Hot Under the Collar

8 Common Anxiety Symptoms and a Few Ways to Begin to Cool Off

By Rachael Bonaiuto, LPC

When you have anxiety, it’s easy to feel like others don’t understand what you’re going through. Anxiety itself can make you feel as though you’re suffering from symptoms, worries and concerns that are not only pronounced – they also feel inherent. Despite how personal this anxiety is to you, the truth is that anxiety is surprisingly common. I witness anxiety symptoms in most people I encounter on a daily basis – clients, students, friends, and family – in the store, at the bank, even at a red light.  Anxiety is uncomfortable at best, and can become paralyzing and defeating.  And it is common…. so incredibly common.

You are at home, preparing to go to a dinner party with work colleagues. You don’t want to go, you dread it, you think of reasons not to go, fantasize about your favorite elastic-waisted pants and the flavor ice cream that would accompany the movie night you’d rather have. You finally surrender to going, but begin to notice tightness in your chest.  As you stare, hot and bothered, at your closet of ‘not quite right’ clothes, your neck begins to hurt and the pain causes even more fear. You snap at your partner, who gently reminds you that you need to get going. You ignore the texts from co-workers asking you if you’ve left your house yet. You can barely breath and you are frozen.  You are experiencing anxiety and it is profoundly challenging.

So, what are some common symptoms of anxiety? Below are eight typical symptoms of anxiety and a few ways to manage this persistent condition.

  1. You feel constantly worried, tense and on edge
  2. You are plagued by fears that you know are irrational but just can’t shake
  3. You avoid situations/activities because they cause you nervousness & stress
  4. You have difficulty thinking, speaking, and following conversations
  5. You experience pain, stiffness, tension, pressure, soreness, or immobility
  6. Your body temperature increases or decreases without external reason
  7. You feel chest tremors, pounding heart, and/or labored breathing
  8. You don’t feel like yourself, detached from loved ones, emotionally numb

Many common anxiety symptoms show up in your body. You may first experience a knot in your stomach, and then you realize you are totally freaked out about an upcoming presentation. You feel a rapid heartbeat and tightness in your chest and later notice that you are completely anxious to drive in snowy weather.  Your jaw is clenched and your breath is constricted just before you unleash the pent up worry and resulting irritability toward your child.  If you can begin to notice the signals from your body that suggest you are anxious, you may find opportunity to take pause, check in, and navigate what you need in the moment.

Here are a few body-oriented tips for how to deal with anxiety:

1.     Pause:

  1. Find pause through breath. Inhale. Exhale. Feel your belly rise and fall. Notice the air come in through your nostrils and exit out your lips.
  2. Find pause through your senses. Pause to notice what you see. What do you hear and smell? Can you feel your clothes against your body? Experience your feet in your shoes, on the floor. Can you taste the salt on your lips or the flavor from your most recent meal?
  3. Find pause through movement. Go for a walk. Put on your favorite song and dance. Shake it out. Stretch your arms wide. Spread your legs and feel your feet rooted into the earth. Put your hands on your heart or give yourself a massage.

2.    Check In:

  1. Notice what is happening with your breath, senses, movements
  2. Notice, without judgment, what thoughts and feelings you have
  3. Simply observe what is happening in your inner landscape
  4. Scan your body for tension, tightness, fear, irritability, disorientation

3.    Take care:

  1. Ask yourself what you need? Remind yourself (or have someone else remind you) that it is okay to have needs.
  2. If you are having trouble accessing what you need, take another pause, a longer pause, lie on the earth and feel it beneath you.
  3. If you are in need of support, ask for help – from a friend, a loved one or a professional.

Anxiety can negatively impact your quality of life – the way you show up for others and for yourself. Knowing the common symptoms of anxiety can help you recognize when you or a loved one is experiencing unease. When you realize you feel anxious, it can be so valuable to pause, check in and take care of yourself in the moment. Building a deeper understanding of the symptoms and an awareness of what is happening in your body can provide access to your available resources through breath, sensation and movement. When you have access to your internal resources, you can also appreciate more deeply when you need additional support and when you are able to navigate your internal terrain on your own. This self-awareness provides empowerment, freedom and a deeper sense of compassion for self and other. Most importantly, if you are experiencing significant anxiety, seek professional help. Psychotherapy can be very effective in providing relief from the debilitating symptoms of anxiety.

Grief and Loss in Parenting

By Miki Fire, Psy.D.
Clinical Psychologist

As a relatively new parent, I have spent a lot of time reflecting on the experience of this new role. Like many of you, my experience in parenting has come with some unbelievable moments of joy; the feeling of holding your baby for the first time, of seeing your baby laugh or smile at you, watching as your baby begins to crawl and then stand and eventually walk and run. Of course, there are all the challenges as well; trying to soothe a colicky baby, endless hours of rocking and bouncing and shooshing your little one to sleep (not to mention your own sleep deprivation), or trying to communicate to a toddler that he needs to have patience and wait a few seconds before you can give him that toy he’s reaching for. Alongside these there might also be myriad challenges in parenting alongside your partner who may have his or her own different ideas of what’s best.

Most of what we are exposed to—in the popular media, in our pediatrician’s office, in the conversations at the playground and even at most new parent support groups—are these kinds of ups and downs.

What we hear much less about, if ever, is a much more subtle experience, yet one that is absolutely felt, and that is the grief and sense of loss that is also associated with parenting. Especially in the early years of being a parent, the feelings of sadness and outright grief and mourning can be quite intense, yet are rarely discussed. Because we don’t often talk about this grief, we sometimes wonder if it’s normal, we may pathologize it, push it away, or simply keep it to ourselves

Have you ever noticed, as a parent, how painful the experience can be? How much that sense of love for your child also brings with it a sense of sometimes overwhelming heartache? How in each moment, even if that moment has been unbelievably trying, there is sometimes a surprising sense of nostalgia for that same experience once it has passed?

Why is there such a sense of grief and loss in parenting?

I think that the first days and weeks and months of parenting can be so new and, for many of us challenging, that we tend to feel primarily the relief and joy with each new development. “Ah, she is finally sleeping five hours straight! She doesn’t need to be burped every time she eats! I can put her down for a few minutes and make myself a cup of tea without her fussing!” But what we don’t always feel as strongly, at least not on the surface, is the ending that comes with each new moment, each achievement.

Not one instant can be held on to. Not one day is the same. The minute a new milestone is achieved whatever preceded it is gone, simply folded into the next movement. Your baby’s balancing on two knees becomes a crawl, then a crouch, which becomes an unbalanced stand, a first step, a walk, a run. Even with language, those little gurgles and raspberries which become babbling and eventually actual words. Once you have a child that has mastered the art of language, it might be hard to imagine that you lived with an essentially non-verbal being for a couple of years! Whatever the development, each new movement echoes some past experience, but we never go back, ever. Our tendency is often to focus on the new step our baby has taken, but we don’t necessarily say goodbye to the previous stage that has now been mastered.

Of course there will be more firsts. In fact, all there ever will be are firsts. But every first is also a last. As parents we often joke about how once you have finally mastered some aspect of your child’s development she is on to the next milestone, leaving you to have to figure out a whole new set of tricks. There is joy and relief in moving onto what is new, but there is also a sense of ineffable loss for whatever phase has now come to an end.

If we really think about this experience for a moment, we can begin to touch on the poignancy of this ongoing experience. In a way, being a parent is to witness what it truly means to be alive, as a human being. To know that each day, each moment, each breath, comes and then goes. Parenting, in this way, gives us a very palpable sense of impermanence.

And of course this reflection of impermanence so perfectly revealed in our children is true for everything. As adults we tend to not see the subtle changes that are happening; maybe because they appear so much less dramatic they are missed, easily overlooked, or even denied. Changes tend to blend into one another affording us the illusion that things are essentially the same. It may not be until we are much older, or witnessing the aging process in our own parents, that we have a palpable sense of the passing of time. But it is simply impossible to not see how quickly everything ends when you are in the presence of your child.

And for many people, this constant experience of endings brings with it a feeling of deep heartache. People may have warned you about many of the other challenges of becoming a parent, but rarely do people warn you of the bittersweetness that comes as each day comes to an end and your child is one day older. Yes, there is a deep sigh at the end of a long day, after all the toys have been cleaned up and you can finally sink into the couch with a good book. But for some people there is also a sense of loss. This feeling may be experienced as a sense of depression even. It may be felt as a general fatigue or apathy. Maybe a tearfulness that you cannot explain, or even a feeling of agitation or irritation. We sometimes talk about post-partum depression or “baby blues,” but we rarely acknowledge that these feelings of malaise may actually be normal and appropriate grief for this new experience.

Because in addition to the sense of loss that can come with watching your child change so rapidly is also a very reasonable experience of mourning that may come with the huge transition you are experiencing as a parent. There may be a sense of loss for the person you felt you were before you had children, or the relationship you and your partner had that was just the two of you. If you already have children there may be a feeling of sadness and loss that you no longer can spend all of your parenting time with your other child or children, that this energy is now shared.

We are generally told that we should be happy and grateful to bring children into the world. But rarely are we told that it is okay to also feel pain for the life we have left behind. And this life is truly behind us, even when our children are older and we can work more, spend more time with our friends and alone, it will never be the same.

A part of you may wonder, what can I do about all of this? What should I do about all of this?

Grief is an experience that many people attempt to bypass because it can often be so painful. But my clinical experience has repeatedly shown me that grief is an incredibly important experience that, if possible, is best travelled through, not around. Especially for anyone who has experienced bouts of depression or anxiety that have not lifted easily, there may be a fear that if you turn towards the feelings of sadness and loss, they may just get bigger and more stuck. When you first turn towards your grief, it may feel like it does get bigger, more poignant, or more painful. This is normal. If it is too much to be with, then let yourself turn away towards something else. But notice when you are intentionally avoiding feelings of grief. Even just this noticing is a subtle acknowledgment of the grief that might be there. Here are a few suggestions for how to be with your grief.

  1. Begin my simply acknowledging that all of the feelings you are having as a parent are completely normal. Give them permission to be here.
  2. When you notice a difficult emotion, like sadness or some pain, just let yourself acknowledge it is there. You don’t have to do anything more. In fact, with the busyiness of parenting, you may not have space to really do more than this.
  3. Find a time in the day when you can turn more fully towards whatever feelings have been coming up. Maybe this is while your child is napping, at school, or in bed for the night. During this time, just give your whole body and mind permission to feel whatever feelings may be there and have been there. Even this is enough. You don’t have to do anything with the feelings, just feel.
  4. If it is hard to just stay with your feelings in an unguided way, here are some suggestions for ways to turn towards, and acknowledge your grief: Use a journal and let yourself write openly about your grief, paint, draw, or engage in any other art form on the theme of grief, set aside 10 minutes to simply sit quietly and invite your feelings to be with you. Just by setting an intention to be present with your feelings, any activity has the potential to be a practice in more fully processing your grief.
  5. Talk with someone. A friend, your partner, a therapist. Naming your feelings can be one of the more powerful ways of working with grief. When we put words to our inner experiences it often leads to a shift in the experience itself and a deeper sense of meaning.

In essence, my suggestion is, take it all in, let whatever feelings you might have in this process be here in their complete fullness. And know that, even whatever you are feeling now will not be with you forever. Grief (unlike some clinical depressions) does have a way of moving and changing. The grief you may feel as a parent will inevitably shift as your child changes.

And remember, really being honest about these feelings and letting yourself really feel is an extraordinary gift, not only for yourself, but also for your child. You are teaching him or her that emotions, even difficult ones, are okay, survivable, and can even serve as doorways to something new.


Sandy Hook Elementary: Our Shared Trauma

By Dr. Jan Hittelman

Hearing about the unimaginable tragedy at Sandy Hook and the profound impact that it has had on all of us, reminded me of another national calamity during my childhood; the assassination of President John F. Kennedy. While I was only seven years-old at that time, I vividly recall how this tragic news stunned everyone and life seemed to stop for a moment while we all grappled with comprehending the enormity of this tragedy and sense of loss that befell us, not just in our country but around the world. Given my young age, I couldn’t completely understand what had occurred; let alone how to deal with it emotionally. All I knew was that my mother and grandmother watched in tears as the news unfolded on television. In some ways, I never fully recovered from that moment of trauma and shock, even after all these years. Unlike that historic event, this time most of the victims were young children. These young victims were about as old as I was when JFK was shot. What makes it much more personal for both children and their parents, is that we cannot help but think: what if that was my school? What if it was my child? Like the JFK assassination, we have all experienced a profound trauma that will take time to heal. As parents, what can we do to help our children, as well as ourselves, to move on from this and begin to heal?

Regardless of what we may say or do, events like this require time to allow us to heal, so first and foremost we must be patient. While we slowly recover, it is important to refocus on our parental priorities; to verbalize and demonstrate our love for our children, while treasuring and cherishing precious moments with those we love. Too often we take our greatest gifts for granted, and tragedies like these remind us to refocus on what’s really important.

As parents, teachers, and community members, we must do our best to reassure our children, letting them know that events like these are extremely rare and therefore we need not fear that something like this will happen to us. It also critical that we provide our children with opportunities to freely express their feelings and provide them with support, acknowledging that we would likely feel the same way and that there are a lot of caring adults in their life who are here to support and protect them. It is also a lesson for all of us, to not take what we have for granted and make the most of this lifetime we are so fortunate to have. This is a time to revel in positive family activities to allow us to reaffirm how much we are blessed and our love for each other.

We cannot undo what happened but we can do our best to wrap our arms around our children as a community and hopefully as a society, to get serious about reducing gun violence, increase mental health awareness, and to make resources accessible for those in need.

Combating Victimization

By Jan Hittelman

Being victimized is a traumatic experience that for some remains a challenge for the rest of their lives. It can also be a lifelong struggle for their friends and family. On a recent trip to Europe with my own family I was reminded of this as we were the victims of theft on multiple occasions. While it was very frustrating to have our money, credit cards and passport stolen, we were fortunate that none of us were physically harmed. We were very emotionally impacted and embittered by our experiences. It will certainly take us a while to fully recover from feelings of being violated and a nagging sense of helplessness that we didn’t do more to possibly prevent it. As we experienced, it is very common for victims to blame themselves and in hindsight consider a variety of things that they should have done differently. There is also a shift of looking at people more critically, being less trustful of others and being more suspicious. But our situation wasn’t really that catastrophic; passports, credit cards, and money are replaceable. For those who are the victims of more serious acts of violence and/or abuse the healing process can be far more challenging.

There are several steps one can take to help in the healing process, these include:
• Talk about it with someone you trust. This can be a friend or family member, or coworker. Keeping these feelings buried always results in additional problems like social withdrawal, depression and anxiety.
• Give it some time. Time doesn’t heal all wounds but can certainly help.
• Resist blaming yourself. Bad things happen and it is the fault of the perpetrator, not your own.
• Learn to trust again. While some people do horrible things, most people have good intentions and are trustworthy. Try not to generalize feelings to those who are deserving of your trust.
• Seek professional help when necessary. If problems persist, particularly with recurrent disturbing memories of the incident, consider seeing a counselor with expertise in treating trauma. There are a variety of techniques (e.g. EMDR, Brain Spotting) that are research proven and effective in addressing these issues.

There are also funds available through the justice system to provide victim assistance to help pay for counseling and other needs for crime victims.

As with physical injuries, we need time to heal from these traumatic events. With the right response, we can work towards recovering from these experiences so that they don’t continue to victimize us further.

Starting with a Good Assessment

By Jan Hittelman

Last month’s column on teen depression highlighted the importance of a good assessment. Several readers questioned exactly what an assessment is, let alone a good one.

You may be surprised to know that even within the mental health field there are a range of definitions regarding a psychological assessment. It is even more surprising that many mental health professionals are not extensively trained in conducting an increase the likelihood of a good fit, BPS offers an online therapist directory. The purpose of the assessment is to clarify the nature of the treatment issues to be addressed.

What is a psychological assessment? First of all it is different than a formal “psychological evaluation”, where standardized psychometric tests are administered (i.e. intelligence, academic, personality, and perceptual tests). Depending on the results of the assessment, a more in-depth psychological evaluation may be recommended. A psychological assessment typically includes several components:

• A detailed history (often from the parent if the client is a minor) that usually includes information on birth, educational, social, familial, and emotional experiences of the referred client.
• A one-on-one interview between the therapist and the client where additional detailed information is collected. This is sometimes referred to as a “Clinical Interview.”
• An opportunity to build a relationship with and empower the client, allowing him or her to be a partner in developing the treatment plan.
• An additional discussion with family members, which may include the client.
• Providing specific diagnoses and recommendations to the client (and/or parent) as a result of the information obtained.

Why is a psychological assessment so important? The assessment is a critical component in helping to develop a thoughtful treatment plan for the client that addresses their underlying social/emotional/behavioral issues. This is of particular importance when the client is a child or adolescent, because, unlike an adult, it may be unclear what the underlying issues really are. An example of why an assessment is critical is teen depression, as it is often misdiagnosed because it can look like anger or irritability. Another common misstep for a client that is a child or adolescent, which can be avoided through an assessment, is providing individual therapy when in fact family therapy may be what is needed. As you can imagine, there are many other examples of issues that are missed without a thorough increase the likelihood of a good fit, BPS offers an online therapist directory. The goal of the assessment is to better understand the initial concerns before investing a lot of time and money in treating the symptoms rather than the underlying problem(s). While there may be an additional cost in obtaining the increase the likelihood of a good fit, BPS offers an online therapist directory, it is well worth the investment and may reduce the overall costs by addressing the correct underlying issue.

What are the Right Questions to Ask? When considering psychological counseling, there are several questions that should be asked: Are you licensed? Do you have extensive experience working with someone this age and who presents these kinds of concerns? And perhaps of equal importance; what is your assessment process and what does it include? Doing a good job as a consumer will increase the odds that therapists will successfully do theirs.

PTSD / Trauma Counseling for Seniors

Have Traumatic Events In Your Life Left You Feeling Overwhelmed?

Have traumatic events in your life left you feeling vulnerable? Is your trauma compounded by anxiety and worries about everyday concerns such as health and finances? Do you feel as if you are losing your independence? Is stress taking its toll physically as well as emotionally? Do you become overwhelmed or flustered even when performing simple tasks? Are there now fewer people in your life with whom to share these burdens? Do the resulting transitions and adjustments to your life seem especially daunting?

Trauma is an emotional response to serious events in life, and as you age trauma caused by physical changes and health maintenance experiences should also be taken into account. Encountered in later life, trauma can seem particularly difficult to deal with, as are on-going symptoms of anxiety, depression, panic, and anger, which can be signs of Post Traumatic Stress Disorder (PTSD). Decreased mobility and chronic illness that sometimes accompany aging can add to your sense of helplessness. Your panic, fear, inability to concentrate, sense of powerlessness, or other anxieties due to trauma can be so disruptive that they can also affect your physical health. Post Traumatic Stress Disorder, the high-level anxiety caused by a past event along with its symptoms can occur without warning. It is important for you to know that reliving traumatic events through anxiety-producing episodes is not a normal part of the aging process. Preventative treatment and stress management techniques have been proven effective and can help you.

Trauma And PTSD Are Treatable

Your reactions, no matter how disconnected you feel right now due to trauma and stress, are normal. What is unique is your individual experience. Trauma and PTSD stem from a wide variety of causes and take many forms, from violent events to emotionally debilitating experiences. Identifying and dealing with present and past trauma, and receiving support in processing these events is important. But whatever your case may be, both trauma and PTSD are treatable. With the help of the right therapist you can begin to develop, at your own pace, the mechanisms needed to heal. If you believe you are suffering from the results of a traumatic experience it is possible to change the way you feel and learn how to manage your emotions for a healthier and happier life.

Therapy Can Help

Therapy can help you. A good therapist can work with you to help define what’s needed. Through effective communication, you can strengthen your coping skills and learn to better manage emotional challenges with someone who has the expertise, knowledge, and resources to help guide you. Therapy can create a safe, supportive environment in which to explore your experiences and emotions and discover the best manner in which to regain control over your own emotional life and wellbeing.

While dealing with PTSD and trauma can take time, and the process is highly individual, your BPS therapist can help you every step of the way. With a focus on your strengths and abilities, the right therapist can partner with you to accompany you on your journey. BPS therapists understand how the practicalities of life become inextricably interwoven with larger issues, and how management and coping day-to-day become causes for concern. A BPS therapist will listen, support, and work with you, as you begin to experience and rediscover a full and balanced life.

But, you still may have some questions or fears…

I recently fell and injured myself. I am often worried about losing my balance and hurting myself. Sometimes I feel very vulnerable and I am afraid of leaving the house and going out. 

You are not alone. Most of us underestimate the impact of aging, physically as well as mentally. This is normal, but what is not the norm is the isolation you may be experiencing. Things have all of a sudden changed, and just as you have done throughout your life, you need to develop the skills to make the transition in a healthy and meaningful way. As well as dealing with the emotional impact of current or past trauma, along with the additional stress brought on by the aging process a therapist can help you in many ways. The arrangements and prioritization of tasks and goals become more important at this stage of your life. What used to seem like matter-of-fact issues and events now take on a new significance. In negotiating this terrain, a well-qualified therapist can be one of your most valuable assets as you plan your strategy and begin to move ahead. A therapist can assist you and help guide you in making choices to fit your individual needs.

I’m up all night worrying. When I turn out the light my mind begins to race. It’s usually about health and money concerns at first, but then shortly after I become anxious about many other things that make it difficult to sleep.  

These are some of the most common issues that seniors deal with. It is important that you share these feelings with someone who understands their root causes. As simple as this sounds it is a necessary part of the process: being able to discuss your needs openly, ask and accept assistance, and rekindle life-management skills that will help you feel more involved and in control of your decisions. Trauma and symptoms of PTSD often reoccur when triggered by seemingly unrelated events. That’s why it is important to share your experiences and deal with the practicalities of life as you sit down to spend time with your therapist.

I’ve recently relocated to be near my children and grandchildren and now I feel more dependant than ever. I’m already asking people to do things for me too much of the time.

Leaving surroundings that are familiar and beginning all over again at this point in life can be difficult enough; added to the trauma you may already be dealing with, and the tasks you face may seem insurmountable. This is a time when additional support can help you. It is important to process your wants and needs in a secure and non-judgmental environment, and be able to explore what’s available to you, personally, institutionally, or through the community. A BPS therapist can assist you in harnessing a system of supports through a sense of self-empowerment to make better and more informed choices tailored to your specific needs.

To increase the likelihood of a good fit, BPS offers an online therapist directory which will help you to determine what your specific issues are and to ensure a good match between you and a BPS therapist in terms of personality, style and expertise.

Check out our free, online therapist directory, which will match you with a therapist who has expertise working with issues of grief and loss.