What to Talk About in Therapy: 16 Ideas

Consider the following scenario. You have just scheduled your first appointment with a therapist. In a consultation, you discussed what you’re interested in treating. You feel good and proud of yourself for taking this big step. However, there is one problem: you feel unprepared! What can you expect? What will you talk about? 

Understandably, you may feel nervous if this is your first time going to therapy. Being vulnerable with someone you just met can seem intimidating and challenging. But don’t worry! This blog will cover 16 helpful ideas you can use to prepare for your next session. 

What Can You Talk About in Therapy?

You can talk about anything in therapy! Thinking of the past, present, and future can be helpful. You could journal these thoughts in advance. But if you’re not sure, the therapist will help you with the answers to these questions.

  • What brought you here?
  • What are your goals for therapy?
  • How will you know when you have met your goals?

Some of those goals could be increased self-compassion, the ability to manage anxiety, or to connect more effectively with other people. Whether you are just starting therapy or you are in the middle, here are 16 topics you can discuss.

1. Explore Traumatic Events

Talking about traumatic experiences, whether recent or from your past, can be challenging. Your therapist can help you understand how past trauma has affected you and move towards healing by discussing it in a safe and supportive environment.

Your therapist can also provide tools and strategies to help you cope with the pain so you don’t feel consumed by it. By exploring these traumatic events, you can gain insight into why certain thought patterns or behaviors occur and learn how to respond better in the future.

2. Unhealthy Behavior Patterns

It is important to recognize unhealthy patterns of behavior such as substance abuse, self-harm, OCD, or codependency so that we can address them. In therapy, we can explore these patterns to gain insight into why we engage in them and devise a treatment plan to deal with our issues in a more healthy manner.

3. Setting Goals and How to Work Toward Them

A good place to set goals for yourself and make positive changes in your life is in therapy. Talking about your goals and how you plan to achieve them can help you stay accountable and provide support every step of the way.

You can stay motivated on your journey to self-improvement by discussing the progress you’ve made, obstacles you’ve encountered, and adjustments you’ve made.

4. How to Express Emotions in a Safe Space

Being able to express your emotions can be challenging, especially if you haven’t been taught. Therapy can help you identify and recognize your feelings, as well as provide a safe place to do so without judgment or criticism. By understanding why certain events evoke certain emotional responses, your therapist will be able to provide you with the tools necessary to manage them effectively.

5. Identify and Manage Your Triggers

There are a wide variety of triggers that cause intense emotions or behaviors, such as panic attacks. Talking about these in therapy can help us gain insight into why they occur and how to deal with them. You might learn relaxation techniques, tools for grounding yourself, or ways to deal with difficult people.

6. Develop Self-Care Strategies

In order to maintain good mental health, self-care is essential, but it’s not always easy to do. When we discuss self-care strategies in therapy, we can develop a personalized plan for how to take care of ourselves. Establishing systems of support, setting boundaries, or finding activities that help you relax and recharge may be part of this process.

7. Process Grief and Losses

There is no doubt that grief and loss can be stressful topics to discuss and that people may experience PTSD as a result, but talking about them is also a valuable part of the healing process.

During this difficult time, discussing these feelings with your therapist can provide much-needed compassion and understanding. Furthermore, it may enable you to see how things might have been different if the loss had not occurred, and it may help you move forward in a more healthy way.

8. Professional Support & Guidance

No matter what topic you choose to discuss, a therapist provides guidance and insight so that you can better understand yourself and learn strategies for managing difficult emotions and situations in a positive manner.

9. Create a Support System

Talking to a therapist can help build a therapeutic relationship. It helps you identify resources and people in your life who will be able to provide support when needed for both you and your family members or friends.

10. Establishing Healthy Boundaries

Therapists can help you recognize what boundaries are healthy for you and how to set them so that you don’t overcommit yourself or allow others to take advantage of your generosity.

11. Understanding Relationships & Communication Styles

Therapy can also be used to explore relationships with others and communication styles that are most effective for each individual. By doing so, we can identify patterns of behavior that may be causing friction in our relationships and learn how to communicate more effectively.

12. Learn Ways to Combat Stress & Anxiety

If stress and anxiety are not managed properly, they can have a negative impact on our mental health. By talking about ways to cope with stress and anxiety, we can create an action plan for reducing their effects. This could include learning relaxation techniques, going on regular walks, or having positive outlets for expressing emotions.

13. Address Childhood Trauma

Often, childhood trauma is buried deep inside of us, but it can affect our day-to-day lives. Healing from the past and moving forward in a healthier way requires talking about it. By talking about traumatic experiences with a therapist, you can gain insight into how they may affect your current life.

14. How to Recognize Signs of Burnout & Stress

In addition to providing support and guidance, a therapist may be able to suggest strategies for managing burnout or stress in a healthy way. This may involve getting more sleep, exercising regularly, or creating a plan for managing tasks and obligations.

15. Resolving Conflicts & Managing Anger

Therapy sessions can also help you resolve conflicts in your relationships and manage anger more constructively. It may mean identifying triggers, setting more effective boundaries, forming coping strategies, and understanding the best communication styles for each individual.

16. Dangerous, Frightening, or “Taboo” Thoughts

We all experience thoughts that can make us feel ashamed, embarrassed, or scared. Through therapy, we can understand why these thoughts arise and work on managing them more effectively by discussing them in a safe, supportive environment. As a result, we can ultimately reduce their impact on our well-being. Furthermore, we can learn how to challenge negative thinking patterns that contribute to these thoughts.

Final Thoughts

These are just some of the topics that can be discussed in therapy. Remember not to put too much pressure on yourself when going to therapy, there is no right or wrong thing to discuss in therapy. Your therapist is there to support you no matter what topic you choose. Through their guidance and insight, you will gain a deeper understanding of yourself, as well as learn how to deal with difficult emotions or situations. 

If you feel like the support of a therapist could help, contactour Care-Coordinator, and we will answer your questions so you can start prioritizing your mental well-being today!

Unveiling the Message: What Your Anger is Trying to Tell You

Anger, often perceived as a negative emotion, is a natural response that humans experience from time to time. While it’s easy to label anger as “bad,” it’s essential to recognize that emotions, including anger, serve as signals from our inner selves. Rather than suppressing or dismissing anger, understanding what it’s trying to communicate can lead to personal growth, improved relationships, and emotional well-being. In this blog, we’ll delve into the underlying messages that anger holds and how to harness its power for positive transformation.

1. An Alarm for Boundaries

Anger frequently arises when our personal boundaries are crossed. These boundaries encompass our values, beliefs, and limits we establish to ensure our emotional and physical well-being. When anger surfaces, it could indicate that someone has violated those boundaries. Exploring the source of your anger can help you identify which boundaries have been breached, allowing you to communicate assertively and reinforce those boundaries.

2. Unmet Needs and Desires

Anger can be a signal that your needs and desires are not being fulfilled. It’s a call to pay attention to your inner desires and reflect on what’s missing from your life. Whether it’s a need for respect, validation, or autonomy, acknowledging these feelings can guide you toward making positive changes that align with your aspirations.

3. Injustice and Fairness

Anger often arises in response to perceived injustices or unfair treatment. This emotion can indicate a deep sense of empathy and a desire for a more just world. By exploring the source of your anger, you might uncover a passion for advocating for equality and making a difference in the lives of others.

4. Suppressed Emotions

Unresolved emotions, such as sadness, frustration, or fear, can manifest as anger. If you’ve been avoiding or burying these feelings, anger might be the way your mind is expressing them. Acknowledging and addressing the underlying emotions can lead to a healthier emotional state and a better understanding of yourself.

5. A Call for Self-Care

Prolonged stress or neglecting self-care can lead to heightened irritability and anger. Your anger might be telling you that it’s time to take a step back, evaluate your stressors, and prioritize self-care activities that rejuvenate your mind and body.

6. Communication Breakdown

Anger often arises when communication breaks down. Whether it’s miscommunication, unexpressed feelings, or misunderstandings, your anger might be urging you to address these issues. Learning effective communication skills and expressing your thoughts and emotions can lead to healthier relationships and a more peaceful existence.

7. Fear of Vulnerability

Anger can serve as a defense mechanism, shielding you from feeling vulnerable. It’s often easier to display anger than to admit feelings of hurt or insecurity. Recognizing when your anger is masking deeper emotions can help you embrace vulnerability and foster more authentic connections with others.

8. Past Trauma and Triggers

Past traumatic experiences can lead to heightened anger in certain situations. Your anger might be triggered by events that remind you of those past traumas. Recognizing these triggers and seeking support to address unresolved trauma can lead to emotional healing and a reduction in reactive anger.

Final Thoughts

Anger is a multifaceted emotion that carries invaluable messages if we’re willing to listen. Instead of suppressing or acting on it impulsively, take the time to reflect on what your anger is trying to communicate. By deciphering the underlying messages, you can gain insights into your boundaries, unmet needs, passions, and unresolved emotions. This self-awareness empowers you to respond to anger in constructive ways, fostering personal growth, improved relationships, and enhanced emotional well-being.

If you need help managing anger or figuring out what is causing it, the San Francisco Stress and Anxiety Center can help. Remember, your anger is not your enemy; it’s a messenger guiding you toward a deeper understanding of yourself and the world around you. Contact our Care-Coordinator today to get started.

10 Effective Coping Mechanisms for Overwhelming Emotions

Life is filled with a spectrum of emotions, ranging from joy and excitement to sorrow and anxiety. While positive emotions are a natural part of being human, we must also acknowledge the presence of overwhelming emotions that can leave us feeling vulnerable and struggling to cope. In times of distress, it is essential to have a toolkit of effective coping mechanisms to navigate these turbulent emotional waters.

1. Mindfulness and Meditation

Mindfulness and meditation practices are powerful tools for grounding ourselves during moments of emotional overwhelm. By focusing on the present moment and observing our thoughts and feelings without judgment, we can gain clarity and reduce anxiety. Regular meditation cultivates a sense of inner peace, allowing us to respond to emotions with a more centered and composed outlook.

2. Deep Breathing Techniques

Simple yet highly effective, deep breathing exercises can work wonders in calming an anxious mind. By taking slow, deep breaths, we activate the body’s relaxation response, which counteracts the physical manifestations of stress and anxiety. Incorporating deep breathing into your daily routine can help you manage overwhelming emotions with greater ease.

3. Emotional Expression Through Journaling

Writing down our emotions in a journal can be a cathartic experience. Journaling provides a safe space to express pent-up feelings and explore the root causes of our emotional turmoil. By identifying triggers and patterns, we gain a better understanding of ourselves, leading to personal growth and improved emotional resilience.

4. Seek Support from Friends and Family

Never underestimate the power of a support system. Reach out to trusted friends or family members when emotions become too overwhelming to handle alone. Talking openly about your feelings can be a therapeutic experience and often leads to valuable insights and advice from those who care about you.


5. Engage in Physical Activity

Physical activity has a profound impact on our emotional well-being. Exercise releases endorphins, the body’s natural mood enhancers, reducing stress and promoting a sense of well-being. Whether it’s a brisk walk in nature, yoga, or a heart-pumping workout, regular physical activity can be a fantastic outlet for overwhelming emotions.

6. Creative Expression

Engaging in creative activities, such as painting, writing, dancing, or playing music, can be a therapeutic way to process and release intense emotions. Creative expression allows us to channel our feelings into something tangible, promoting healing and personal growth.

7. Establish Healthy Boundaries

Setting clear and healthy boundaries is essential in managing overwhelming emotions. Learning to say “no” when necessary and avoiding unnecessary stressors can prevent emotional overload and protect your mental well-being.

8. Practice Self-Compassion

Be gentle with yourself during challenging times. Practicing self-compassion means acknowledging that it is okay to experience overwhelming emotions and that everyone faces difficulties at some point. Treat yourself with the same kindness and understanding that you would offer to a friend in need.

9. Mindful Distractions

While it is essential to address overwhelming emotions, sometimes a temporary distraction can provide relief. Engage in activities that capture your attention and provide a sense of enjoyment, like reading a book, watching a movie, or spending time with a beloved pet.

10. Professional Therapy and Counseling

For some, seeking professional help through therapy or counseling is a crucial step in dealing with overwhelming emotions. Trained therapists at San Francisco Stress and Anxiety Center can provide guidance, tools, and techniques to address deep-rooted emotional issues and help you develop healthy coping strategies for the long term. 

To Sum It Up

Navigating overwhelming emotions is an integral part of the human experience. By embracing these coping mechanisms and incorporating them into your daily life, you can effectively manage your emotional landscape and find balance even in the most challenging times. Remember, seeking support and employing these strategies is a sign of strength, not weakness. Embrace your emotions, lean on your coping mechanisms, and embark on a journey of personal growth and resilience.

Need help managing some overwhelming emotions? Get started by contacting our Care-Coordinator here.

Get To Know Dr. Nicole Coffelt

SF Stress therapist Doug Newton, LMFT, sat down with Dr. Nicole (Nikki) Coffelt to chat about how she got started working as a psychologist, how she works with her clients, and more.

How did you become interested in psychology in the first place?

From a young age, I’ve been fascinated by human behavior.  I used to read author biographies before diving into fiction and nonfiction alike – as I felt their stories contextualized and enriched the stories they had written!

You seem to understand a lot about shame.  How do you support your clients to help them deal with shame?

I have extensive training in somatic experiencing, which deals with shame (especially developmental shame) on a deep, cellular level. We view this as an embodied experience – and one that is generally resistant to mere cognitive “reprogramming” or “restructuring”  Although the latter certainly does initially help to counter and challenge the shame-based conditioning we are all immersed in here in America, day in and day out .  I also like to focus on solutions with my clients, such as developing a nurturing and generative inner voice that will eventually become “louder” than the introjects that get in the way of a person stepping into their fullest potential.

How does a focus on the body help people work through difficult experiences and come into a more accepting sense of self? 

As Babette Rothschild once said, “The body remembers.”    We all store accumulated, pleasant and traumatic memories that can keep people stuck in overwhelming experiences from the past that will guide our present-day journey .  Incorporating the body in a safe, therapeutic container assists people in metabolizing past experiences so they can finally move forward with their lives .  Greater congruence between the mind and body, tapping more of their potential and encouraging overall nervous system health are just a few potential outcomes.

How do you think your personal experiences translate into helping your clients?  

I truly walk my talk .  I have been on a personal journey of recovery and healing for nearly two decades .  I understand intimately what it feels like to be broken, in total despair and also to reclaim the most essential parts of oneself in order to truly self actualize.  It is possible.  And so very rewarding .

Tell me about how you support the LGBTQ population?   

As a member of the LGBTQ community myself – these clients feel like home to me.  Marginalized populations often have unique experiences that people from more privileged, mainstream backgrounds simply don’t understand.  I work skillfully with those looking for a refuge in which to claim their brilliance, beauty and sovereignty – in a world continuously trying to erode and erase these aspects of the queer community .  

What have you found useful around building trust with clients who experience shame, self-blame and trouble with self-judgment?  

I have a warm and empathic style, and remain pretty neutral when working with clients’ self criticism . I bring in and teach the Jungian concept of shadow work and assist the client in transforming the deeper layers of their shame.

How do you weave the arts into your work with clients?  

I don’t directly do “art therapy” with people but my relational style is very curious, spontaneous and organic/spacious.  This comes directly from many years of the inner / outer work required of professional artists.

Interested in working with Nicole? Schedule your appointment here.

Managing ADHD Symptoms with Therapy

Treatment for Attention Deficit Hyperactivity Disorder (ADHD) includes medication and therapy for those aged six and older. There are many different forms of therapy, and one of the most common you might come across is cognitive behavioral therapy (CBT). It is often considered one of the most effective forms of therapy. This blog will explain how CBT works and how it can help with ADHD.

What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy, or CBT, is a widely used psychotherapy and talk therapy intervention. CBT aims to help individuals change their thinking patterns to make them healthier and more beneficial for them. Various types of CBT exist and can be modified to help people with various life impairments and disorders. 

There are many conditions in which CBT can be used, including anxiety disorders, depression, insomnia, eating disorders, relationships, stress, self-esteem, and, yes, attention deficit hyperactivity disorder. There are many ways to conduct CBT, including in groups, individually, or in other settings.

How CBT Helps with ADHD

It’s important to note that CBT does not address the “core symptoms” such as hyperactivity, inattention, or impulsivity of adult ADHD. However, it has other benefits that can assist individuals in their daily lives, such as:

  • Emotional regulation skills
  • Improving follow-through of tasks, decreasing procrastination.
  • Symptom management
  • Time management
  • Self-esteem and confidence.
  • If applicable, help with comorbid conditions.


Cognitive behavioral therapy uses various techniques in order to address the challenges associated with ADHD. During an ADHD treatment session, a therapist might use the following techniques with you or your child:

Goal-setting and planning

Goal-setting and planning are often part of various forms of therapy, including CBT. Therapists who specialize in cognitive behavioral therapy can help you complete tasks by teaching you to break them down into smaller, more manageable pieces or by using other techniques to make them easier to complete.

Different things work for different people; external tools like timers, schedules, routines, and adjusting beliefs that hold you back, especially for those that are perfectionistic in nature, are examples of tools that a therapist might work on with you to help you focus and be less distracted.

Cognitive reframing

Cognitive reframing involves transforming an unhelpful or maladaptive thought into one that is more helpful. As part of CBT, it is common to identify cognitive distortions. This is a term used to describe different types of negative thoughts or patterns of thought. Some examples of negative thought patterns are catastrophizing, labeling, and discounting the positive, and overgeneralizing.

As an example, let’s look at catastrophizing. A catastrophizing thought might be, “I’m having so much trouble with this assignment. I’ll never graduate!” This type of thinking can cause nervousness, sadness, and self-esteem issues. Cognitive reframing might allow you to change that thought into, “This assignment is challenging for me, but I can still succeed if I ask for help!” Using this perspective is both helpful and realistic.

Positive self-talk

Essentially, self-talk entails creating a positive internal dialogue. It is common for people with ADHD to struggle with perfectionism or self-esteem issues. Using positive self-talk techniques can help you adjust your internal dialogue so that it is kinder and more beneficial to your life so that you can achieve your goals and move through life with increased confidence.

Guided discovery

In guided discovery, a counselor or therapist asks questions or otherwise prompts the client to help them work through problems or approach things differently. This may relate to cognitive distortions you have and could go alongside cognitive restructuring practices.

For instance, you might say, “There’s no way I can accomplish this project at work. I am so frustrated with myself for not being able to carry out the task even when I know how to do it. I feel like I’m stuck!” Your therapist might ask you to describe a time when you accomplished a similar task successfully. By doing this, you can improve confidence and explore different ways of approaching the project so that you can get it done.

Relapse prevention

Creating a relapse prevention plan is one of the greatest things therapy can help with. A plan might be needed in this case if symptoms worsen or reappear. Many people find that CBT is effective in helping them create tools they can use outside of therapy sessions. This isn’t an extensive list of all of the techniques that can be used. Other tools, such as mindfulness, are also frequently used.

Effectiveness of CBT for ADHD

Several psychiatry research studies support CBT’s efficacy for ADHD. One randomized controlled trial following treatment for ADHD in 88 college students undergoing CBT found that participants showed significant improvements in executive functioning and a reduction in ADHD symptoms. The study also found a reduction in depression and anxiety symptoms, as well as a decline in ADHD symptoms.

Researchers found that these improvements remained 5 to 7 months after the group’s treatment ended. It was found that mindfulness-based CBT can support attention and emotional control well-being in adults with ADHD. Despite the study above focusing on adults, CBT is not just effective for adults with ADHD. Cognitive behavioral therapy can also be used for kids.

In fact, cognitive behavioral play therapy (CBT combined with play therapy) has been shown to reduce ADHD symptoms in children between the ages of 7 and 9. Older kids and adolescents are more likely to engage in forms of therapy such as CBT in a manner similar to adults. CBT’s effectiveness is likely due to neural plasticity. The term neuroplasticity refers to the brain’s ability to change, which is what CBT aims to accomplish.

Changing thought patterns through CBT techniques leads to new, healthier thought patterns becoming more natural over time. The use of CBT can be combined with other forms of treatment, such as ADHD medications. 

How Long Does It Take for CBT to Work?

Perhaps one of the most exciting things about cognitive behavioral therapy is that people often see results quickly. It is widely known that CBT can be highly effective as a short-term treatment; even just 12 sessions can help. Nevertheless, cognitive behavioral therapy often lasts longer than that. This way, individuals can get the most out of the experience and learn a variety of new skills that can help them in the future. You can attend therapy for as long as you need to.

CBT vs. Other Treatment Options

What are some other treatment options for ADHD, and how do they compare to CBT? Here are some forms of support and therapy that may be helpful:

  • Medication. Medications that stimulate the central nervous system (CNS) are highly effective in treating ADHD. In fact, central nervous system stimulants help 70 to 80% of ADHD sufferers reduce their symptoms. There are also non-stimulant ADHD medications available.
  • Other forms of therapy. There is evidence that other therapies, like acceptance and commitment therapy, can also reduce the symptoms of ADHD.
  • Accommodations. In addition to treatment, many people with ADHD require accommodations.
  • Occupational therapy for ADHD: helps develop and regain meaningful activities in everyday life
  • Parent training. A parent training program can be helpful and is recommended for parents of children with ADHD.
  • Games and behavior-tracking apps. In some studies, games used to treat ADHD can increase attention by 68% within 90 days.

Do you suspect you have ADHD?  There is no cure for ADHD, but research on cognitive behavioral therapy suggests that symptoms can be improved. You should consult your doctor before changing a physician-recommended treatment regimen.


Cognitive behavioral therapy (CBT) is a common, well-researched, and non-invasive method of treatment for various concerns and conditions. It has been shown that this form of therapy can help people with ADHD meet a variety of goals they may have. CBT can also help with comorbid conditions such as anxiety, depression, bipolar disorder, and insomnia. 

ADHD is a disorder that can be disabling to different extents. CBT can benefit people of all ages with ADHD, even though some adjustments may be made to the therapeutic process depending on the person’s age. If you or your child are showing symptoms of ADHD, the San Francisco Stress and Anxiety Center can help, connect with an expert today.

Navigating Family Relationships When a Loved One Has Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious mental health disorder that affects how a person sees themselves and others. Their unstable sense of self, intense fear of abandonment, erratic mood swings, impulsive behaviors, and unpredictable, intense emotional reactions can make it difficult for them to maintain healthy relationships, even (or maybe especially) with the people that matter most to them. People with BPD suffer from emotional dysregulation that makes it difficult for them to manage their own extreme emotional responses, and they may turn to unhealthy behaviors like violence, self-harm, or substance abuse to attempt to cope with emotional pain.

In the context of family relationships, the struggles of somebody with BPD have a negative impact on everybody in the family. Often family members describe their experience with a child or parent with BPD as feeling like they’re walking on eggshells, unsure of when they will unwittingly provoke an outburst, or a rollercoaster, in which moments of happiness and hope for improvement are rapidly replaced with anxiety and fear as their loved one lapses into destructive behavior again.


Borderline Personality Family Dynamics

When one family member has BPD, the overall experience is one of instability. One moment they may be loving, the next, lashing out. A child may be skipping school, or their self-destructive behavior may escalate to a suicide attempt. A parent with BPD may be overly attached and controlling or demonstrate affection inconsistently. Ongoing unpredictability skews how the family interacts with one another.

Stress and worry are constant, as family members fear for their loved one’s well-being. Guilt is another common feeling—parents may feel responsible for their child’s mental health and behavior, or children may feel that they somehow caused a parent’s mental illness. They may also feel exhausted or helpless when previous attempts to set healthy boundaries or provide support haven’t worked.

To complicate the issue, a family history of BPD or early disruption of family life are both risk factors for developing BPD. If you have BPD, you may not be the only one in your family struggling with their mental health, and parents may have unconsciously passed on patterns of toxic family relations. Improving family relationships often requires getting help for everyone, not just the family member with borderline personality disorder.


Starting with Self-Care

Therapy is the main form of treatment for BPD, helping you understand the disorder, improve your response to someone with BPD, learn to manage uncomfortable emotions and your response to their impulsiveness, as well as,  improve your relationships. Dialectical behavior therapy (DBT), a form of treatment developed by clinical psychologist Marsha Linehan, is considered one of the most effective types of therapy for BPD and those who are in the circle of someone with BPD.

DBT focuses on improving life skills through:

  • Distress tolerance: Learning how to tolerate negative emotions so that you don’t react impulsively or self-destructively.
  • Emotional regulation: Learning to recognize and handle emotions to improve control over thoughts, behaviors, and feelings.
  • Mindfulness: Learning to be focused on the present as well as nonjudgmental of yourself and others.
  • Interpersonal effectiveness: Learning skills to better handle relationships, such as how to communicate more effectively, how to advocate for yourself and set healthy boundaries, how to build relationships, and how to end relationships that aren’t healthy.

By cultivating acceptance and balance, patients are able to validate the emotions they’re experiencing while addressing and changing problematic behaviors.

Therapy can help you understand your triggers and put effective coping mechanisms in place before you need them. This might mean things as simple as stopping to use a breathing exercise or listen to music to ground yourself before negative emotions spiral out of control. It may mean knowing when to step away from a situation and giving yourself time to collect your thoughts and calm down. With these kinds of tools, you’ll be better equipped to work on your relationships with your family in a healthy, productive way.


Developing Better Relationships

When a family has been coping with borderline personality disorder, it’s likely that the person with BPD isn’t the only one who will need to learn healthier ways to interact. Family therapy can be extremely helpful in preventing parents and kids from slipping back into patterns that may be unintentionally triggering or enabling negative behaviors. The guidance of a mental health professional can also help a family learn how to better support your recovery, enabling them to replace feelings of helplessness and frustration with the rewarding sense of being able to help you make progress toward your goals. Families may also want to join a support group to connect with others who share their experience.


Finding Help

If BPD has upended your family, positive change is possible. Therapy can be instrumental in helping give you and your loved ones the tools to build the healthy relationships you want. To get connected with a therapist who can help with either online or in-person sessions, contact the SF Stress & Anxiety Center here. We’ll schedule a free initial phone consultation with one of our compassionate Care Coordinators to match you with the right therapist for your needs.


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Managing Stress and Anxiety When You Have ADHD

For somebody who has been diagnosed with ADHD (attention deficit hyperactivity disorder), stress and anxiety may be constant unwanted “bonus” problems that seem difficult, if not impossible, to separate from the disorder itself. While the symptoms of ADHD can look different in adults and children, the inattention, impulsivity, and restlessness/hyperactivity that characterize it tend to make even simple tasks at home, school, or work harder to complete. Daily life can become an ongoing source of uncertainty, worry, and stress—in fact, anxiety disorders are one of the most frequent comorbid diagnoses among adults with ADHD.

Of course, the relationship between ADHD and anxiety isn’t necessarily that simple. It can be a bit of a chicken-and-egg problem to figure out whether ADHD is the cause of anxiety or if they are issues that exist side by side. Either way, learning to cope with stress and anxiety when you have ADHD can help make treatment for both conditions more effective.


ADHD vs. Anxiety

ADHD and anxiety can have similar symptoms, especially ADHD-inattentive type (what was once known as ADD or attention deficit disorder). For example, being unable to focus or having trouble concentrating, experiencing sleep problems, or being restless or irritable can be symptoms of either anxiety or ADHD. The key difference is what underlies the symptoms. For someone suffering primarily from anxiety, distraction is caused by overwhelming fearful thoughts that make it difficult to concentrate, while someone with ADHD is easily distracted even in situations when they’re calm.

Unfortunately, determining the source of troubling symptoms might not be that straightforward, because people with ADHD are also likely to feel anxious about problems brought on by their struggles with their mental health condition. ADHD can negatively affect nearly every aspect of daily life, and someone coping with it can be highly aware of how they’re failing to live up to their own expectations but still have trouble changing their behavior. Missing important deadlines or meetings at work; being unable to prioritize important tasks; missing instructions because you couldn’t focus on a conversation; feeling guilty because an impulsive outburst offended someone you care about—these common situations that can arise from ADHD also produce anxiety.

The overlap in ADHD and anxiety symptoms can be the source of misdiagnosis or delayed diagnosis. It’s important for a mental health professional to carefully screen symptoms to rule out an anxiety disorder when diagnosing ADHD, and vice versa. Having an accurate diagnosis is the first step toward effective treatment.


Can ADHD Get Worse with Stress?

If you’ve been under stress and thought it made your ADHD even harder to deal with, you’re not imagining it. Your body’s physical response to stressors exacerbates classic symptoms of ADHD. Stress hormones are designed to activate a fight-or-flight response that, among other things, routes blood away from the prefrontal cortex, the part of the brain that governs executive function and which is already affected by ADHD. The stress response weakens working memory, mental flexibility, impulse control, coping skills, and the ability to sustain concentration. Worse, chronic stress can cause biochemical changes to the brain that make it harder for it to function correctly. It’s entirely possible to end up in a vicious cycle where stress exacerbates ADHD, leading to more stress. However, it is possible to break that pattern with the proper assessment and treatment.


Getting the Help You Need for ADHD, Anxiety, and Stress

The best treatment for ADHD and anxiety may vary somewhat by individual, especially if the anxiety they’re experiencing is primarily due to their ADHD. You’ll get better results if you know exactly what you’re dealing with, so if you don’t have a confirmed diagnosis already or think it might not be accurate, we encourage you to seek out assessment and testing to get a clearer picture.

In general, ADHD is treated with a combination of medication (either stimulant or nonstimulant), therapy, and behavioral tools. A comprehensive approach is essential for success—therapy is not a substitute for medication, and medication can’t replace therapy. Medications help balance levels of important neurotransmitters to improve the symptoms of ADHD. Therapy can assist in identifying negative thoughts and behavior patterns and help patients change them so they’re better able to function and manage their ADHD symptoms. Dealing with ADHD head-on, coming to understand that daily difficulties with it are not character flaws but the effect of a disorder with a neurological basis, and learning better coping strategies can all go a long way toward relieving ADHD-related anxiety as well as improving the overall diagnosis.


In addition, lifestyle changes can help you better deal with stress and anxiety when you have ADHD. Setting a regular schedule that incorporates breaks and exercise helps, as does maintaining a healthy diet, reducing the use of alcohol and/or caffeine, and quitting smoking. Learning relaxation techniques such as breathing exercises can help provide tools to mitigate feelings of stress before they become overwhelming. These changes will work best when you can be consistent; consider phasing them in gradually so they become habits that are easy to follow rather than an abrupt shift.


If you’re struggling with ADHD and anxiety, or suspect you might be, the SF Stress & Anxiety Center can help. Our experienced therapists use evidence-based methods to help you overcome the challenges you face and learn strategies that allow you to improve your quality of life. For your convenience, we offer both in-person and online sessions. Schedule your free initial phone consultation with one of our compassionate Care Coordinators to be matched with the right therapist for you.

Breathe Your Way Through Stress and Anxiety

What is the simplest, most effective way to address stress?  What can you do to slow your heart and feel more centered when things are challenging?  Deep breathing, and Square Breathing in particular, can help you recover, find your center and lower the impact of stress and anxiety.  


You take your lungs wherever you go

Because we are always breathing, bringing attention to this fundamental process can seem simple, even simplistic.  Fortunately, square breathing is one of the easiest and most effective stress reduction techniques we have.  

What’s the easiest way to lower your heart rate?

Just arrived at work and need to reset your focus?  Get centered with 5 rounds of square breathing.  Feeling a little socially anxious at the wedding reception?  Take a moment to step outside and do some breathing, then hit the dance floor.  Need a moment to decompress from work before attending to your home life?  Take a moment to yourself to re-establish your focus before you walk in the door.  

How do you breathe to relieve stress?

Sit down if a seat is available, and keep your back straight, while also relaxing your shoulders.  Relax your abdominal muscles to allow your lungs to expand into your diaphragm.  Inhale for 4 to 5 seconds, while counting.  Choose a number of seconds that fills your lungs to a deep breath without pushing too hard against that natural limit.  Hold your breath for that same count.  Exhale for the same amount of time.  Then stay at the bottom of your exhalation for 4 or 5 seconds, whichever feels right to you, before you repeat the cycle.  


Benefits of Deep Breathing 

Deep breathing calms down the Fight, Flight or Freeze response. A slow exhalation engages the parasympathetic nervous system, which is involved in relaxation.  It turns down your brain’s alarm center. This leads to a reduction in cortisol, the stress hormone.  Your shoulders tend to drop.  You can feel yourself correct your posture a little and expand your chest cavity to accommodate a deeper breath.  The awareness from breathing can make you feel more restful, calm and aware.  According to psychologist and author Rick Hanson, focusing on the breath can be profoundly centering.  

According to the New York Times’ Alisha Haridasani Gupta, just breathe, “When you slow your breathing down, ‘the parasympathetic system — what we call the ‘rest and digest’ system — hopefully takes over and helps calm you down,’ she said.”  Because stress and anxiety are deeply woven into the physiological stress response, square breathing can be key to resetting your mood, your perspective, and your awareness.  


Further Reading:

Harvard Medical School Relaxation Techniques  

Deep Breathing to Relieve Acute Stress

NHS Breathing Exercises for Stress  

University of Michigan One Minute Strategies to Relieve Stress


If you’re seeking further guidance and support in managing stress and anxiety, SF Stress & Anxiety Center is here to help. Our experienced professionals can provide personalized techniques and coping strategies for long-lasting relief. Schedule a consultation today to take control of your well-being.


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Understanding the Link Between Stress, Anxiety, and Eating Disorders

Eating disorders such as anorexia nervosa, bulimia nervosa, and binge-eating disorder are serious conditions that not only have a profoundly negative effect on physical and mental health, but are also difficult to treat. These problems often start in adolescence and in early adulthood, although they can occur at any age. The disordered eating behaviors that result can affect the body’s ability to get adequate nutrition and cause physical damage, with potentially serious long-term health consequences. While the exact cause of eating disorders is unknown, certain risk factors that can contribute to their development are well understood, including stress and anxiety. Understanding how these factors can trigger, influence, and exacerbate eating disorders is essential for effectively treating them. 


Can Anxiety Cause an Eating Disorder?

Stress and anxiety are a part of life, as much as we might wish otherwise. Sometimes stress can be helpful, such as when it motivates us to get an important project done before a deadline or study harder before a big test. However, when anxiety becomes unmanageable, persistent and overwhelming worry can make it impossible to function on a day-to-day basis or to maintain healthy relationships. While anxiety disorders may occur on their own, they can also occur with other mental illnesses such as depression.

Anxiety disorders are common among those also struggling with an eating disorder. According to statistics from the National Institute of Mental Health, 47.9% of those with anorexia nervosa, 80.6% of those with bulimia nervosa, and 65.1% of those with binge-eating disorder were also diagnosed with some form of anxiety disorder. The most common types of anxiety disorders associated with eating disorders are obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Anxiety and eating disorders can interact in complex ways, which makes it essential not to overlook the role the former plays when treating the latter.

It’s easy to see how anxiety or a stressful life change—such as going away to college, family issues, a new job or promotion, or moving—could push someone already at risk into developing an eating disorder. A family history of eating disorders, having been teased or bullied about weight, past trauma, and/or frequent dieting are all factors that are known to increase the risk of an eating disorder, and adding stress to the mix may be the catalyst that provokes problematic eating behaviors. However, the relationship is more complicated than that. 


Understanding the Connection between Anxiety and Eating Disorders

Eating disorders are progressive—they often start intentionally as a way to feel a sense of control. Once a habit forms, though, it is easy to lose control over disordered eating behaviors and exercise habits. People with eating disorders become compelled to continue their destructive behaviors, which tend to worsen over time. In turn, the consequences of those behaviors can amplify the stress and anxiety they were initially meant to help relieve.

For example, someone with anorexia may begin severely restricting their food intake, repeatedly measuring their weight, or undertaking an extreme exercise regimen as a way of trying to cope with anxiety and a distorted body image. They may also develop ritualistic behaviors such as cutting food into tiny bites or weighing everything they eat. However, having to hide these behaviors from concerned family, friends, or colleagues can become a new source of stress and anxiety. In addition, malnutrition can also make anxiety worse.

Anxiety, stress, and bingeing can create a different dynamic that nevertheless serves to amplify the negative feelings that provoke disordered eating. Instead of avoiding food, people with bulimia or binge-eating disorder have episodes in which they consume large amounts of food in a short period of time. Negative emotions like sadness, loneliness, guilt, or hopelessness are often identified as triggers for a binge, which might begin with eating comfort foods to self-soothe but balloon into uncontrolled eating. Because this releases brain chemicals like serotonin, it works in the short term. In bulimia, that binge is followed by a purge (such as vomiting or laxative abuse) in response to the uncomfortable physical and emotional symptoms of the binge. The immediate feeling of relief, for both those with bulimia and people with binge-eating disorder, is quickly replaced by feelings of guilt and shame.

As with anorexia, binge-eating (whether it is followed by purging or not) is accompanied by secrecy and anxiety. Those suffering from these disorders tend to hide food, eat alone, and otherwise go to great lengths to hide their binges. Embarrassment over their lack of control over their behaviors may also amplify the negative emotions that are more likely to spark binge episodes. Physical consequences such as gastrointestinal problems or weight gain may become an additional source of stress and anxiety as well. 


Treating Eating Disorders and Anxiety

While someone might not develop an eating disorder from anxiety alone, when an anxiety disorder is also present, it is necessary to treat both conditions simultaneously. Otherwise, symptoms of anxiety can worsen disordered eating or cause discouraging relapses during treatment. Learning how to reduce anxiety and develop healthier coping mechanisms can help break the cycle of self-destructive behavior.

At the SF Stress & Anxiety Center, our therapists specialize in treating anxiety, using evidence-based methods to produce lasting relief. If anxiety has you feeling stuck, overwhelmed, or hopeless, we can help. To keep treatment accessible and convenient, we offer both in-person and online therapy. Schedule your free initial phone consultation with one of our compassionate Care Coordinators to be matched with the right therapist for you.


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How to Help Adult Anxiety

Feeling nervous or anxious at times is normal, especially if you’re going through a stressful period at work or home. However, there’s a vast difference between typical moments of nervousness in response to pressure and an anxiety disorder—intense, persistent, excessive worry and fear that interferes with your ability to function at work, at home, or in social situations. Adult anxiety is far from rare—according to the National Institute of Mental Health, 19.1% of U.S. adults experienced an anxiety disorder in the last year, and 31.1% of adults have experienced an anxiety disorder at some point in their lives. While it’s all too likely that you or someone you care about will be affected, adult anxiety can be effectively treated.

It isn’t fully understood what causes anxiety disorders, although most experts believe that multiple factors play a role. Genetic predisposition, your personality type, traumatic experiences, and prolonged or extreme stress can all interact to bring on anxiety that is difficult to control and out of proportion to the stressors you face. For example, if you’ve felt more anxious since the pandemic, you’re not alone. A recent study shows that one in three adults worldwide was living with an anxiety disorder during the COVID-19 pandemic due to uncertainty, disruptions in daily routines and health concerns for themselves or loved ones. Understanding what adult anxiety can look like and how best to respond can help keep anxiety from limiting the possibilities of your life. 

Signs and Symptoms of Anxiety

People suffering from anxiety disorders may experience a range of physical symptoms, as well as anxious thoughts and behaviors. Possible physical signs include a racing heart or heart palpitations, shortness of breath, nausea, diarrhea, sweating, shakiness, edginess or restlessness, dizziness, lightheadedness, insomnia, and/or becoming fatigued easily. Characteristic thought patterns can include a sense of impending danger or doom, racing thoughts, an inability to concentrate on anything except the present worry, a constant belief that the worst will happen, and persistent worry that is difficult to control. This physical and mental discomfort leads to common anxiety behaviors such as avoiding feared situations and social withdrawal.

People suffering from anxiety may be reluctant to socialize, afraid to talk on the phone, fearful of going out, and scared to interact in even simple ways with other people, such as speaking to a cashier at a store. When these symptoms of adult anxiety persist and/or get worse over time, interfering with your work, your relationships, or ordinary daily activities, you shouldn’t wait to seek help in the hope that they’ll go away on their own. 


Types of Anxiety Disorders

The type of anxiety disorder someone experiences may be differentiated by the situation that triggers their anxiety and their symptoms. Some types are:

  • Generalized anxiety disorder (GAD): Persistent, excessive worrying about everyday issues over a period of months or years, producing a sense of fear or dread that interferes with daily life.
  • Panic disorder: Regular attacks of sudden fear producing intense physical symptoms in the absence of any real danger or apparent cause.
  • Social anxiety: Intense and ongoing fear of being watched or negatively judged by other people. Some sufferers may experience fear or anxiety in all social settings, while others have difficulty only in certain situations, such as eating in front of others or performing or speaking publicly (performance anxiety).
  • Separation anxiety: Extreme fear or distress at being separated or the thought of being separated from a loved one. While some separation anxiety is a normal stage of development for very young children, as an adult disorder it can prevent normal functioning at work or home when the sufferer is away from their spouse, child, or other loved one.

Of course, not every case of anxiety fits neatly into a single category. Anxiety may also occur alongside other mental health disorders, such as depression or substance abuse. While this may complicate a diagnosis, it doesn’t mean that anxiety can’t be treated. 


Adult Anxiety Treatment

It’s common for people to believe they can’t control anxiety or their tendency to have panic attacks and that it’s just a problem they’ll have to learn to live with. In fact, that isn’t the case at all—many people are able to move past the symptoms of anxiety disorders and learn to improve their quality of life. If your attempts to manage anxiety on your own aren’t working, it is possible to get effective help.

One of the first steps should be to consult your primary care physician for a physical evaluation. Sometimes symptoms of anxiety can be related to an underlying health condition or medication you’re taking, so it’s best to rule that out as a possible cause or contributing factor. Properly treating any such medical condition may help alleviate anxiety.

If anxiety doesn’t spring from a physical cause, consulting a mental health professional should be your next move. Psychotherapy helps people with anxiety disorders identify the causes of their worries and fears and develop healthier coping mechanisms and skills to overcome anxiety. Two types of psychotherapy that can be effective for people with anxiety disorders are:

  • Cognitive behavioral therapy (CBT): This type of short-term therapy pairs cognitive and behavioral approaches to recognize our existing patterns of thought and behavior and examine how they can hold us back. Patients then learn how to change those thought patterns and habits. CBT sets specific goals that are meaningful for each patient and teaches them skills to take action to achieve them.
  • Dialectical Behavior Therapy (DBT): DBT is a modified form of CBT developed to help people develop mindfulness, tolerate distress, regulate their emotions, and improve their interpersonal effectiveness. It can include group therapy for behavioral skills as well as individual therapy sessions. DBT validates a patient’s experience while gently challenging them to make positive change.  

Lifestyle changes can also have a positive impact on getting anxiety under control when paired with psychotherapy. Regular exercise, getting adequate sleep, healthy eating, avoiding alcohol or recreational drugs, and cutting back on stimulants like caffeine can all be beneficial. In addition, relaxation techniques such as meditation or breathing exercises can help keep stress at manageable levels. Your therapist can help plan a mix of treatments for anxiety best tailored to your unique situation and needs.


Reclaiming Your Life from Anxiety

When anxiety takes hold, it can gradually take over your life, isolating and limiting you. At the SF Stress & Anxiety Center, our therapists can help you overcome your anxiety and develop psychological resilience so you can thrive in your professional and personal life. We offer both in-person and online therapy sessions to keep treatment accessible. 

To get started, schedule a free introductory phone call with one of our compassionate Care Coordinators to be matched with the right specialist.


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