Coping With Mental Health Problems When Treatment Isn’t Available
Access to mental health care in the US is riddled with barriers, including a shortage of mental health providers. These concerns are not new and are staggering when you consider that 53 million adults in the US, or 21% of the population, had a mental illness in 2020, and 14 million adults, or 5.6%, had a serious mental illness. Mental health organizations argue that many people cannot access mental health care when they need it most and emphasize that millions of people are left without medical care every year.
In fact, a U.S. Government Accountability Office report released in March showed that those who do try to seek medical care may find that mental health providers are not accepting new patients, or that it takes a long time to see them. These problems can lead to higher health care costs, delays in getting care, and difficulty finding providers close to home. Given this landscape, what should a person do if they are going through hard times and cannot get professional help?
What if you can’t access mental health care?
“I think skills are incredibly important because I really think part of the benefits of therapy is that you have space to process and have someone listen and hopefully provide some reflection and ideas and encourage understanding.said Kathryn Gordon, clinical psychologist and authorof Suicidal Thoughts Workbook: Cognitive Behavioral Therapy Skills to Reduce Emotional Pain, Increase Hope, and Prevent Suicide . “But it’s also helpful to have certain things a person can do on their own, either when they’re no longer in therapy or in between sessions.”
Gordon added that many skills can be taught outside the context of therapy when access to care is limited through self-help books , free apps such as Virtual Hope Box and COVID Coach , YouTube videos and podcasts . Here are skills that can help you learn healthier behaviors, calm yourself in stressful situations, and teach you to talk to yourself with more empathy.
Focus on identifying your emotions
According to Gordon, one of the most basic and important skills that people can learn is the ability to identify their emotions. While it may seem simple enough, the psychologist explains that some people don’t stop and think about their emotions. They can only know if they feel good or bad. However, once a person identifies an emotion, they may experience a sense of relief or clarity in knowing how they feel, which allows them to test themselves.
For example, if a person pinpoints that they are angry when something happens, they may try to understand why they are angry and find a solution.
“Is this also the first step in determining what I need?” Gordon stated. “If I’m angry, do I need to somehow assert myself? If I feel lonely, should I reach out and connect with someone? Identifying feelings is, I think, the first step to the next step, namely: what do I need right now to lean towards this emotion?
Practice Mindfulness
Likewise, the mindfulness taught in Dialectical Behavior Therapy, or DBT, can also be very helpful. Dialectical behavioral therapist Britt Rathbone , founder and director of Rathbone & Associates in Maryland, said mindfulness is awareness. If people are not aware of what triggers the moods that cause them to engage in behaviors that can be harmful, they cannot take steps to change those behaviors.
Noticing thoughts and feelings is part of mindfulness, Rathbone explained, and it can be learned by using language a little differently. For example, instead of saying “I hate this person” or “This person hates me,” Rathbone suggests looking at the thought in a different way. Try: “I notice the thought that I hate this person” or “I notice the thought that this person hates me.”
“What we do is that instead of you being your thoughts, we widen that lens a bit and create [a situation where] you watch your thoughts arise,” Rathbone said. Because thoughts are not facts. So if you can go beyond a thought, then you can watch it and then decide what to do with it, differently than if you were in the thought.”
By noticing a thought, feeling, or urge, the therapist indicates that people have more room to think about how they are going to respond, rather than acting on autopilot based on old knowledge. While autopilot is good most of the time, Rathbone says it can sometimes get people in trouble when they resort to knowledge that is no longer effective or useful.
Do the opposite of what your emotions tell you
Another skill taught in DBT is the opposite action. According to Rathbone, the opposite action is a tool that people can use when emotions turn into moods. Although he emphasized that all emotions are normal and that everyone experiences them, emotion turns into mood “when we feed them, when we feed them, when we interact with them.”
Counteraction is a skill to use when people’s moods or emotions are not true and make you want to do something that could be counterproductive or even harmful in the long run. In such cases, Rathbone says, people should check the facts and do the opposite of what their emotions tell them to do.
As an example, he suggested imagining someone who is sad about failure and just wants to lie down in bed. Although grief is a normal emotion in this situation, is lying in bed a good coping strategy?
“If we start listening to [emotions] and never get out of bed, get up and do something again, then it will turn into depression. And then it gets harder and you dig deeper and deeper into that hole,” Rathbone said. “And so the opposite actually starts spinning that spiral again, so you get active, connect with people, and then your mood starts to improve.”
Monitor your self-critical thoughts and mental dialogues
In difficult times, self-critical thoughts and negative dialogue are the last thing we need, especially if we want to improve. Valentina Stoycheva, a clinical psychologist and owner of Stress and Trauma Assessment and Psychological Services (STEPS) in Huntington, New York, says no one ever changed their behavior because they shamed themselves.
Stoycheva emphasized that it is very important for people to have compassion for themselves as they learn to recognize and observe their thoughts and feelings with less judgment. She sometimes noticed that after learning this skill, patients would come back and tell her that they didn’t even realize how negative and abusive they were to themselves.
“This is really very important because if you want to change something and constantly shame yourself and humiliate yourself, it will be much more difficult,” she said. “A good strategy is to ask yourself, “What would you say to a friend who is in the same situation and feels the way you are right now?”
Prevent Crisis with Complacency
For people going through a really difficult moment, self-soothing, a DBT skill for stress resilience, can help. As Rathbone explains, many of the clients he visits may do something at a difficult time, such as use drugs, that can change their lives forever or harm them in some way. In such situations, people have to reduce the intensity of their experiences.
“If you’re thinking about mood on a scale of 0 to 100 when you hit 80 or so, you’re not thinking straight,” he explained. “The mood has taken over and you are likely to do something impulsive and emotional.”
Through self-soothing, therapists seek to teach people to do something different in that moment to prevent and get through a crisis. Complacency can involve a number of actions, Rathbone says. Some people enjoy petting their dogs, listening to upbeat music, watching movies on Netflix, running or even playing video games.
While people love this skill, Rathbone warns that it’s not a permanent solution. The urges that people felt will return, so once they have calmed down, they should start solving problems. If not, you may be stuck in an avoidance cycle to deal with the situation.
Focus on what you can change with radical acceptance
Another disaster tolerance skill taught in DPT is radical acceptance , although Rathbone notes that it can be a little more difficult for people to master. It is easy to remember because the name is intuitive. Radical acceptance is the idea that things are the way they are, and since fighting reality will only make you miserable, we must accept reality the way it is, even if it hurts.
He explained that when people are upset, they often struggle with reality. However, once we accept reality, we can focus on what is truly within our power to change. As a simple example, Rathbone suggested imagining someone very upset because they want it to rain so they can water their garden. The person has no control over whether it rains or not, but is still frustrated and doesn’t think of the other options available, such as watering the plants by hand or buying plants that don’t need as much water. If a person does not accept that there really is no rain, he will not find another way to water the plants and will continue to suffer.
Make self-care a part of your daily routine
While self-care is a buzzword these days, Stoycheva says its real meaning when it comes to mental health is very misunderstood. She stressed that self-care is not about massaging when something hurts, but about taking action to make sure the person is okay. This may include exercising regularly, taking regular walks, taking time out to read, or talking to a friend who reassures you.
“Some of these things that help you should be part of your routine,” Stoycheva said. “[You need to make time for them] not only in times of crisis.”
She also pointed out that these self-care activities are often the first things that fly out the window when people burn out, and yet it is counterintuitive since self-care activities are a buffer against burnout.
Set good personal and emotional boundaries
Learning to set the right boundaries is also an important skill for maintaining good mental health. According to Stoycheva, having good boundaries means not accepting the feelings of others as your own and not trying to fix others around you. Both tendencies can lead to great suffering.
When Stoycheva sees patients, she sometimes asks them what changes they would like to see happen in an ideal situation. In cases where the person says they want their child or partner to stop doing something, she stops them and explains that while she really wishes it could happen, the person cannot control it. She then tries to reformulate the person’s thinking and asks him: what can you focus on, what is under your control? In this way, it helps them create emotional boundaries.
Try to think about the problems you are dealing with and divide them into two groups: problems you can control and problems you can’t control. Once that’s done, Stoycheva says, focus on a stack that you can control.
Be mindful of your triggers
Although the word “trigger” is often used, it can actually refer to many things in the field of mental health. Stoycheva explains that triggers can be frightening situations, certain people, certain places, or even certain concepts. It could even be a TV show that talks about something unpleasant that may be happening in your life. It is important to know your triggers so that people can minimize their exposure or prepare if they are unavoidable.
In case a person is provoked, he should not pretend that this has not happened, because there is a high probability that he will have a reaction.
“It is better to anticipate this and exercise more caution,” she said. “So it happened, I’m excited. Let me go read a book for a minute. Let me calm down.”
Check the Evidence of Negative Thoughts
Anyone who has dealt with chronic negative thoughts knows that they can be a bit of a “hit the mole” thing. It is unlikely that they will ever completely disappear, but, fortunately, there is a skill to keep negative thoughts under control. Gordon explains that one effective way to combat negative thoughts is to look for evidence for and against the thought to determine if it is true.
Say, for example, the thought is that you are a terrible person, she said. In such a situation, we must ask ourselves a few questions. First, what is the evidence for this thought? What is the evidence against this idea? Is there a more accurate way to say this to lessen the intensity of these negative feelings?
“If I think I’m a terrible person because I made a mistake or something, the evidence to back it up might be, ‘Well, I made a mistake.’ The evidence against it is that [it] doesn’t reflect on me in general,” Gordon said. “I could think of some positive things I’ve done that aren’t terrible human behavior. And then I can come up with a new thought that will be more accurate, for example: “I am unhappy that I made this mistake, but in general, the facts indicate that I am a decent person who tries, and everyone makes mistakes.” ‘”
Know that this too shall pass
When it comes to coping with stress, clinical psychologist Gordon supported Rathbone and suggested that people do something that is physically appealing or evokes positive emotions to help them get through a difficult moment. However, she also noted that it is important for people in such situations to be mindful of the effect of time on stress.
“Thinking that even if you didn’t do any of those comforting self-soothing things, you will only feel better because our moods fluctuate. And so sometimes it can also help people cope with a disaster,” Gordon said. “I’m like, ‘OK, it’s not good right now, but maybe in an hour or two it won’t be so bad.’
When to Seek Professional Help
Rathbone, a dialect behavioral therapist, emphasizes that the key to any skill is practice. While some people may think that mental health skills should work immediately, this is not the case – you have to learn to do things differently with practice and practice.
In addition, mental health care is not “one and ready,” Rathbone explained. It’s like fitness. If you exercise, you can get in shape, but if you stop, you will lose shape. Most importantly, it’s important to know when practicing these skills on your own isn’t enough: anyone experiencing suicidal thoughts or prolonged stress seeks professional help immediately.
Stoycheva suggests visualizing yourself as a thermometer. Below is a green thermometer. It is followed (top) by yellow, orange and red at the top. Green means you are ok. You feel good, you are happy and relatively calm, although you may have some problems. Next comes yellow, which indicates the presence of some stressors. You don’t feel very well, but you manage and see a way out. It’s hard, but you can do it.
Above the yellow is an orange zone, where, according to Stoycheva, problems begin. People at this moment feel that they are not in control of the situation and feel helpless. They either haven’t been feeling well for a couple of weeks now, or they feel like they can’t handle their anxiety. People with this mindset know they are not okay and may start isolating themselves. They don’t want to talk to people because it overwhelms them and they don’t want to go anywhere. In some cases, they may use substances to calm themselves, or behave in an unhealthy or unusual way for them. In other cases, their nutrition may be disturbed.
“Usually, at such moments, you need to lend a helping hand,” Stoycheva said. “This means that your nervous system was overloaded, and you tried to disable it yourself. Even if you’re thinking, “I have this, I can do it myself,” your body is telling you that you shouldn’t be doing this on your own. Because you can be the strongest person in the world, you can lift 300 pounds, [but] this one is 350. And you can’t lift it on your own.”