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Understanding the Connection Between Emotional Dysregulation and Anxiety Emotional dysregulation and anxiety often go hand in hand, making it difficult to manage stress, cope with uncertainty, and maintain a sense of calm. Emotional dysregulation refers to difficulty controlling emotional responses, leading to heightened reactivity, mood instability, and overwhelming feelings. When combined with anxiety, these symptoms can feel even more intense, often resulting in avoidance behaviors, panic attacks, and persistent worry. Many individuals who experience generalized anxiety disorder (GAD), panic disorder, social anxiety, or obsessive-compulsive disorder (OCD) also struggle with emotional regulation. Understanding this connection and learning strategies to manage it can help improve emotional well-being. How Emotional Dysregulation Fuels Anxiety The relationship between emotional dysregulation and anxiety is complex, but some common patterns include: Heightened Sensitivity to Stress: Situations may feel more stressful than they actually are, leading to excessive worry and overthinking. Intense Emotional Responses: Anxiety can amplify emotional reactions, making them harder to manage and leading to cycles of distress. Avoidance Behaviors: Fear of emotional overwhelm can cause avoidance of certain situations, reinforcing anxious thoughts and fears. Negative Thought Patterns: It can be easy to get stuck in loops of worry and fear, increasing overall anxiety levels. Difficulty Recovering from Stressful Events: A minor stressor may trigger prolonged distress, making it harder to regain emotional balance. Practical Strategies to Improve Emotional Regulation and Reduce Anxiety The good news is that emotional regulation skills can be learned and strengthened over time. Here are some effective techniques: 1. Mindfulness and Grounding Techniques Practicing mindfulness can help create space between emotions and reactions. Techniques such as: Deep breathing exercises (e.g., box breathing, diaphragmatic breathing) Progressive muscle relaxation (PMR) Grounding exercises (e.g., 5-4-3-2-1 sensory method) These approaches help anchor individuals in the present moment and reduce anxiety-driven emotional dysregulation. 2. Cognitive Restructuring and Thought Challenging Cognitive Behavioral Therapy (CBT) techniques, such as thought challenging and cognitive reframing, help identify irrational or exaggerated worries and replace them with more balanced perspectives. Recognizing cognitive distortions can reduce anxiety’s hold over emotions. 3. Emotional Labeling and Journaling Writing down thoughts and emotions can provide clarity and reduce emotional intensity. Journaling helps to: Identify emotional triggers Recognize patterns of anxiety and dysregulation Develop healthier ways to express emotions 4. Dialectical Behavior Therapy (DBT) Skills DBT includes distress tolerance, emotional regulation, and interpersonal effectiveness techniques. Strategies such as: Self-soothing activities (e.g., listening to music, taking a warm bath) Radical acceptance (acknowledging emotions without judgment) Wise mind decision-making (balancing logic and emotions) can improve emotional resilience. 5. Building a Healthy Lifestyle Lifestyle factors play a significant role in emotional regulation and anxiety management. Consider implementing: Regular exercise to release pent-up stress A well-balanced diet to support brain function Adequate sleep to improve emotional resilience Consistent routines to foster a sense of stability When to Seek Professional Help While self-help strategies are effective, some individuals may need additional support. If emotional dysregulation and anxiety significantly impact daily life, therapy can provide guidance. Treatment options include: Cognitive Behavioral Therapy (CBT): Helps manage anxious thoughts and behaviors. Dialectical Behavior Therapy (DBT): Teaches emotional regulation and distress tolerance skills. Exposure Therapy: Reduces avoidance behaviors related to anxiety. Mindfulness-Based Therapy: Helps manage emotional reactivity by staying present. Final Thoughts Emotional dysregulation and anxiety can create a challenging cycle, but with the right tools and support, individuals can learn to manage both effectively. By practicing mindfulness, developing cognitive coping strategies, and seeking professional guidance when needed, it’s possible to build resilience and regain control over emotions. Get Support at Upper East Side Psychology If you are struggling with anxiety and emotional dysregulation, Upper East Side Psychology offers evidence-based therapy to help you build skills for emotional resilience and balance. Contact us today to schedule a consultation and take the first step toward feeling more in control of your emotions and well-being.

Establishing routines can be challenging for individuals with Attention-Deficit/Hyperactivity Disorder (ADHD). While neurotypical individuals may find habit formation more straightforward, those with ADHD often encounter obstacles due to symptoms such as distractibility, impulsivity, and difficulty with sustained attention. However, with the right skills and tools, routine development and maintenance can be successfully established. Understanding the Challenge For individuals with ADHD, turning tasks into automatic routines is often hindered by: Inconsistent Motivation:  Relying solely on internal drive can be unreliable. Executive Functioning Deficits:  Challenges in planning, organizing, and initiating tasks. Sensitivity to Boredom:  A tendency to avoid repetitive or unstimulating activities. Strategies for Developing and Maintaining Routines 1. Start Small and Specific Begin with manageable tasks. For instance, instead of committing to a comprehensive exercise regimen, start with a five-minute walk daily. This approach reduces overwhelm and builds confidence. 2. Utilize Habit Stacking Pair a new habit with an existing one. For example, if you already have a morning coffee routine, use that time to review your daily schedule. This technique leverages established behaviors to introduce new ones. 3. Incorporate External Accountability Engage in activities with a partner or group. The presence of others can enhance focus and commitment. This method, known as body doubling , has been effective for many with ADHD. 4. Set Environmental Cues Modify your surroundings to prompt desired behaviors. Placing workout clothes beside your bed can serve as a reminder to exercise upon waking. Visual cues reinforce routines. 5. Implement Reward Systems Establish immediate rewards for completing tasks. This could be as simple as enjoying a favorite snack after finishing a chore, providing positive reinforcement and motivation. 6. Maintain Flexibility Understand that perfection isn’t the goal. Allow for adjustments and be compassionate with yourself if deviations occur. Flexibility can prevent discouragement and promote long-term adherence. Tips for Staying Motivated Visual Progress Tracking:  Use charts or apps to monitor your achievements, providing a tangible sense of accomplishment. Regularly Update Routines:  Introduce variety to prevent monotony and maintain engagement. Seek Support Networks:  Connect with others who understand ADHD challenges, offering mutual encouragement and accountability. By implementing these strategies, individuals with ADHD can develop routines that, over time, become as intuitive and manageable as they are for neurotypical individuals. The journey requires patience, self-compassion, and persistence, but the rewards of established routines are well worth the effort.

Mastering Organization and Time Management for Better Mental Well-Being In today's fast-paced world, staying organized and managing your time effectively can be an uphill battle. At Upper East Side Psychology, we often hear from clients about the stress caused by cluttered schedules and disorganization. The good news is that building strong organization and time management skills can significantly reduce stress, improve productivity, and create more time for self-care and other personal activities. Here's how you can enhance these skills to foster better mental well-being. Why Organization and Time Management Matter Effective organization and time management aren’t just about accomplishing more; they are crucial for maintaining balance and reducing stress. Here are some key benefits: Lower Stress Levels : Structured schedules help reduce the chaos of day-to-day life. Improved Focus : Organized spaces and plans make it easier to concentrate on tasks. Enhanced Productivity : Prioritizing tasks ensures that the most important items get done efficiently. Better Work-Life Balance : Effective planning allows you to better meet both professional and personal goals. Tools to Enhance Organization and Time Management Use Your Digital Calendar You Can Access on Your Phone Schedule appointments, set reminders, and plan your day all in one place. Share relevant events in the calendar with family members, clients, or co-workers so everyone is on the same page.  Set Alarms  Sometimes it is easy to lose track of time when working on a task or doing a leisurely activity  Setting alarms so you know when to move on to your next task can keep you running on time.  To-Do Lists Writing out your daily or weekly to-do lists can help you stay on task.  You can also use apps like Todoist, TickTick, Microsoft To Do, Apple Reminds, and Things to help you stay on task, prioritize lists, and set deadlines and reminders to stay on track. Time-Blocking  Divide your day into time slots where you focus on a different task or set of tasks during each block of time. For example, 8 am-9 am: review emails, 9 am-11 am: work on x project, 11 am-12 pm take a break and eat lunch.   This helps to allocate time to different tasks each day and minimize distractions and switching between tasks rather than doing one task at a time.  Implement the Pomodoro Technique  Set a timer for 25 minutes, a Pomodoro Timer, and work for the 25-minute interval then take a 5-minute break, and after 4 Pomodoros take a longer break.  Tips for Improving Organization and Time Management Start Each Day with a Plan Spend 5-10 minutes each morning prioritizing your tasks for the day. Declutter Your Space A tidy workspace promotes focus and reduces feelings of overwhelm. Spend a few minutes at the end of each day organizing your physical and digital spaces. Break Down Big Tasks Divide larger projects into smaller, manageable steps to avoid feeling overwhelmed. Set Realistic Goals Focus on what’s achievable within the time you have. Avoid overloading your schedule as this can result in feeling overwhelmed and/or task avoidance. Prioritize Self-Care Build breaks and downtime into your schedule to recharge and avoid burnout. Eliminate Distractions Identify what interrupts your focus and find ways to minimize these disruptions. Review and Adjust Regularly Take time at the end of each week to assess your progress and make adjustments to your approach. Building strong organization and time management skills can transform your day-to-day life, reducing stress and creating more time for the things that truly matter. By incorporating these tools and techniques into your routine, you can achieve greater balance and improve your overall mental well-being. How Upper East Side Psychology Can Help If you’re struggling to stay organized or manage your time effectively, our team at Upper East Side Psychology is here to support you. We offer personalized strategies to address the stress and overwhelm that often accompany disorganization, helping you create systems that work for your unique needs. References:  https://zapier.com/blog/best-todo-list-apps/ https://www.nytimes.com/wirecutter/reviews/best-to-do-list-app/ https://www.pomodorotechnique.com/

Depression: Symptoms, Causes, and Treatment Options Depression is a common mental health disorder that affects millions of people worldwide. It is characterized by a persistent feeling of sadness and loss of interest in activities that were once enjoyable. Depression can also cause changes in appetite, sleep, energy levels, concentration, and self-esteem. Major Depressive Disorder (MDD) is one of the most common disorders worldwide. It is estimated that 21 million adults in the United States have had at least one major depressive episode in their lifetime (USDHHS, 2022). Depression can onset at any age, although the likelihood increases in and after puberty; in the United States incidences of depression peak around the mid-twenties (APA, 2000; APA, 2013). The onset of depression later in life is also not uncommon, especially when one is suffering from a chronic or severe medical condition (APA, 2000; APA, 2013; Meng & D’Arcy, 2014). Depression is more common in adolescent and adult females than in adolescent and adult males (USDHHS, 2022; APA, 2000; APA, 2013; Meng & D’Arcy, 2014). Description of Depression Symptoms: Depression is characterized as having one or more Major Depressive Episodes (APA, 2000; APA, 2013). One suffering from Depression may experience a lack of emotions (i.e., experiencing no feelings), feelings of anxiety, sadness, increased irritability over minor events, or somatizations (e.g., bodily pains or tensions and/or headaches) (APA, 2000; APA, 2013). Brooding and rumination are also not uncommon complaints of depressed patients (APA, 2013). There is usually a loss of interest or pleasure. For example, one may withdraw from activities that are important to them or that once brought them joy (e.g., hobbies and social activities), and “in some individuals, there is a significant reduction from previous levels of sexual interest or desire” (APA, 2013, p. 163). Many individuals become socially withdrawn or experience challenges in their social interactions when they’re depressed (APA, 2013). One might also experience psychomotor agitation (i.e., difficulty sitting still or fidgeting) or psychomotor retardation (i.e., slowed down thinking, speech, movements, long pauses before answering) and/or decreased energy (e.g., fatigue with minimal or no physical exertion) (APA, 2000; APA, 2013). Patients also commonly report experiencing difficulties with concentration, memory, and decision-making (APA, 2013). In some cases, one is unable to engage in cognitively demanding tasks and as a result will see a drop in grades or poor work quality (APA, 2013). A potential explanation for these cognitive deficits during a depressive episode is that, when one is depressed, one tends to engage in-depression-relevant thinking (negative thinking or rumination), which takes up cognitive resources and energy available for performing other tasks (Hartlage, Alloy, Vazquez, & Dykman, 1993). Typically, one returns to their previous level of functioning after receiving treatment for the depression or when the episode passes and their depression goes into remission (APA, 2000; APA, 2013). The symptoms of depression can vary from person to person, but they often include some of the following symptoms for most of the day nearly every day for 2 weeks or more: Sadness Feelings of Emptiness Loss of interest or pleasure in activities Changes in appetite or weight (either increased or decreased) Insomnia or hypersomnia (either sleeping is increased or decreased) Fatigue Difficulty concentrating Difficulty making decisions Thoughts of death or suicide Feelings of worthlessness or guilt Course of depression: The course of depression is variable. Some individuals rarely “experience remission (a period of 2 or more months with no symptoms, or only one or two symptoms to no more than a mild degree), while others experience many years with few or no symptoms between discrete episodes” (APA, 2013, p. 165). Recovery typically begins within 3 months to 1 year of the onset of MDD (APA, 2013). The risk of MDD recurrence is higher when the previous episode was severe, the individual is younger, mild depressive symptoms occurred in remission, and the patient has had multiple previous episodes (APA, 2013). The risk of recurrence reduces as the remission duration increases (APA, 2013). Causes of depression: The causes of depression are variable and not fully understood as no one circumstance or cause predicts the onset of depression. It is widely held that a combination of genetic, environmental, and psychological factors creates the circumstances for depression. Some of the things that can increase your risk of developing depression include: Family history of depression, especially a first-degree biological relative with depression Temperament, especially high levels of neuroticism, place one at a higher risk for depressive episodes in reaction to stressful life events (APA, 2013) Personal history of trauma or abuse Exposure to adverse experiences in childhood (e.g., dysfunctional family environment, parental negativity or highly punitive parenting styles, or early experiences with trauma or childhood abuse) Certain medical conditions, such as chronic pain or thyroid problems Substance abuse Smoking Cigarettes as cigarette smoke contains neurotoxins that may be involved in the mechanisms of depression (Quattrocki, Baird, & Yurgelun-Tood, 2000 as cited in Meng & D’Arcy, 2014) Stressful life events (e.g., job loss, divorce, poor social support, or marital problems) Treatment for depression: There are many effective treatments for depression including therapy, psychotropic medication, and lifestyle changes. Cognitive Behavioral Therapy (CBT) has empirical support for treating depression (APA, 2010); Using techniques like “behavioral activation, problem-solving, cognitive restructuring, and homework…” patients are able to learn effective skills to better cope with their depression and see improvement in symptoms (Simons et al., 2010). CBT is also shown to have superior relapse prevention compared to other treatments of depression (Lopez & Basco, 2014). Additionally, it is shown that CBT with medication therapy can be more potent than CBT alone or medication alone (APA, 2010). Therapy can help you understand the causes of your depression and develop coping skills and tools. Lifestyle changes, such as getting regular exercise and movement, a healthful diet, and improved sleep hygiene, can also help to improve your overall well-being. If you are struggling with depression, don’t wait seek professional help, find a therapist right away. There are many effective treatments available to help you navigate these challenges. You do not have to go through this alone. References: 1. U.S. Department of Health and Human Services (USDHHS). (2022). Major depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression 2. American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. 3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. 4. American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder, (3rd ed.). Retrieved from 5. Lopez, M., & Basco, M. (2014). Effectiveness of cognitive behavioral therapy in public mental health: Comparison to treatment as usual for treatment-resistant depression. Administration And Policy In Mental Health And Mental Health Services Research, doi:10.1007/s10488-014-0546-4 6. Simons, A. D., Padesky, C. A., Montemarano, J., Lewis, C. C., Murakami, J., Lamb, K., & Beck, A. T. (2010). Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes. Journal of Consulting And Clinical Psychology, 78(5), 751-756. doi:10.1037/a0020569 7. Meng, X., & D’Arcy, C. (2014). The projected effect of risk factor reduction on major depression incidence: A 16-year longitudinal Canadian cohort of the national population health survey. Journal of Affective Disorders, 15, 56-61. doi: 10.1016/j.jad.2014.02.007 8. Hartlage, S., Alloy, L. B., Vazquez, C. & Dykman, B. (1993). Automatic and effortful processing in depression. Psychological Bulletin, 113, 247-278. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8451334

What Is CBT-E? A Guide to Enhanced Cognitive Behavioral Therapy Enhanced Cognitive Behavioral Therapy-E (CBT-E) is a transdiagnostic treatment created to improve outcomes for those suffering from eating disorders; it is based on the transdiagnostic theory of eating disorders by Christopher Fairburn, Zafra Cooper, and Roz Shafran (2003). This leading evidence-based treatment for eating disorders has seen remarkable success, with two-thirds of patients showing significant, long-term improvements (Byrne et al., 2011; Fairburn, 2008; https://www.cbte.co/what-is-cbte/current-status-cbte/). ​ CBT-E is a type of Cognitive Behavioral Therapy that centers on recognizing, disrupting, and altering the maintaining factors of eating disorders. It is a brief and structured treatment that incorporates cognitive and behavioral techniques and strategies. Additionally, CBT-E stresses the importance of a productive, collaborative relationship between patient and therapist. Like most evidence-based CBT therapies, it employs self-monitoring records, psychoeducation, implementation of techniques, cognitive restructuring, and problem-solving skills. CBT-E primarily focuses on understanding the maintaining factors of the eating disorder. Using the information gathered from the monitoring records and in sessions the patient and therapist work collaboratively to craft a formulation of patient’s disorder, which serves as a road map for therapy. Formulations are often changed over the course of treatment to accommodate the shifting presentation of the patient and the symptoms they’re experiencing. ​ CBT-E consists of an initial assessment session, followed by about 20 weeks of individual therapy sessions. In certain cases, the forty-session version may be needed (e.g. underweight or diagnosed with anorexia nervosa), but this is only applicable to less than twenty percent of adult outpatients (Fairburn, 2008). Please note the ranges provided are for ideal circumstances and the length of treatment differs based on the patient’s situation, diagnosis and specific needs. How Can CBT-E Help with Eating Disorders? CBT-E is a suitable option for those suffering from any type of eating disorder, including binge eating disorder, anorexia nervosa, and bulimia nervosa. Patients who are underweight or have been diagnosed with anorexia nervosa likely require the longer, more intensive version of CBT-E. With this form of CBT, those suffering from eating disorders can gain insight into how their disorder functions, how it is sustained, and how to interrupt the cycle of reinforcement that maintains it (Fairburn, 2008). Additionally, patients gain education about their eating disorder and their health, helping to combat the false beliefs, problematic behaviors and damaging patterns that exacerbate their eating disorder (Fairburn, 2008; Fairburn, 2013). The ultimate goal of treatment is to develop the tools and skills to manage your eating disorder long-term and live a balanced and healthful life.

Understanding Maudsley Family-Based Therapy for Anorexia and Bulimia Maudsley Family-Based Therapy (MFBT) is an evidence-based treatment for anorexia nervosa (AN) and has emerging evidence to support the treatment of bulimia nervosa (BN). MFBT was developed by Christopher Dare and colleagues at the Maudsley Hospital in London (1). MFBT is a short-term, highly structured therapy that involves the entire family. MFBT is based on the belief that the family plays an important role in resolving the eating disorder and that recovery can be done while at home and in the patient’s natural environment. MFBT is based on the idea that AN is a family illness. The family is seen as playing a role in the development and maintenance of the eating disorder. The therapist helps the family to understand the eating disorder and to develop a plan for recovery, which usually includes meal support, parental involvement, and education about AN. MFBT has been shown to be the most effective treatment for children and adolescents with anorexia nervosa. Research shows that 70-90% of patients that achieve healthy weight by the end of their treatment maintain recovery five years post-treatment (3). Emerging research is showing that MFBT has similar effectiveness with children and adolescents with bulimia nervosa as well (2). MFBT is can often be an alternative to partial or inpatient programs. How does the MFBT work? MFBT is a three-phase treatment that can span from 6 to 12 months (Lock and Le Grange , 2013). MFBT teaches parents how to take charge of the refeeding process to aid their child in becoming weight restored, enhance understanding of the eating disorder and modify dynamics that might be contributing to the eating disorder and restore age-appropriate roles and responsibilities to the patient and the family. Phase One: Weight Restoration The goal of this phase is to conduct an initial evaluation with the family, set the landscape for treatment (i.e., refeeding, weekly weigh ins, and the roles of each family member), and aid the patient’s parents in understanding and engaging in practices for efficiently refeeding their child to facilitate weight restoration process. From the first point of contact the therapist imparts on the family the seriousness of their situation (i.e., having a child with anorexia nervosa) and the need to work quickly to get the child's weight restored. The entire family is asked to attend the initial family therapy session. The therapist provides the family with directives, encouragement, specific advice, and feedback based on the family's unique needs and challenges in the refeeding process. The therapist tasks the parents with refeeding and asks any siblings to be a source of support and encouragement. Additionally, the therapist teaches the family how to separate the eating disorder from the patient through externalization. Phase Two: Returning Control of Eating to the Adolescent Once the parents are in control of the eating disorder and the patient is gaining weight and approaching their ideal body weight, then it is time to consider moving to phase two. Typically, the parents gradually increase independence as the patient gains mastery over each meal or snack. Throughout this phase, the therapist and the family collaborate to set realistic goals, problem-solve any challenges, and return age-appropriate opportunities and meals to the patient. At the conclusion of phase two the patient is fully weight restored and has had all age-appropriate meals and opportunities (e.g., going out to meals with friends, having sleepovers, exercising, spending the day at a friend’s house) returned to them. Phase Three: Establishing a Healthy Identity Once the patient has maintained a stable weight independent of parental monitoring of meals, then phase three begins. Phase three is short and typically consists of helping the family to return to previous activities and ways of being, such as assuming healthy identities and roles in the family and their individual lives. Special attention is given to the parents to reestablish a healthy relationship with the patient, themselves and each other that does not include the ED as the basis of interactions. The therapist also helps the family to develop healthy communication and coping skills and transitions them out of therapy. Who is the Maudsley Method right for? The Maudsley Method is right for children and adolescents with anorexia nervosa or bulimia nervosa who are medically stable enough to receive outpatient treatment. The treatment is also used for children and adolescents who have just been discharged from inpatient treatment or are part of a partial or inpatient treatment program that includes the family in the process. What are the benefits of Maudsley Family Therapy? The Maudsley Method has been shown to be effective in helping children and adolescents recover from anorexia nervosa. Unlike inpatient programs for refeeding, MFBT allows for the patient to remain at home, work through challenges while continuing to be exposed to daily stressors and maintain social support and connection through contact with their friends and family. MFBT allows the patient and family to heal and refeed the patient under “usual circumstances” rather than facing triggers and day-to-day stressors throughout the recovery process, which is a major advantage of MFBT. Maudsley family therapy has been shown to be effective in the treatment of AN. If you are considering MFBT for your child, I encourage you to talk to your therapist or pediatrician about the pros and cons of this treatment option. 1. Lock, J., & Le Grange, D. (2013). Treatment manual for anorexia nervosa: A family-based approach (2nd ed.). New York: Guilford Press. 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2651218/ 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414759/ 4. Hurst, K., Read, S., & Wallis, A. (2012). Anorexia nervosa in adolescence and Maudsley family-based treatment. Journal Of Counseling & Development , 90 , 339-345. doi:10.1002/j.1556-6676.2012.00042.x

Edited by: Dr. Gabrielle Schreyer-Hoffman, Ph.D. General Statistics and Information on GAD General anxiety disorder (GAD) is a common mental health disorder that affects millions of people worldwide. The main characteristic of GAD is a pattern of excessive and persistent chronic worrying that is difficult to control. The estimated prevalence of generalized anxiety disorder in the general population of the United States is 3.1% in a one-year span (Stein & Sareen, 2015). Women and adolescent girls experience generalized anxiety disorder at a rate of at least twice as often as men and adolescent boys (American Psychiatric Association [APA], 2022). People of European descent tend to have symptoms that meet the criteria for generalized anxiety disorder more often than individuals of African and Asian descent (APA, 2022). The prevalence rate of GAD for Seniors aged 75 ranges from 2.8% to 3.1% in the United States, Israel, and European countries (APA, 2022). For Seniors, the onset of chronic physical disease or chronic pain can trigger excessive worry. In addition, those who are physically frail, have safety concerns about falling and need to limit their activities in response to this, tend to feel more distressed and anxious. (APA, 2022). GAD sufferers are also susceptible to a high rate of secondary co-occurring anxiety disorders such as social -anxiety and panic disorders (Borza, 2017). Notably, Stein & Sareen (2015) found that alcohol and drug-use-related problems can develop in individuals with generalized anxiety disorder who use drugs and alcohol as a means to relieve symptoms of anxiety associated with GAD. What is GAD? Generalized Anxiety Disorder (GAD) is characterized by excessive and persistent anxiety and worry, to the extent that this worry is disproportionate to the actual situation anticipated or actual event. Individuals with generalized anxiety disorder find it difficult to control their worry and to keep worrisome thoughts from interfering with overall functioning and the tasks they are trying to accomplish (American Psychiatric Association [APA], 2013). A core feature of GAD is excessive and persistent worrying, even if the focus of worry may shift from one topic to another (Stein & Sareen, 2015). Adults who have generalized anxiety disorder may worry excessively about circumstances in their daily lives, such as job responsibilities, their finances, their own health, and/or their family member’s well-being to the point where it negatively impacts their own functioning. Whether the source of the person’s worry is day-to-day ordinary life circumstances or includes situations or events that are more complex, it is the pervasive, chronic and relentless nature of their worrying that causes significant distress for individuals with GAD (APA, 2013). Adults may worry excessively, for instance, about being late or about completing routine household chores, and may simultaneously experience feelings of helplessness and/or physical symptoms associated with stress, such as sweating, muscle tension, dizziness or difficulty sleeping. Children and adolescents with generalized anxiety disorder are prone to excessive worry about their own capabilities and performance and may be anxious about their peer relationships [APA], 2022). Additionally, symptoms of GAD in children can appear as physical symptoms such as recurrent abdominal pain that may cause disruption in school attendance (Stein and Sareen, 2015). The symptoms of Generalized Anxiety Disorder can affect individuals physically, cognitively and emotionally and vary from person to person. Some of the physical symptoms of GAD include those associated with stress such as headaches, muscle tension, nausea and gastrointestinal issues. In addition to excessive worry and anxiety, other emotional and cognitive symptoms of GAD may include feeling keyed up or on edge, difficulty concentrating, irritability and a sense of helplessness in the face of the symptom (Stein & Sareen, 2015; Cuijpers et al.,2014, APA,2022). Here are common symptoms associated with GAD: ● Excessive worry ● Chronic anxiety ● Difficulty concentrating ● Mind going blank ● Sleep problems ● Irritability ● Easily fatigued ● Feeling keyed up or on edge ● Muscle tension ● Muscle aches or soreness ● Sweating ● Nausea ● Diarrhea ● An exaggerated startle response ● Difficulty in tolerating uncertainty Causes Of GAD The causes of GAD are variable and no one circumstance can predict the onset. Research shows that it is likely a combination of genetics, environmental factors and life events that create the circumstances for GAD to develop (Stein & Sareen, 2015; APA, 2022). Some of the factors contributing to the increased risk of developing GAD include exposure to childhood trauma and adversity, such as physical or sexual abuse or neglect (Stein & Sareen, 2015; APA, 2022). Other documented contributing factors of increased risk are low socioeconomic status and being born female (Stein and Sareen, 2015). Treatments for GAD There are many effective treatments for GAD, including therapy, psychotropic medication and lifestyle changes. Research has shown that the use of psychotropic medication by itself to treat GAD can be effective, though efficacy increases when combined with therapy. Therapy has been documented as a preferred treatment by both clinicians and patients in treating GAD (Stein & Sareen, 2015; Cujipers,et al., 2014). Cognitive Behavioral Therapy (CBT) has empirical support for treating GAD. CBT is a structured and collaboratively therapy that utilizes a variety of techniques like cognitive restructuring, exposure and step-wise problem-solving. Additional therapeutic approaches proven to be beneficial in treating GAD are Acceptance and Commitment Therapy (ACT), relaxation techniques, Mindfulness training and meditation (Cujipers, et al., 2014). Lifestyle changes can also offer potential benefits for managing the symptoms of GAD. Research has shown that exercise and avoiding or reducing alcohol use can reduce anxiety symptoms (Stein & Sareen, 2015). Good sleep hygiene habits including maintaining a regular sleep schedule and not using devices such as smartphones or iPads at night have been shown to improve sleep which helps mitigate anxiety (Stein and Sareen, 2015). If GAD goes untreated it can lead to an increased risk of developing other physical health conditions or can exacerbate physical symptoms like chronic pain, asthma and inflammatory bowel disease (Stein & Sareen, 2015.) Additionally, untreated symptoms of GAD increased one’s risk of developing other co-occurring mental health conditions (Borza, 2017). Having generalized anxiety is challenging and you shouldn’t have to go through it alone. If you are struggling with GAD, it is important to seek professional help and to get treatment as soon as possible. References American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 American Psychiatric Association. ( 2022). Anxiety Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.) https://doi.org/10.1176/appi.books.9780890425787 Bomyea, Ramsawh, H., Ball, T., Taylor, C. , Paulus, M. , Lang, A. , & Stein, M. (2015). Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. Journal of Anxiety Disorders, 33, 90–94. https://doi.org/10.1016/j.janxdis.2015.05.004 Borza. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in Clinical Neuroscience , 19 (2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza Cuijpers, Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology Review, 34(2), 130–140. https://doi.org/10.1016/j.cpr.2014.01.002 If you're a constant worrier, you may have an anxiety disorder: generalized anxiety disorder can cause health problems if not treated properly. Don't ignore the symptoms. (2009, May). Women's Health Advisor , 13 (5), 4. https://link-gale-com.proxy.wexler.hunter.cuny.edu/apps/doc/A200408466/AONE?u=cuny_hunter&sid= bookmark-AONE&xid =da3ff197 McLean, Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. https://doi.org/10.1016/j.jpsychires.2011.03.006 Stein, & Sareen, J. (2015). Generalized Anxiety Disorder. The New England Journal of Medicine, 373(21), 2059–2068. https://doi.org/10.1056/NEJMcp1502514

Navigating Stress in the City: Practical Tips from Upper East Side Psychology Living in the hustle and bustle of any city can be exhilarating, but it also comes with its own set of unique challenges. New York City is known for its vibrant energy and cultural attractions, but it's also home to high-pressure environments, demanding careers, and fast-paced lifestyles. The constant noise, congestion, and sensory overload can exacerbate anxiety, leaving many residents struggling with a mind that won't stop racing, making it difficult to relax and unwind. Managing Stress in the City Fortunately, there are strategies that can help individuals navigate stress and find a sense of balance in the midst of urban chaos. Here are some practical tips for managing stress in the city: Mindfulness and Meditation: Take time each day to practice mindfulness or meditation. These techniques can help quiet the mind, reduce anxiety, and increase resilience in the face of stressors. You can also try structured mindfulness exercises like: Body scan meditation: Lie down, focus on each body part top-to-bottom, noting sensations, emotions, and thoughts. Sitting meditation: Sit comfortably, focus on breath, acknowledging interruptions, and returning focus to breath. Walking meditation: Find a quiet spot, walk slowly, stay mindful of sensations and balance. (Mayo Clinic Staff) Establish Boundaries: Set boundaries around your time.  Set parameters around your working hours and workload to avoid burnout.  Be judicious about what social activities you commit to, and honor the time you have carved out for activities that promote relaxation and self-care.  Set timers (and stick to them!) for your social media use.  Avoid the “doom scroll”! Physical Activity: Incorporate regular exercise into your routine. Take the stairs, join a class, or find a home workout that you love. Whether it's a yoga class, a jog in Central Park, or a bike ride along the East River, physical activity is a powerful way to reduce stress and improve your overall well-being.  Healthy Lifestyle Habits:  Pay attention to your diet, sleep, and hydration.  Eating nutritious foods: Did you know that the foods you eat can increase the amount of serotonin in the brain? Focus on adding more good eating habits, rather than cutting out the bad – it helps you avoid a deprivation mindset while you build your healthy routine!  Get enough sleep: The average adult needs at least 7 hours per night.  Set a nighttime routine and stick to it.  Soothing music, a good book, hot tea, and skincare are just a few ways many people practice self-care before going to bed.  Staying hydrated: Even slight dehydration can affect mood. Aim to sip on 2.5 to 4 liters of water each day to keep your energy levels up and your mood in check.  (Sawchuk, Ph.D., L.P.) Seek Support:  Don't hesitate to reach out for support from friends, family, or mental health professionals. Shoot a message to a good friend and open a dialogue. Say something like, "Hey, I've been feeling overwhelmed lately and could really use a friendly ear. Can we catch up sometime soon?".  Talking about your feelings and experiences can provide perspective and validation, helping to alleviate feelings of isolation and anxiety.  Stress Management Services at Upper East Side Psychology At Upper East Side Psychology, we understand the unique stressors associated with city living, and we're here to help. Our experienced therapists help with stress management in a way that is tailored to your individual needs. Whether you're struggling with overwhelm, mind racing, or anxiety, we provide compassionate support and evidence-based techniques to help you regain a sense of calm and balance in your life. If you're ready to take the first step toward better stress management, we invite you to learn more about our services and schedule an appointment today. Together, we can navigate the challenges of city living and cultivate resilience for a healthier, happier life. Works Cited Mayo Clinic Staff. “Mindfulness Exercises.” mayoclinic.org , The Mayo Clinic, 11 October 2022, https://mayocl.in/3J21wxu . Accessed 1 April 2024. Sawchuk, Ph.D., L.P., Craig N. Sawchuk, N. “Coping with anxiety: Can diet make a difference?” The Mayo Clinic , Mayo Clinic, 2017, https://mayocl.in/3VDc6Tj . Accessed 1 April 2024.

Navigating Eating Disorders: A Path to Recovery Despite how common eating disorders are, they are largely misunderstood. Often mistakenly thought to be about vanity and will power, eating disorders are a serious mental health condition caused by biological, psychological, and environmental factors. Unfortunately, today’s social media landscape, contemporary marketing, and high stress environments add a compounding layer of societal pressure by imposing unrealistic beauty standards. Understanding the Root Causes of Eating Disorders Eating disorders are a deeply complex set of conditions. They have traditionally been understood through the lens of family history, social factors, and trauma. Studies show that on average 45% of individuals with EDs have experienced traumatic life events. (Convertino and Morland)   However, more recent twin and family research suggests that genetics and hereditary factors play a role. These studies indicate a frequent co-occurrence among eating disorders and traits such as anxiety disorders/symptoms, body weight, and possibly major depression. The findings from twin studies are particularly compelling in highlighting the genetic component of eating disorders. By comparing the prevalence of eating disorders in identical twins, who share nearly all their genes, with fraternal twins, who share about half, researchers have found higher concordance rates among identical twins. This strongly suggests that eating disorders are hereditary conditions, influenced not just by environmental factors, but by genetic predisposition as well. (Berrettini, MD, PhD)   Prevalence and Misconceptions Modern beauty standards are both unattainable and ever-changing. The examples set in the media and society at large can exacerbate feelings of inadequacy and further fuel disordered eating behaviors. Dieting cycles and fear of gaining weight can indicate risk for disordered eating and eating disorder development. One of the most pervasive misconceptions about eating disorders is that they are solely about weight loss and stem from self-centeredness. In reality, individuals with eating disorders often use food and weight as a way to cope with underlying emotional distress or to gain a sense of control in their lives.  A patient’s struggle to gain control around family life, relationships, finances, school or work can manifest in restrictive eating and maladaptive thought patterns.    Seeking Treatment with Upper East Side Psychology  At Upper East Side Psychology, we work collaboratively with our patients to help them identify problematic patterns, modify them, and implement coping skills and tools. This approach is tailored to the needs and stressors of the patient and targets the different aspects of behavior that maintain an individual’s eating disorder. Through our use of CBT-E, or Enhanced Cognitive Behavioral Therapy, we teach patients how to develop ways to modify maladaptive and inaccurate styles of thinking, adjust problematic behaviors, and tolerate challenging emotions and situations so they can achieve long-term coping skills and balance. Our team of therapists uses evidence-based therapies and compassionate support that can help you create just the right environment for a successful recovery. Works Cited Berrettini, MD, PhD, Wade. “The Genetics of Eating Disorders.” National Library of Medicine , 2004. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010958/ Convertino, A. D, and L. A Morland. “Trauma exposure and eating disorders: Results from a United States nationally representative sample.” International Journal of Eating Disorders , vol. 55, no. 8, 2022, pp. 1079–1089, https://doi.org/10.1002/eat.23757 .

Phobias Unveiled: Overcoming Fears and Finding Freedom Phobias are more than just fears; they are intense, irrational reactions to specific objects, situations, or activities that can significantly impact an individual's quality of life. At Upper East Side Psychology, we understand the profound effect phobias can have on daily functioning, relationships, and overall well-being. In this blog post, we will shed light on common phobias, their origins, and effective therapeutic approaches to help you overcome these fears and reclaim your freedom. Understanding Phobias Phobias are a type of anxiety disorder characterized by an overwhelming fear of a specific trigger. Some of the most common phobias include: Acrophobia: Fear of heights. Claustrophobia: Fear of confined spaces. Arachnophobia: Fear of spiders. Agoraphobia: Fear of two or more of the following: public transportation, open spaces, enclosed spaces, crowds or lines, being outside of the home. Social Phobia: Fear of social situations. While these fears may seem irrational to others, they are very real to those experiencing them. The origins of phobias can be complex and varied, often stemming from a combination of genetic, environmental, and psychological factors. Traumatic experiences, learned behaviors, and even evolutionary survival mechanisms can all play a role in the development of phobias. Phobias can feel like insurmountable obstacles, but with the right support and therapeutic strategies, it is possible to overcome them. Therapeutic Approaches to Overcoming Phobias At Upper East Side Psychology, we utilize evidence-based therapeutic approaches to help our clients confront and conquer their phobias. Cognitive-Behavioral Therapy  (CBT) helps individuals identify and challenge negative thought patterns and behaviors associated with their phobia.  Exposure Therapy is a type of CBT that helps individuals confront their fears and anxieties. The therapy works by gradually exposing the person to the source of fear in a safe, controlled environment, allowing them to learn to manage their reactions and reduce their fear response. For example, a fear of heights can become debilitating for some. For a person with acrophobia who is motivated to move on from this fear , gradually exposing themselves to heights with the guidance of a therapist can help desensitize them to the trigger. This type of therapy can be extremely beneficial for those suffering from post-traumatic stress disorder, phobias, and other anxiety-related disorders. Mindfulness-based treatments and relaxation techniques such as deep breathing and progressive muscle relaxation can help individuals manage the physical symptoms of anxiety and remain calm while confronted with their phobia. Someone with claustrophobia, who may struggle to do every-day activities like ride elevators, could benefit from mindfulness-based treatments.  By spending a few guided seconds in an enclosed space, slowly increasing the length of time they stay in that space, and focusing on the breath, the patient can accommodate and decrease their anxiety at their own pace. Finding Freedom Phobias can feel like an insurmountable obstacle, but with the right support and therapeutic strategies, it is possible to overcome them. At Upper East Side Psychology , we are committed to helping our clients face their fears and find freedom from the constraints of phobias. If you or a loved one is struggling with a phobia, reach out to us. Together, we can unveil the path toward a fear-free life. For more information or to schedule an appointment, contact Upper East Side Psychology today. Let us help you embark on your journey to overcoming fears and finding the freedom you deserve.

Building Stronger Connections: The Benefits of Couples Therapy Building and maintaining a healthy relationship requires dedication, communication, and sometimes, professional guidance. Couples therapy, marriage counseling or couples counseling, offers a safe and supportive space for partners to explore their dynamics, address challenges, and strengthen their bond. Effective Communication Communication is the cornerstone of any successful relationship. Yet, miscommunication and unresolved conflicts can lead to tension. Take, for example, a couple who constantly argues about household responsibilities. In therapy, they would learn how to express emotions constructively, allowing them to better understand each other's perspectives and devise ways to resolve conflicts in an effective and balanced manner. Couples therapy  teaches effective communication skills like active listening, expressing emotions constructively, and resolving conflicts respectfully. By improving communication, couples can better understand each other's needs and perspectives, leading to greater connection and intimacy. Every relationship faces its own set of challenges and stressors. Couples therapy provides a supportive environment where partners can explore life’s challenges together, identify underlying issues, and develop strategies for overcoming them. Whether it's addressing trust issues, navigating financial disagreements, or rebuilding intimacy, therapy offers the guidance and tools to strengthen your relationship. Deepening Connection and Preventing Future Problems The demands of everyday life can take a toll on a relationship, leading to feelings of disconnection and sometimes resentment. Couples therapy helps partners reconnect emotionally, rediscover shared values, and reignite their relationship. Through tailored exercises, discussions, and interventions, couples can deepen their connection and cultivate a more fulfilling partnership. Couples therapy isn't just for couples experiencing present issues or challenges; it's also for learning healthy styles of communication to prevent future problems. By addressing underlying patterns of behavior, communication styles, and relationship dynamics, couples can identify potential areas of conflict and proactively work towards solutions.  Before a problem occurs, empower yourself and your partner to understand each other better and take on the exciting journey that awaits you in getting to know each other on this deeper level. Therapy equips partners with the skills and insights needed to build a resilient relationship that can withstand the test of time. Take the First Step Towards a Stronger Relationship Are you and your partner experiencing challenges in your relationship, or simply looking to strengthen your communication? Couples therapy can provide the support and guidance you need. Our therapists  at Upper East Side Psychology are here to help you on your journey towards greater intimacy, connection, and happiness together. Reach out to us today and take the first step towards a stronger, healthier relationship.

Cultivating Career Confidence: A Guide to Professional Well-Being In today's fast-paced professional world, the demands of work can easily lead to stress, anxiety, and burnout. High-stakes projects, tight deadlines, and soaring expectations can make anyone feel overwhelmed. Conversely, the uncertainty of employment, career transitions, and the fluctuating job market can leave us feeling insecure and worried about the future.  At Upper East Side Psychology , we can help equip you with ways to cope with a grueling workload and career pressure.  De-Mystifying the Work-Life Balance Even when our careers are on track, achieving a work-life balance often feels like a distant dream. We often over-commit, both at work and in our personal lives, leading to exhaustion or resentment. To maintain good mental health, it’s crucial to strike a balance and, beyond that, to find passion and meaning in our work. Without joy and purpose in what we do, even the most stable job can become a source of stress. To help regain control of your career and personal life, consider integrating a few key strategies into your routine. First and foremost, setting boundaries is essential. Before taking on new commitments, ask yourself if you have enough time to manage both your work duties and personal responsibilities. Often, we make concessions in one area to satisfy demands in another, leading to an imbalance that can be detrimental to our well-being. Pausing to reflect on what truly matters to you can help you make more informed decisions about where to invest your time and energy.  Prioritizing self-care is equally important. Beyond the obligations of work and personal life, it’s vital to carve out time for yourself. Engage in activities that bring you joy and relaxation, such as exercise, hobbies, or simply taking a break from the daily grind. Regular self-care practices can help recharge your batteries and keep burnout at bay. Another critical aspect of maintaining balance is learning to delegate. It’s tempting to try to handle everything on your own, but this often leads to feeling overwhelmed or simply running out of time. Trusting your teammates and sharing tasks can lighten your load and create a more manageable workflow. Remember that it can be a sign of strength to know when to ask for help from your peers and colleagues. Seeking Outside Help When we find ourselves at a crossroads or are feeling stagnant between jobs, the expertise of a career counselor can be invaluable. A career counselor can provide personalized guidance to help you better understand your skills, interests, and values. They can assist with practical aspects of the job search, such as resume writing, interview preparation, and skill enhancement, all of which can boost your career prospects. Furthermore, they offer support in making crucial career decisions, whether it involves changing paths, negotiating offers, or pursuing further education. By working with a career counselor, you can navigate career obstacles more effectively and regain control over your professional and personal life. Engaging in work that is misaligned with your purpose or passion can take a significant toll on your mental health. The modern workplace presents numerous challenges that can impact our mental wellness. High-pressure environments, job uncertainty, and the struggle to balance work with personal life are common stressors.  Engaging in work that is misaligned with your purpose or passion can also take a significant toll on your mental health. To navigate these challenges, it’s essential to establish clear boundaries between work and personal time. Designating specific hours for work and prioritizing leisure and family time can prevent burnout. Incorporating self-care rituals such as exercise, hobbies, and relaxation techniques into your daily routine can help recharge your energy. Mindfulness practices, including short breaks throughout the day, can alleviate stress and enhance resilience. Additionally, delegating tasks and learning to say no to additional responsibilities are vital skills in preventing overwhelm. How Upper East Side Psychology Can Help When career challenges seem insurmountable, a career counselor’s guidance can provide the support you need to overcome these obstacles. Career counseling offers a space for self-exploration to gain clarity on your skills and interests. Our counselors also provide professional development assistance such as helping write or edit your resume and prepare for interviews, as well as guiding you through the difficult decisions that come with career transitions.   If you’re ready to prioritize your career well-being and unlock your full potential, consider the career counseling services at Upper East Side Psychology . Our experienced counselors are dedicated to supporting you through career challenges, helping you seize new opportunities, and fostering fulfillment and success in your professional journey. Take the first step towards a brighter tomorrow by scheduling a consultation today.