Mental Health Matters 🧠 - Ask me anything!

Hey, folks, welcome to another episode of Mental Health Matters. I'm Evan. I'm your resident mental health and addiction therapist. And I'm here because we're going to discuss matters regarding mental health and addiction and because mental health is important. So today we're doing one of my favorite styles of life, which is the q and a. So I gathered some questions, questions that I got from poked on the Cadre app, from other creators, from email, social media posts. So I just gather questions that people ask and I'm just going to go ahead and answer those.

And a lot of these questions are ones that I get quite frequently. So I think it's indicative of what people want to know more about and get some answers from a professional on. So I'll give you my opinion on some of these questions. And for those of you who are going to be joining, hopefully we get even more questions and more engagement. So let's see here. Let's get the questions going. This would only work. All right, here we go. First question. So this one came up when I was working with a bunch of professionals and someone had a client and they were talking about different theoretical orientation.

So as a lot of, you know, in therapy, there's a lot of different therapeutic methods, like maybe you've heard of something called cognitive behavioral therapy or exposure therapy or psychoanalysis, something coming from more the, the freudian camp, psychodynamic, that also comes from this. It's like a family. It's like family's a therapy. It's kind of like evolution where you have fish and whales and dolphins and felines. So there's these different kind of clusters of different theoretical orientations in therapy with different related ones.

And they, they view problems, they conceptualize them in a different way. So the question is, like, which one do you go with? How important is that, really, that your therapist has a particular orientation or a type of therapy that they do? So I think one of the most important things, you know, it's more about the connection and relationship you have with the therapist and the fact that that therapist is trained in a particular orientation or multiple, like, I've done trainings in multiple, let's say, things like acceptance and commitment therapy, trauma therapies like EMDR or brain spotting, different types of cognitive behavioral therapies, motivational interviewing.

So there's a whole bunch of different ones and there's, I think, value in all of them as they conceptualize problems in a different way and also how to interact with clients and how to solve some of those different problems. So again, there's so many different ones out there. Hello, car jazz. So there's so many different types of therapy out there. So how do you know which ones? So, again, I think it's important to, you know, when you're looking for a therapist to maybe go online to read their bio, see if what they're saying matches with you.

Look at the theoretical orientations they go by. Like, something on psychology today will list the different ones and look them up and see. It's all about, like, kind of what vibes with you, whether the therapist vibes with you, and whether that orientation does, too. But I think the therapist is more important just making sure they have the experience and some of that training. And a lot of times, people will learn about a certain theoretical orientation. Like EMDR has a lot of popularity for a trauma therapy, or people hear about something called brain spotting, and then they reach out because they search, or they search online for people who are trained in that, and that's how they often will find you.

And they want to try that. So I've done that before. So, yeah, I encourage you to look into some of those. I think they're interesting. Something like cognitive behavioral therapy is one of the most tried and true tested therapies out there. But cognitive behavioral therapy, it's actually a family of many different therapies. So, for example, in cognitive therapy, it's about kind of assess, kind of understanding how your thoughts affect your emotions, which affect your actions and behaviors, and how sometimes we operate on maybe faulty beliefs, things that come from our childhood or just our experiences.

And when we operate on these faulty beliefs, sometimes we don't act always in our best interest, and that leads to us not being as happy as we can be. So that's what a cognitive therapy looks at. So, yeah, so. So those are a pretty safe bed as well. And. Yeah, so I think that answers that one. Next one. People were talking about, like, phobias, and this is actually a common reason people come to treatment. But so what is a phobia compared to, let's say, like, a general type of anxiety? So some people come with phobias, and that would be having anxiety around a very particular trigger.

And it's typically really extreme for some people. It could be around driving. I've had people who have driving anxiety, a lot of people who get in an accident. You know, it could be someone fearing getting on the highway or driving on the highway, but it could also be a phobia of spiders, of loud things, of certain textures. Right. So it's basically a phobia is having a fear of something that is outsized compared to the level of risk that that presents. So, like, if I'm living in Minnesota here, which I am, and I go to the lake for a swim and I'm afraid of sharks, or I'm afraid of whatever could be lurking under the surface, and a lot of people have that.

But some people, to the point where it's like, has a negative impact, where they want to go swimming but they can't, or they don't want to go on a boat or, you know, the key is this is something that really has a negative impact. Now, we all sometimes have these irrational fears, things that kind of ick us out, and that's, you know, fairly normal. But when it affects you to a point where you can't engage in these things, you otherwise would or causes such anxiety throughout your life that it takes up a lot of your mental head space, then that may be something that's worth getting treated.

A couple of clients, the most common ones I've had are a couple people who had different driving phobias. And that's often associated with panic. That could lead people to have panic attacks, which are these really acute episodes of severe anxiety and overwhelming physical symptoms. Often people wind up in the hospital because they think there's something physically wrong with them and they're having a panic attack. So then the question, you know, how do we treat these phobias when they come up and that through a lot of different anxiety, severe anxiety, or even something like OCD, obsessive compulsive disorder, which is fairly related in a way where you have this intense fear if you don't perform a ritual, that something really bad will happen, whether it's, I have to, you know, touch the doorknob, like an even a number of times.

Otherwise something really bad is going to happen or have to wash my hands multiple times or I'm going to get sick if I don't do it like 20 times and, you know, checking behaviors, I have to check my alarm 20 times to make sure it's set correctly. These are all related. I feel like diphobia is kind of these almost sometimes compulsive or more obsessive mindsets around a certain trigger. And one of the most tried and true interventions for phobias is typically something having to do with exposure.

Regardless of the type of therapy. There is exposure therapy, prolonged exposure therapy, some of these things that also apply to trauma and trauma triggers. So it's basically desensitizing yourself to these triggers. So having gradual exposure, for example, like, if I'm afraid of spiders, right? It may start with just, you know, thinking about it, you know, sitting there and thinking about it and sitting with it until your anxiety goes down. And maybe that goes to having a little tornado spider next to you and then multiple, and then maybe actually having a spider in a box or, you know, something like that, where you gradually expose yourself to it and use coping skills, you know, like deep breathing, meditation.

And even just facing those fears for a prolonged period of time will help lower it and lower your sensitivity to the point where it doesn't really affect. So it's really a gradual way of facing those fears in a. In a way that escalates, that gradually becomes more intense compared to the level that you can handle it. And so it's. You don't want to push clients to a point where they're like, have a panic attack or freak out, like, right away. You want to slowly want to find what's okay. So. So it's like, you always rate like, all right, this makes me a level three anxious.

All right, so we're going to work with that trigger till it becomes less than a three, and then we're going to move up to something that's higher. And then as you go, it gradually becomes less intense and less fearful. So again, this applies to phobias, but this works for a lot of different types of anxiety, anxiety triggers, panic triggers, PTSD triggers, phobia triggers. Right. So it's a really beneficial type of therapy for that. So the last question is about borderline personality disorder. And I've talked about that multiple times in here about some of the different personality disorders.

But this individual on social media was like, I hear this all the time. Like, please break it down. Like, I like, detailed. I need to understand it. And it is, you know, fairly complicated in a way. So I figured I'll try to break it down in the easiest way possible because it is one of the most common, if not probably the most common, personality disorder. So on a broad view of personality disorder is having a pattern of behavior and way of interacting with the world that is extreme and problematic within the context of one's culture, right?

So exhibiting extreme types of behavior, and each, there's about eleven or twelve personality disorders that are all a different pattern. Some are kind of odd. I mean, this is what they say, like, literally, like, kind of odd type behaviors. Some are dependent type behaviors, and some are more lack of behavioral and emotional control. And that's what this one would fall into. Borderline personality disorder called that cluster b, which is four personality disorders that are characterized by a lack of behavioral and emotional control.

One being narcissistic personality disorder. Like feeling like you deserve and more than so, like narcissism. Be like, kind of like a self obsession, a lack of empathy, a feeling like you deserve more, regardless of the effort you put into something that you deserve more recognition and, you know, special treatment. And then you have, like, antisocial personality disorder, which is more like kind of criminal in nature, more predatory. You know, someone like, defrauds people and charities, and a very high percentage of people in prisons have this pattern.

And then you have, what was the other one in that category? Like a histrionic personality disorder. One of a way of interacting the world in a superficial, maybe manipulative type way, a dramatic type way, and then borderline personality disorder, which is, you know, a lack of ability to emotionally regulate and chronic suicidal type behaviors and other self soothing destructive behaviors and attachment. So I think that's like, the best way to look at it is how do I usually describe it? Is basically, I always joke.

Instead of BPD, borderline personality. Personality disorder should be called, like, emotional regulation and emotional regulation, destructive behavior and attachment disorder. I forget what. I have a funny little five letter system for it. But yeah, those are the three components. Difficulty regulating emotions, acting out in self destructive behaviors like substance use or self harm. And then the last one would be the attachment. So fearful type attachment, fear of people leaving you in trouble in interpersonal relationships is usually how that one's categorized.

And one really key element to someone who really struggles to manage their emotions. Maybe a lot of anger outbursts, a lot of behaviors that may seem bizarre as far as, like, that may come off as, like, manipulative and. Yeah, like I said, the self harm piece. A lot of substance abuse and fear of people leaving you, or almost having sometimes almost, like, delusions of how people view you and in those relationships are very difficult. So these folks often wind up in therapy because they usually wind up in the system because maybe they end up in the hospital for suicidal ideation or self harm.

And, you know, but there's some really good therapies. We're talking about treatment orientations like dialectical behavioral therapy, which is one of the cognitive therapies that's all about really a strong emphasis on learning and using coping skills consistently and persistently in order to help regulate your emotions and have better skills interpersonally, you know, not acting out in self destructive type behaviors. And it's really good for a whole bunch of different you know, it's actually a lot of wisdom in there, like how to cope with life.

So it's a really, really good program that people, a good orientation people do. And so borderline people. Why the h*** they call borderline? Borderline, and it's kind of an older term that was kind of thought to be on the border of neurosis and psychosis. So neurosis being a proneness to negative emotions like depression and anxiety and then psychosis, actually delusions. That one's kind of interesting of like, why would it be, you know, psychosis? Because usually it isn't characterized by psychosis, but sometimes that person may be in a delusional type state.

I talked about how their perception may be really skewed to the point where it almost seems like they're in this frantic type state of needing to get their needs met. So, I mean, a lot of people criticize the way it's described. Of course, times change and is a very old term, and that's why I joke about, you know, coming up with a different set of letters for it, even if it's maybe five or six letters long, because it can be complicated and hence why the person asked this question. Yeah. So what else can I say about borderline personnel?

I mean, the other probably main thing that people would scream at me if I didn't mention is the presence of trauma. So usually people who have borderline personality disorder, borderline personality disorder traits have experienced severe trauma. And, you know, just like anything, it's a spectrum. Some people, I feel like can exhibit a lot of the traits, but maybe don't meet the full criteria. Basically, I always say it's like if you take someone who's very sensitive, maybe struggles with intense emotions, struggles to manage intense emotions, someone maybe who has more of a preoccupied, what we call an anxious attachment, a fear of people leaving them, and an engagement in relationships that may almost be overbearing.

Right. So it's kind of a. I don't say personality type, but, you know, we're all born with certain personalities outside of the box. So, you know, if you take any person and add a ton of trauma and adverse life experiences, their personality, their tendencies can become so extreme that it morphs into what we would call a personality disorder. So in this case, there's usually a strong, strong, strong presence of childhood trauma. But I think the thing with BPD is with really good treatment, with really good engagement, folks get better than and they no longer meet the criteria for it.

I've seen a lot of people get better and they don't necessarily have to say they have that anymore if they don't want to. It's in remission like any other disorder, physical ailment. So I think that's the good news. And I find that people with BPD often do really well if they continue to engage. They really like therapy. They find a lot of benefit for therapy, from therapy. They usually attach well to their therapist, hopefully in a healthy way. But when they're engaged, they do quite well because they're at its worst.

They're in a very persistent and consistent state of anguish, of a mental, emotional, psychological, sometimes physical anguish. And their life is extremely difficult. And so oftentimes you're really motivated to live a different life. So, yeah, hopefully that is interesting, any one of those three questions. But I really encourage you all to go on the community feed and tag me or post any other questions I'll probably see. And then I could answer it in the next live session. Or if you just go watch any of my videos and have follow up questions, just comment, I'll probably, probably see it there too.

And in two weeks, on the next episode of Mental Health Matters, I will answer those questions. So anyway, it was fun being here with all you and have a good rest of your day.