed and your anxiety?  While this can be extremely frustrating to many people, causing them to have extreme anxiety about certain places or things, you can also use this association to your advantage when your worry is getting out of control.   Pick a place that is easy to access where you are not needed to perform any other tasks and make it your worry spot.  In order to make the association you may need to be able to go to this place often at first.  Set a timer and place yourself there at regular intervals.  While there you can let your worry happen unchecked.  Allow yourself to cry, stress, and, to the extent possible, come up with a plan for managing future projected worries.  When you leave your worry spot, tell yourself that you are leaving the worries there and can come back to them later. 

The second stage of the plan once you have established a strong association between your anxieties and your worry place is to create a predetermined worry time.  For example, perhaps you would like to allow yourself two “worry sessions” a day in your worry spot and limit them to fifteen minutes each.   As your association with worrying in this place grows, you can extend the time period in between “worry sessions”.  If a concern comes up in between these sessions keep a list to take to your worry spot.  For some people, worrying right after lunch will give them time to come up with a plan for a challenging project you were trying to tackle in the afternoon at work.  For others, worrying at night before they start their bedtime routine will allow them to put the anxiety away and sleep restfully.  Be thoughtful about what time of the day you will have regular access to your space and when it will most benefit you to have this type of contained anxiety.  Many people have used this method with great success to navigate stressful work or personal situations or to help improve sleep. 

It may be a good idea as you go along building your mastery of this type of restriction to also use your worry place as a testing ground for new stress management techniques.  For instance, you could use this time to practice worry journaling, mindfulness, Socratic questioning or thought replacement techniques in a quiet and safe environment.  The good news about worry restriction techniques is that they allow you to regain a sense of control over feelings that often feel out of control and help you create limits on unhealthy habits that have a tendency to increase over time if left unchecked.  You may even find yourself reaching a point where you can skip a session at your worry spot because you have gained an ability to manage your anxiety without it!  If anxiety is impacting your life, don’t just wait, take action to regain control over these feelings. 




Anti-Bullying Programs: Are They Effective?

I was recently reading an article that discussed Melania Trump’s recent speech regarding her “Be Best” platform.  One of the three main facets of this program included today’s hot button topic of bullying.  Anti-bullying programs seem to be popping up in every school in the last decade as more and more attention is being drawn to the increasing problem of social media’s impact on bullying.  While there is no denying the negative impact social media has had on the bullying epidemic, I often have to wonder about the efficacy of some of the programs that have been designed to “defeat” bullying in schools.

One such program is Christian Buck’s Buddy Bench, to which Mrs. Trump gave a nod in her speech.  For those of you that don’t know, a Buddy Bench is simply a bench placed strategically on the playground.  The idea behind it is that kids who are lonely at recess can sit on it and other children will ask them to participate in games and activities with their group of friends.  I can certainly see how this bench could be a valuable tool for kids that are new to the school and have not had the opportunity to make friends, which is why it came to Christian’s attention in the first place.  However, it seems highly unlikely to me that students who are predisposed to shyness are going to put themselves out there to be rejected just because a bench exists for that purpose.  And even if they did, how is this teaching them the skills they will need later in life to make friends and assert themselves when there isn’t a Buddy Bench to assist?  As adults it seems unlikely that the water cooler clique will be looking around to see who is sitting alone and inviting them to join the office lottery pool. 

The even bigger issue with the Buddy Bench, in practice, is whether the use of the bench negatively impacts the peers of the children who are more likely to sit on the Buddy Bench.  Let me explain.  If, as discussed above, the shy children are less likely to put themselves in the spotlight by sitting on the bench, who is comfortable doing so?  Often, the answer is children that might have previously exhibited aggressive and bullying behavior, which behavior has alienated their classmates.  When this is coupled with the fact that the kids encouraged to engage with children sitting on the Buddy Bench are often those children predisposed to be sensitive and kind to others, the use of the bench can perpetuate, rather than alleviate, bullying by pairing sensitive children back up with their bullies.   What is the take away message for these children?  It doesn’t matter how someone treats you, you still have to be nice to them.  Worse yet, the take away message for the aggressive child is that it doesn’t matter how you treat others, they still have to play with you.  I am not really sure those are messages I would like to be reinforcing.

While I am obviously not a huge fan of the Buddy Bench, I do really like the programs that work to create kindness by exposing children to service projects that connect them to other populations within their community.  Exposing these children to the reality that we are all people, and helping them learn more about philanthropy and cultural groups to which they wouldn’t normally be exposed, will be much more likely to develop kinder and more thoughtful individuals.  I also love the education programs going into teaching kids ways to be “upstanders”.  It is never a bad idea to teach kids how to assert themselves and stand up for what is right. The message that a group can be just as powerful toward the positive end of bullying as it can be in perpetuating the bullying is a message I want my own kids to hear loud and clear. 

What I would really like to see is parent education about helping your child be more assertive and building self-esteem.  Staff education for teachers about how to identify kids who are being bullied and how to handle potential bullying situations would also be nice.  However, nothing will beat having more qualified mental health providers in the school assessing for potential victims and working with them to build up their assertiveness and confidence.  The truth is that kids are cruel and they are likely to continue being so.  Technology removes the discomfort of seeing the effects of the pain you inflict, which is emboldening kids who otherwise might never bully.  Programs must be aimed at helping victims become less likely to be victimized and educating parents to become more involved and aware.  Finally, the adults of our society could do a lot of work modeling common courtesy.  I have been dismayed to see that as our efforts to create kinder children have increased, we have also become a far less courteous society overall.  What message is that sending to the watchful eyes of our children, I wonder?




Are You Suffering From Insomnia?

In the past, I have talked about matters of sleep hygiene or ways that you can create the best possible chance of getting quality sleep.  However, none of this is particularly helpful in curing true insomnia and the number of sufferers is increasing.  So how can you tell if you might have insomnia?  The first step is always to rule out any underlying medical issues.  Fatigue may be a symptom of many medical problems and should always be addressed with your medical doctor. 

Additionally, there are diagnosable sleep disorders that can wreak havoc on your daily life.  Normally the way to determine whether you have insomnia or a sleep disorder is to consider two factors: your risk factors and the type of symptoms that are occurring.  Risk factors include a tendency to snore, high blood pressure, aged over 50, male gender, body mass index over 35, neck circumference larger than 17 inches (16 inches for women), and whether anyone has observed you stop breathing while sleeping before.  Symptomology is trickier to determine.  The main difference between insomnia and a sleep disorder is that those with insomnia express feeling tired and fatigued while those with a sleep disorder actually doze or fall asleep during the day.  If you suspect a sleep disorder you should seek professional assistance as soon as possible. 

Yet, if you have insomnia, there are many things you can do to work on the problem on your own.  There are two biological factors that work in tandem to help you have quality sleep.  One of those is sleep drive.  The more you are awake and active, the more sleep drive you build up throughout the day.  If you are waking up frequently, or too early in the morning, perhaps you are not accruing enough sleep drive throughout the day.  The answer may be as simple and easy as increasing the amount of hours you are awake or the amount of time you are spending active during the day. 

The other biological system at play is circadian rhythm.  This is the system in your body that notices when light starts to ebb and makes you sleepy.  It is easy for a body’s circadian rhythms to get out of sync when sleep and wake times aren’t consistent throughout the week.  Keeping a sleep diary can be a huge help to determine whether or not you have insomnia and what the underlying causes might be.  While there are many available templates for a sleep diary, the information should at least include what time you get into bed, what time you try to fall asleep, what time you actually fall asleep, how many times you were up and for how long total, what time you wake up for the day, what time you get out of bed, and how you would rate the quality of your sleep.  In order for this information to be useful, it is important to keep track of it for a period of at least a week.  Sleep diaries often help you determine bad habits that may be affecting your sleep and what is the best thing for you to change to improve the quality of your sleep. 

You may notice that you spend a lot of time in bed, but very little of it is time that you are sleeping.  A lot of people have the mistaken idea that every adult requires eight hours of sleep.  This is not always the case.  You may be waking up or not sleeping as well because you are spending too much time in bed.  In that case, you could try restricting the amount of time you are in your bed.  For instance, if you are noticing that you are only sleeping five hours a night, you would wait until you are sleepy to go to bed and allow yourself five and a half hours in bed before your desired wake up time.  Then as you start to see yourself sleeping the full time you are in bed you can increase the amount of hours you are in bed by a half an hour every few weeks until you begin to feel rested.  Note, however, that it is never safe to restrict your time in bed to lower than five and a half hours even if you are actually sleeping less than that.

Another problem you may encounter is that your sleep and wake up times may differ depending on the day.  In that case, you may have to work to try and pick a middle ground sleep and wake up time that would work for the full week.  Once you implement this it is important that you try not to go more than half an hour off of the times you have set for yourself if you truly want to see improvement. 

A final problem that is often encountered is that you may have developed worry about sleep that has caused your body to develop a negative association with your bed.  This may occur in people who have a tendency to be anxious and find themselves stressing while lying awake at night in bed.  A good indicator that this is your problem is that you may be falling asleep on your sofa watching TV but as soon as you are in bed you are wide awake.  The best way to deal with this is to create a “nest”.  The idea is to remove your mind’s negative association with your bed.  So when you cannot sleep, don’t just lay there tossing and turning.  Get up and go to a quiet and calming place.  Engage in a restful activity such as meditation, reading, knitting or even watching non-stimulating TV.  Once you feel sleepy, head back to bed.  Initially this may require you to go to your nest often, sometimes even more than once a night.  However, soon the nest becomes the place that you associate with wakefulness and worry instead of your bed and you will find yourself reclaiming quality sleep.

A combination of the techniques I have suggested may be necessary to solve your insomnia issues.  Also, the problem often feels worse before it gets better.  The first few weeks of change are the hardest, but if you stick with it the results of quality sleep will be well worth the time.  If you want more information about any of these ideas I highly suggest purchasing the book Quiet Your Mind and Get to Sleep by Colleen Carney and Rachel Manber.  Finally, if you notice your insomnia getting worse or have concerns about your ability to stick to any of these techniques, consult a professional and get the help you need.


How Can You Maintain A Relationship When You Are Starting a Family?

A lot of couples find that their relationship undergoes a drastic change immediately following the birth of a child.  There is often a misconception that having a child will bring a couple closer together.  However, the opposite is more likely.  While having a joint love and interest can allow you to see wonderful qualities in your significant other shine, it can also create new hurdles that previously didn’t exist or just seemed like minor annoyances.

The first facet of the relationship that is likely to be affected is sexual intimacy.  A lot of women remark that changes in their bodies make them self-conscious even before the baby has arrived.  Then, post baby, there is a period of time where healing takes precedence.  A lot of men tend to take cues from their significant other regarding the availability of intimacy so there is a tendency for a long period of time to elapse before normal physical intimacy patterns are restored.  While all of this is normal and transpires in most relationships, for some it is hard to get back to sexual desire once so much time has gone by.  Sleepless nights and physical exhaustion exacerbate the problem. 

Even though having a child is a wonderful experience, it is also a stressful one.  Like any major life transition, it requires a lot of adaptation, which can be very difficult for some.  Add in the demands of a baby and sleep deprivation and it is often a recipe for a lot of irritation, argument, and resentment.  Additionally, there is the whole new world of parenting decision making that may cause a couple to butt heads.  Communication patterns that may have been healthy previously may devolve and bad habits may develop that will be hard to break when things settle into a routine.

Furthermore, it is easy for a child to become the center of your focus.  This is especially true because each new experience causes a shared excitement.  The problem is that a child can become the only thing you talk to your significant other about, leaving no room for focus on other aspects of your relationship together.  Once you begin to disagree about parenting decisions, it becomes hard to see your significant other as more than an adversary when parenting is your biggest or only current connection.

Therefore, the question becomes, what are some easy things that you can do to keep your relationship healthy and strong during this period in your life and going forward?  First, I suggest a “Babymoon”.  Before the baby arrives take some time to be together.  For some people that involves a trip but it can also just involve a staycation where you are unplugged from everything but each other.  Talk openly about fears, concerns, and things that are important to you with regards to parenting.  Try to maintain some physical intimacy even if sex is out of the question and definitely keep a conversation about it going.  Make eye contact and touch each other lovingly a lot.  Foot massages and other forms of loving physical contact help maintain your connectivity.


Once the baby arrives, you may have your hands full, but make standing dates where you spend quality time together and don’t talk about the baby.  A candlelight dinner while the baby sleeps or a picnic lunch in front of the fireplace can be great ways to show each other that you are making your relationship a priority even if you don’t have reliable trusted childcare or money for outings.  While occasionally the baby may make keeping your appointments with each other impossible, it is important that nothing else short of a serious emergency get in the way of this time.  Remember, this is also a time where both of you will be sensitive to criticism and unsure of your abilities to be good parents, so praise each other often. 

It is easy to take for granted that your strong relationship with your significant other will still be strong when you adjust to this new journey on which you are embarking.  However, resentment is likely to build when your significant other feels that they are being taken for granted.  Keep communication flowing and find little ways to let your partner know that they are still a priority in your life. This small time investment now will pay off in a big way in the future when you are sharing the triumphs of parenting together as a team.