The Gift of Self-Forgiveness

You’ve fallen off the diet wagon. Again.

Six months later and you’re still not pregnant.

Two weeks have passed since you’ve set foot in that gym.

If this were you, what would your reaction be? Inevitably, we all end up failing to reach our goals sometimes, and sooner or later even the most disciplined person is going to have a lapse. What happens then?

Odds are, you will react to this by treating yourself harshly. You might call yourself lazy, unmotivated, a failure, or other epithets unsuitable for a family blog. This might be a typical reaction for many people, but alas it is an extremely unhelpful one. Treating yourself harshly in face of setbacks, such as by becoming self-critical, can backfire by making you even less likely to succeed in the long-run. The reason for this has to do with shame.

When we do something wrong, it is normal (and often healthy) to feel some amount of guilt. Guilt is when we feel bad for what we did. However, often we instead shame ourselves. Shame is when we feel bad for who we are. So instead of saying to yourself, “I shouldn’t have eaten that piece of chocolate,” you instead might say, “I’m a pig!” This self-shaming then lowers morale, worsens feelings of anxiety or depression, and can create a downward cycle.

So how to stop this cycle of self-shaming in the face of mistakes? With self-forgiveness! Self-forgiveness, also often referred to as self-compassion, involves cutting out the self-shaming and instead actively working to bring peaceful, calming feelings to the perceived failure. Not only does this improve your self-esteem and mental health, but it can also increase your motivation to self-improve!

Here’s one way to practice self-forgiveness:

1. Identify the mistake (e.g., “I cheated on my diet.”)
2. Take responsibility for what happened (e.g., “Nobody forced me to do it, I made the choice.”)
3. Take a few moments to think about the incident, and pay attention to what comes up for you. Listen closely for any messages of self-condemnation (e.g., “I’m a failure; I’m fat; I’m weak.”)
4. Remind yourself that those messages of self-condemnation are not true. They are simply negative messages you have received from the past and from the outside world. They are not you.
5. Close your eyes, take a few deep breaths, and give yourself some positive affirmations, such as reminding yourself that mistakes and setbacks are a normal part of growth, and that you are worthy as a person.
6. Tell yourself, out loud if possible, that you forgive yourself and that you will continue to do your best.

 
There are many ways we can practice self-compassion and self-forgiveness. Can you think of others? They can be quick and easy, such as simply giving ourselves a big hug, or laughing at our own mistakes instead of shaming ourselves for them.
The key is that, because many of us are used to treating ourselves so harshly for most of our lives, self-forgiveness takes some active effort on our part as well as repetition for it to sink in. It’s ok if forgiving yourself does not immediately make you feel better. This is a practice that plants seeds for the future, and the more you practice it the better you will get at it. Treat yourself as well as you deserve!

References:
Breines, J. G., & Chen, S. (2012). Self-Compassion Increases Self-Improvement Motivation. Personality and Social Psychology Bulletin, 38(9), 1133–1143. http://doi.org/10.1177/0146167212445599

Dealing with the Diagnosis of PCOS

A diagnosis of Polycystic Ovary Syndrome (PCOS), or any other chronic illness, changes your life. The formal diagnosis might have been preceded by years of battling with mysterious symptoms, feelings of inadequacy or shame, the trials of judgmental or unsupportive family members or friends, and a deep feeling of anxiety about just what the heck was going on with you. How does getting such a diagnosis affect you? How do you cope and move forward?

Different people will react to being diagnosed with PCOS or another chronic illness in a myriad of ways. For some, receiving a diagnosis might feel like a relief after a long and exhausting search for an answer. For others, a diagnosis might feel more like a life sentence.

Many negative reactions to receiving a serious diagnosis are common. Fear, for example, might be the most common of all. Receiving a serious diagnosis can feel terrifying for the patient, as they struggle to wrap their heads around what it might mean for them, their family, and their future. Another common negative reaction is anger. Even for those whose diagnosis feels like an answer to a mystery, they might feel angry at the time and energy they have lost searching for answers. Anger might be sparked by thinking about the delays in getting diagnosed and treated. Often, such anger may co-exist with, or even be covering up, deep feelings of loss and grief. People who receive a serious diagnosis like PCOS must give themselves the time and space to grieve and heal. Being diagnosed with PCOS can mean needing to face a restructuring of one’s identity and expectations for the future.

On the other hand, many women experience positive reactions to finally being diagnosed with PCOS. For example, often there is a feeling of gratification at finally having an answer. Without a diagnosis, a woman might have been struggling in the dark for years with mysterious symptoms and dismissive doctors. A formal diagnosis can have a tremendously validating impact on a woman by proving to herself and others that she is not crazy, and that there really is something wrong. Furthermore, getting diagnosed can give the years of preceding pain and confusion a sense of meaning. Rather than struggling against a strange and nameless foe, a diagnosis allows the person to marshal their resources against a specific and well-defined enemy. Finally, a diagnosis provides a label for one’s health problems that can be easily communicated to others. It provides a common language with which to communicate your health concerns and needs.

One other benefit of receiving a formal diagnosis is that it is a necessary and important step in the road to long-term adjustment to chronic disease. Researchers recommend that patients with a chronic disease, like PCOS, should take several concrete steps to begin adjusting to their diagnosis. One is maintaining an active lifestyle, with regular exercise, as this not only boosts your physical health but also improves your mood. Another recommendation is to express one’s emotions fully and constructively, be it to partners, friends, or helping professionals. This is where a qualified health psychologist (like me!) can really come in handy, by helping you learn how to effectively communicate your needs and feelings in order to reduce stress and build supportive alliances with others around you. In addition, researchers recommend that patients actively engage in self-management of their condition, such as mobilizing personal resources, balancing, pacing, and prioritizing your lifestyle, and recognizing and monitoring your own personal boundaries, such as your energy levels and work hours.

Finally, healthy adjustment to a chronic disease involves trying to find the hidden positive outcomes of the disease. While a disease like PCOS can cause numerous unwanted and even traumatic outcomes, such as infertility, there is the possibility that adjusting to the condition may result in improved appreciation of life, an enhanced sense of purpose, better attention to self-care, and improved communication and/or relationships. The road of having PCOS or some other chronic condition is certainly not easy, but it also has the potential for hidden upsides.

References:
de Ridder, D., Geenen, R., Kuijer, R., & van Middendorp, H. (2008). Psychological adjustment to chronic disease. Lancet (London, England), 372(9634), 246–55. http://doi.org/10.1016/S0140-6736(08)61078-8

Dating with PCOS: How to NOT Freak Out

If you’re new to dating, the whole thing can be kind of strange and terrifying. If you’ve been at it a while, you may be feeling less optimistic, a little jaded, or even have experienced some deep hurt in the process. One of the most daunting things facing women with PCOS is how to handle PCOS-related topics while dating. Here are some tips on how to bring up the subject.

Early Dating: Surface Exploration
If you’re serious about finding a relationship partner, the purpose of a first date is merely to determine if you’re interested enough to have a second date. Because PCOS is an unknown for most people, and it’s a “disease,” treat it the way you would handle any other bad news. You don’t want to talk about your crazy ex, the abortion you had in high school, your mother’s alcoholism, or anything else that might scare someone off. Same with PCOS.

This is not about lying; it’s about becoming more intimate in a gradual and meaningful way that strengthens a growing relationship, while protecting you from injury by someone who isn’t attached enough to be decent and thoughtful, and may just bail out on you.

Next Stage Dating: Getting Intimate
This means getting more intimate emotionally as well as physically. As a health psychologist, I’m all about protecting and promoting your health, so of course I’ve got to throw in a reminder about having a talk about pregnancy and STDs. And what a great opportunity to start opening the lines of conversation around PCOS! You might say something like “I have something called PCOS, which means that getting pregnant is much less likely for me, and…condoms are still a priority for me (or, “I’m on birth control because of my PCOS, but we still need to use condoms to protect both of us.”).

If your partner is female or trans, it’s still good to have the STD conversation, because no one’s exempt. It just changes the conversation a bit. You might say, “Before we go any further, I need to let you know something about my health. I have PCOS.” If it’s your style to be funny or dramatic, feel free to use a dramatic pause so that they’re freaking out thinking you might have a STD; that way PCOS sounds like nothing! If you’re afraid that PCOS will scare someone off, yes, it could. But it’s not likely – and wouldn’t you rather know now than when you’re two years down the line and planning a wedding?

More Mature Relationship: Grooming, Mood Swings, and More
I have a friend who thinks couples should know/do/see everything about the other person. Her husband says: “Mystery! Please, maintain a little mystery!” The more time you spend together, the more likely your partner is to notice any discomfort you have with your body. You can hide your early morning shave for a long time, but eventually a pesky random hair is going to protrude and get noticed. Acne and hair loss are visible no matter what. Most people won’t ask. But if you would feel more comfortable bringing attention to it, do so with kindness to yourself, and like it’s not a big deal, and you’ve got it covered. Something like “You might have noticed that my hair is thinning a little. I’m kind of embarrassed, but I’m seeing a good dermatologist, so don’t worry that I’m going to end up looking like The Rock.” (As you can see, I really like to insert a little humor into painful and uncomfortable situations.)

Deeper subjects, like infertility or PCOS-related depression/anxiety/mood swings, can be approached when you have built trust in your partner. Appropriate timing, respecting your own needs for privacy as well as for self-disclosure, and a little humor will go a long way in easing your new beloved into the subject of PCOS.

Gretchen Kubacky, Psy.D., “The PCOS Psychologist,” is a health psychologist in private practice in Los Angeles, California. She a Certified PCOS Educator, and the founder of PCOSwellness.com. You can contact Dr. Kubacky at AskDrGretchen@gmail.com.

Antidepressants: What are they, and how do they work?

If you struggle with depression or anxiety, you may have heard your psychologist (or a partner, or a particularly nosy friend) recommend taking antidepressant medication. But what exactly are antidepressants, and how do they work? And what might be some other alternatives?

Before we get into the nitty-gritty details of how antidepressants work, we first need to discuss some basic brain anatomy. As you may know, brain cells are called neurons, and while there are many types of neurons, they share a basic structure. Branching off from the cell body are various branches (like on a big oak tree) called dendrites. At various points along each dendrite it will touch the dendrites of other neurons, and these points of connection are called synapses. Think of a synapse as like two hands meeting for a handshake. Neurons communicate together by passing special chemicals called neurotransmitters from one cell to another through these synapses. The neurotransmitters most commonly implicated in depression and anxiety are serotonin, dopamine, and norepinephrine.

Some theories argue that depression and anxiety are caused, in part, by deficiencies of these mood-related neurotransmitters in certain parts of the brain. Antidepressant medications aim to help correct this by boosting levels of these neurotransmitters. When one neuron signals another, it releases a neurotransmitter into the synapse, or into the tiny space between where the two dendrites touch, which then pass into the other neuron. After a short time, excess neurotransmitter molecules are vacuumed back up by the first neuron in a process called reuptake. Antidepressants often work by inhibiting this reuptake process, which boosts the overall amount of neurotransmitter molecules in the synapse, which (in theory) aids neural signaling and can ease depression and anxiety symptoms.

The most common types of antidepressant medications, therefore, are named after this process and the type(s) of neurotransmitters they work on. For instance, the most common type of antidepressant medication is called a Selective Serotonin Reuptake Inhibitor (SSRI). Other common types include Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) and Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs). In addition, there are numerous other less-common types of medications, such as mood stabilizers, tricyclic and tetracyclic antidepressants, and atypical antipsychotics (so named because, at higher doses, they are used to treat schizophrenia and related disorders). Antidepressant medications are generally well tolerated, but common side effects include difficulty with sexual arousal or orgasm, minor weight gain, and upset stomach.

If you are suffering from depression or anxiety, it is important to consult with a licensed and qualified psychiatrist or psychiatric nurse practitioner about the benefits and drawbacks of these medications, and to find the right one for you. Often, several medications may need to be tried in order to find one that works well with no, or very few, side effects. Don’t worry, this is normal! While general practitioner doctors can prescribe antidepressants, they often have less training and knowledge about them than specialists such as psychiatrists.

It is important to note that prescription medications are far from the only effective treatment for depression! First off, psychotherapy with a qualified and licensed psychologist (like me!) has been proven to be effective at treating depression and anxiety. In particular, psychotherapy plus medication are often more effective than either one alone.

Second, regular aerobic exercise has been shown to be practically as effective as antidepressant medications, with the only “side effects” being better health, reduced weight, and improved cardiovascular functioning!

Finally, there are a number of over-the-counter supplements that you can take which have antidepressant effects. These include Sam-E, St. John’s Wort, and 5-HTP. Some of these supplements may have their own side effects or may interact with other medications you are taking, so make sure to ask your doctor or psychiatrist first before starting to take them!

Depression and anxiety are very common problems that many people struggle with at various points in their lives. If you believe you may suffer from these conditions, please know that it does not mean there is anything “wrong” with you, and remember that successful treatment is possible! Speak to your psychologist and doctor about your concerns and get the help you deserve!

References:

Bet, P. M., Hugtenburg, J. G., Penninx, B. W. J. H., & Hoogendijk, W. J. G. (2013). Side effects of antidepressants during long-term use in a naturalistic setting. European Neuropsychopharmacology, 23(11), 1443–1451. http://doi.org/10.1016/j.euroneuro.2013.05.001

Blumenthal, J. A., Smith, P. J., & Hoffman, B. M. (2012). Opinion and evidence: Is exercise a viable treatment for depression? ACSM’s Health and Fitness Journal, 16(4), 14–21. http://doi.org/10.1249/01.FIT.0000416000.09526.eb