Oftentimes, we take sleep for granted and it can be very difficult to fall asleep and stay asleep. Whether you’re depressed, anxious, or just really feel like you have a tough time sleeping, here are three tips to help you get a good night’s sleep. Number one, no screens, 30 to 60 minutes before bedtime. Screens emit blue lights, which are harmful to our circadian rhythm. They make our bodies think it’s daytime. When we have a screen in front of our face, our bodies say, okay, we’re going to be awake, and then the second you shut it off, the body doesn’t think, oh, alright, now it’s time to go to sleep. It thinks now it’s time to start winding down. So it’s really important to not have any screen time including phones, tablets, televisions, computers, any kind between half an hour and an hour before bed. Second, develop a routine. Try and come up with a few different things you can do the night before to prepare yourself for the next day. Preferably things that don’t include screens such as laying your clothes out for the next day, brushing your teeth, making your lunch, preparing something to help you get ready for bed. Just doing something that doesn’t require a lot of thought and you can just do without looking at screen. As a side tip, many electronics now have a night mode where it eliminates all the blue lights and that are harmful for your eyes and for your circadian rhythm. That being said, it’s still good to pair down the electronics as it gets closer and closer to bedtime. And number three, try to come up with a relaxing bedtime ritual such as mindful meditation or a breathing exercise that can help really bring your energy down so that you’re ready to go to sleep. Keep in mind that it’s a process to get yourself to sleep and be kind to yourself. Give yourself the opportunity to fall asleep. By utilizing these three steps, you’ll find that you can have better what we call sleep hygiene or taking care of yourself towards sleep, and you’ll find you’ll have a much more restful sleep.

One of the most tragic outcomes of depression can be suicide. People oftentimes think, oh, the world would be better off without me, or I just can’t go on anymore. If you’re having those thoughts, it’s important to immediately seek help from either a mental health professional or your doctor. If you are having current plans of wanting to hurt yourself, go to the emergency room. You can also call a suicide hotline to help you talk about all the things that are going on in your head. But this is not a substitute for therapy or treatment. It can be difficult to have thoughts of suicide or wanting to kill yourself, and it can be even more difficult to deal with them on your own. Find someone to help you deal with those thoughts and hopefully develop a plan to move forward.

Therapy can be very expensive at times. Consider that if you’re seeing a therapist once a week and paying somewhere between $150 and $250 an hour, that can really add up. Fortunately, there are ways to offset the costs of therapy. First of all, if you have health insurance, it could be a good idea to reach out to your health health insurance provider and ask which therapists would be covered under your plan. Sometimes therapists can be covered in network as well as sometimes your insurance plan may have out of network benefits, which means it will cover part of the therapy for therapists that may not be in your insurance network. Additionally, some therapists offer what’s called a sliding scale, where they will make an assessment of your need based on your income and offer you a rate that you can afford. Additionally, group therapy can be a very economical way of getting therapy and getting help. If you’re on a college campus, go seek out your college counseling services. They’re oftentimes included as part of your tuition.

There’s often a stigma associated with going to see a therapist. You might say to yourself, if I go see a therapist, that means I’m crazy. Or if I go see a therapist, that means I can’t handle my own issues. The truth is that many people seek therapy, even people who aren’t dealing with mental health disorders. Oftentimes therapy can help us become better versions of ourselves by helping us learn skills as well as insights about ourselves. A good therapist will help you find the strength within yourself to deal with the situations that you’re dealing with.

There are three things that you should ask your therapist before starting therapy with them. Number one, their previous experience treating patients like you. It’s really important to know that your therapist knows how to treat a patient, that is dealing with the things that you are dealing with to education and licensure. This is really important to make sure that the therapist that you are seeing is held by a certain ethical and legal code and is educated about that code. And number three, fees. It’s often uncomfortable to talk about money, especially when you meet someone for the first time, but it’s really important to understand how much therapy is going to cost you, especially because therapy can be pretty expensive.

When you’re meeting your therapist for the first time, it can often be difficult to know, is this the right therapist for me? What you’re looking for is what we call fit or patient therapist fit. What that means is that the personality of the therapist fits your needs as a patient. That doesn’t mean the therapist needs to be your best friend, but it does mean that the therapist needs to be able to push you when you need to be pushed and at the same time help you along through your journey. If your first therapist or your first experience with therapy didn’t go exactly the way you wanted, there’s a good chance that it was related to fit and if so, give it another try and see if you can find a therapist that might fit your needs a little bit better. Don’t be afraid to tell your therapist what you need or if you feel the fit isn’t exactly right. It’s your therapy. Make sure you’re taking care of yourself. Therapists are trained to recognize a good fit with a patient and a therapist, and if they feel that it’s not a good fit, they’ll refer you to someone else. It’s kind of like if you go to see a dentist for a broken bone, that dentist isn’t going to be able to help you, and so they’ll refer you to a doctor that will be able to help.

One good tip to getting sleep at night if you’re lying in bed with a racing mind and not able to sleep, is to get up out of bed and stand next to your bed. What’s really important is to have your brain associate your bed with sleep. So if you’re lying in bed thinking, your brain is now associating your bed with thinking. Instead, if you get up, do all your thinking until you’re so tired that you have to go to sleep, you’ll then go right into bed and fall asleep. Many therapists emphasize the importance of what’s called sleep hygiene, which refers to the many different things you do before going to sleep to prepare yourself for sleep. Oftentimes, we can’t just fall asleep after a hard day’s work. We need what we call a wind down period.

If you’re on a college campus and you’re dealing with homesickness, friends issues, relationship problems, anything related to your academics, go seek out your college counseling services. They may be able to help and they’re included in your tuition.

Individual therapy is where you meet one-on-one with a therapist to talk about your problems. Sessions can typically last between 45 and 60 minutes. Individual therapy is a great way to get personalized therapy tailored towards your needs. You’ll be able to sometimes learn skills or just talk about yourself and learn what makes you you, what makes you tick.

Automatic negative thoughts are thoughts that pop into your head and create a negative evaluation of the world around you or of yourself. Everybody deals with automatic thoughts. The problem is when you’re suffering from anxiety or depression, these automatic thoughts are believed to be true, and then you start evaluating everything with a negative or anxious light. Through CBT, you’ll be able to learn to recognize and identify these automatic negative thoughts as well as challenge those automatic negative thoughts and come up with new, more positive thoughts.

Oftentimes in college, there’s a lot of pressure to figure out what do you want to do. In fact, probably when you went home for the holidays, five different people asked you, so what’s your major? And you’re probably thinking, I have no idea. I don’t know what I want to do. That’s okay. You don’t need to know what you want to do yet. That’s what college is for. It’s for exploring all the different possibilities and opportunities. Live in the moment. Be present. Try to experience college and understand what you like, what you don’t like, what you’re good at, what you’re not good at, and that will help guide you towards finding a future and a career.

You get to your college dorm room and who’s the first person you meet? Your new roommate. It can be very exciting. Sometimes roommates are perfect fits best friends last forever. Sometimes it can be a little difficult. If you are in a situation where you and your roommate just aren’t getting along, it’s important to try and find common ground. Maybe talk to your RA or find another friend to be an intermediate between the two of you. Also, keep in mind you don’t need to be best friends with your roommate. You just need to be roommates. You and your roommate can come up with common ground rules that each of you will abide by in order to make the living situation bearable. If you feel like the situation with your roommate is not livable, talk to someone about potentially getting switched to a different room. Sometimes that can happen, but if it can’t work with your roommate to try and find things that he or she may want you to do and then you can in turn ask them to do certain things for you. If you feel like the situation with your roommate is getting to a point where it’s almost unresolvable, try and schedule a conversation with your roommate. Try and do it in a place that isn’t your room. Maybe on a neutral ground where both of you feel comfortable. Take turns talking so that each of you can hear each other and try to come to some sort of resolution that will help both of you feel comfortable in the space that you need to share. Some of the issues you may face with a roommate could be poor personal hygiene, loud parties at night, eating your food, taking up the common space for themselves, leaving their stuff all over the place. If you have any of these problems, it may be good to assertively communicate with your roommate. Hey, this bothers me. I was hoping we could find some sort of resolution. At the beginning of any roommate relationship where you feel there may be a little bit of tension, it could be good to set up some ground rules such as cleanliness, noise, light, all these things that really impact you personally. Sometimes personalities clash and it’s just not a good fit. If that’s the case, it may be time to talk to your RA or housing administrator.

In college it can be really exciting to try all these new, different things. You may find yourself having a really busy schedule going to this club, joining this group, doing this homework, meeting these people. Make sure you schedule some time for you. Take care of yourself. It’s what we call self care. This is really important to make sure that you don’t lose sight of who you are in the college experience. Find time in the day for you. Schedule a time for you to just take a walk. Schedule time for you to go on the computer and just watch TV or a movie. Find time to just be you within the college experience.

Depression can be difficult and oftentimes may seem like it’s too much to bear. It’s important to remember that you’re not alone. You can have the help of family and friends as well as mental health professionals help guide you through this difficult time. It’s not hopeless. You can get through it. Just make sure that you get the help that you need.

Our bodies work on what’s called a circadian rhythm, which is where our bodies are awake during the day when it’s light out and asleep at night when it’s dark. Similarly, when our environment is bright, our body thinks I should be awake, and therefore as you get closer and closer to sleep time, your room should get progressively darker and darker. When a person is suffering from anxiety, oftentimes they’ll have racing thoughts and find it difficult to fall asleep. Conversely, when people are depressed, they’ll want to sleep all day long and spend all the time in their bed. Neither of those situations are ideal for sleep. It’s really important to get a very steady seven to eight hours of sleep daily, depending on your own cycle.

CBT or cognitive behavior therapy is a therapy that was developed by Aaron Beck and focuses on how your thoughts impact your behaviors as well as your emotions. The C or cognitive focuses on your thoughts. This means any sort of thought that might come into your head at any given moment. For example, if I bumped into someone on the street, I may have the thought, oh, that person hates me. When I think about that thought a little more, I may realize, oh, they look like they were in a rush. Maybe they don’t hate me. The behavior refers to any actions or physical feelings you might have as a result of that thought. So for example, if someone bumps into me, I may turn around and look at them funny. Finally, emotions are the result of the thought as well as the behavior. The emotion that comes out of thinking someone hates me can be very defensive or insecure. However, if I’m able to reformulate that thought, I then have a different emotion of more security and confidence. CBT is typically short term and structured. Your CBT therapist will typically assign you homework assignments for you to do over the course of the week so that when you come back to therapy, you can pick up where you left off. Research shows that CBT therapy is one of the most effective forms of therapy and should be considered in a wide variety of settings including anxiety, depression, and ADHD. CBT is a skills-based therapy, so if you feel like I really need to learn more skills to cope with and deal with my anxiety, CBT might be right for you. CBT is typically useful when you have an acute problem or specific issues that you want to deal with. If you are coming into therapy thinking, I just want to talk about myself, CBT might not be right for you. But if you have something that is going on in your head, maybe a bunch of thoughts racing and you want to learn how to control those thoughts, CBT might be the right fit. CBT focuses on automatic negative thoughts, which are automatic thoughts that pop into your head, but that involve a negative evaluation of either yourself or the situation. These thoughts can be very problematic because they can color the way you interpret a situation. Oftentimes, CBT therapists will recommend breathing exercises or mindful meditation to help you get in that state where you can finally evaluate your automatic thoughts and maybe even restructure them and come up with a more helpful and useful thoughts.

Hi, I’m Dr. Benjamin Hamburger, a clinical psychologist in Los Angeles, California. I’m originally from Potomac, Maryland, just outside of Washington, D C. I went to University of Michigan where I got my bachelor’s in science, in brain behavior and cognitive science. I then went on to get my doctorate degree at Yeshiva University’s Ferkauf graduate school of Psychology. Today, I’m excited to talk to you about different types of therapy and commonly asked questions about depression.

When dealing with depression or anxiety or any other mental illness, oftentimes people will experience issues with sleep. Sleep is really important for our development and growth. Oftentimes people think, oh, when I’m sleeping, my brain turns off. It’s actually the exact opposite. While you sleep, your brain processes everything you’ve learned over the course of the day. If you don’t get that sleep, you haven’t learned whatever it is happened during that day. Sleep can be restorative. It can provide you with energy as well as a clear mind to tackle the next day. One thing that can be difficult when dealing with mental illness is that either you get too much or too little sleep. Both of these can actually be difficult and problematic.

Sometimes it can be difficult to live with someone even if you chose to live with them. Oftentimes people will choose to live with their best friends because they think, oh, our personalities mesh so well that this can’t fail. But when you start living with each other, you start noticing little things that impact your ability to live in the space. Oftentimes, roommates struggle with having a similar level of cleanliness, noise, light, sleep times. All these things go into creating a good roommate relationship. A good way to avoid common pitfalls is to develop a set of rules and chores that each of you can do so you’re each carrying your share of the load. A roommate relationship can be something you can treasure for the rest of your life. It’s really important to not let these little quirks get in the way of a bond that could really last your whole lifetime. The bond between two roommates can last a long time and it’s important to cultivate that relationship while you’re living together in an environment where you both feel comfortable. Not only that, it’s important to have some fun. Make sure you schedule some time to just hang out with your roommate. These relationships can last a lifetime if you put that work into developing that strong roommate bond.

Psychodynamic therapy is where you sit with a therapist and talk in a more open-ended free flowing conversation. Typically, therapists will either give you their insights or their perceptions on the dynamics that are going on in the therapy session or that you describe with other people outside the therapy session. Psychodynamic therapy can often be very helpful for patients who don’t really know what’s wrong with them. They just have a general feeling that something might be wrong. Oftentimes this therapy can be open-ended as well as patient-driven. Sometimes you’ll have an active psychodynamic therapist who will talk with you one on one. Other times you’ll have someone who sits there and listens and gives you their feedback occasionally. Whenever you’re doing psychodynamic therapy, the most important thing to consider is fit. If you don’t feel that your therapist is a good fit for you, tell him or her that you think that you would like to see a different therapist and they’ll provide a referral. Psychodynamic therapy can be for everybody. You don’t need to be depressed or anxious to enter psychodynamic therapy and get something out of it. Psychodynamic therapy can help you see all the different aspects about yourself that maybe you couldn’t see on your own. It can help you succeed in a wide variety of realms. Relationship, business, social. Psychodynamic therapy is different than talking to just a friend because your psychodynamic therapist is there to help you. They’re professionally trained to work with you, to try and help you explore in a nonjudgmental way your issues.

College is all about figuring out who you are and who you want to be. Oftentimes you’ll be encountered with peer pressure from other friends telling you, oh, this is what you should do. It takes a certain strength to be able to say, no, I don’t want to do that. I’d much rather do this or, no, that’s okay, thanks. It’s difficult to say because oftentimes you feel like you’re being judged or you’re being evaluated by other people and if you don’t do this thing, then maybe you won’t look cool, but in truth it’s really up to you to decide what’s worth it. Consider all the legal, ethical and moral ramifications of anything you do or anything someone asks you to do. It’s important to choose your friends wisely and if you see a friend who you think might be peer pressured into doing something they don’t want to do, help them find the strength to say, no, I don’t really want to do that. Or, hey, let’s try and do something else. If you feel like you’ve been dealing with a lot of peer pressure and you need someone to talk to, find a supportive friend or a parent or a college counselor, or even a professor. Find someone who can support you and help you make the decisions that you want to make. So that next time when you’re in a situation where there’s peer pressure, you’re able to assert yourself and say no in a way that makes you feel comfortable.

Oftentimes there’s a stigma about seeking therapy. People feeling as though if I go to see a therapist, I’m crazy, or I can’t handle my own issues. It’s exactly the opposite. Think about it. If you broke a bone, you wouldn’t think, oh, I have to deal with this on my own. You would go to a doctor. Similarly, if you’re feeling depressed or anxious, it’s important to go seek the help of a mental health professional. Specifically, there’s a stigma against men seeking therapy. Frequently men don’t feel comfortable sharing their emotions, and as a result, don’t feel comfortable seeking out therapy. It may make them feel weak or vulnerable. It’s very important to make sure you take care of yourself just as much as you would if you had broken a bone. If you’re feeling depressed for most of the day, nearly every day, go seek the help of a mental health profession.

Inpatient therapy is round the clock therapy where you’ll get supervision from doctors, nurses, therapists, and social workers. Typically, inpatient units offer group therapy and individual therapy to help you learn skills and talk with other people about their experience. Following an inpatient stay, your doctor may suggest an intensive outpatient therapy program or partial hospitalization to make sure that you’re fully ready to go back to your regular life. Intensive outpatient therapy is a daily or semi-daily therapy where you go into a center and you see doctors, therapists, as well as social workers to help you figure out all the supports you need in order to function at the level that you’re used to. Typically, these centers will have group therapy and individual therapy. Intensive outpatient centers can be expensive, however many are covered by insurance, so please be sure to contact your insurance provider. Intensive outpatient therapy is really geared to be short term and helping you get the skills necessary to get yourself back on your feet and into your everyday life.

It’s very common to feel homesick when you go to college for the first time. You’ve never lived in a place that didn’t have your parents helping you and guiding you through every experience. Sure, sometimes you may fight with your parents, but that doesn’t mean you don’t miss them. They’ve been with you for your whole life up until this point, and it’s normal to feel a little sense of missing them. What’s important is to find relationships with friends and develop those relationships so that you can become an independent person. Many campuses will have activities, groups, or even support groups for students who feel homesick. You can seek these out at a college counseling center. Also talking to other students about how they’re feeling may help. Oftentimes, you are not the only one who’s feeling homesick. In fact, it’s very common. That’s why we’re making this video. Homesickness is normal and it’s part of the college experience, and if you can find the people that you can share it with, you can get through it together.

Group therapy typically consists of between four and 10 patients and between one and two therapists. Group therapy can be used to treat a wide variety of patients, patients suffering from depression, from anxiety, from PTSD. Group therapy can often be very helpful because you get the social support from all the other patients in the group to sort of understand that you’re not alone in this journey. The things you’re experiencing other people are experiencing too. Also, when you’re in group therapy, people can give you advice on, Hey, I dealt with that. Here’s how I dealt with that. Group therapy can often be a less expensive alternative to individual therapy. However, oftentimes patients will see individual therapy as well as group therapy. Group therapy can either be process-based or skills-based. Process-Based group therapy focuses on people sharing their experiences with one another and talking about how they feel about those experiences. Oftentimes it can be very cathartic to hear other people speak about their issues as well as being able to speak about your issues to other people. Skills-Based group therapy is much more focused on learning skills to cope with specific issues such as depression or anxiety. When deciding between a skills-based or process-based group, it’s important to consider where you are in your journey. If you’re just getting started, maybe a skills-based group would be good for you to learn some coping skills for your anxiety or your depression to manage it and then maybe you might consider going to a process-based group. Group therapy is a very popular form of therapy and there may be one closer than you think. Talk to your doctor or therapist about a group therapy that might be the right fit for you in a private practice, clinic, or hospital setting.

Oftentimes when people are depressed, they’ll just want to stay in bed all day and not talk to anybody. The problem is that actually perpetuates depression. Instead, it may be good to go schedule meeting up with one friend during the day, just plan to have one interaction with another person. The more you interact with people, the better you will feel. When we interact with people, we get certain neurotransmitters that go through our brain that make us feel better. When you’re feeling depressed, it may be natural to feel like I don’t want to talk to anybody and avoid all social contact. That’s the exact opposite of what you need to do in order to feel better. Social support and social contact can really help to improve your mood and increase your likelihood of getting out of a depression. If you can just schedule one meeting with a friend or a family member a day, you’ll notice that you’ll start to feel better and you’ll be able to schedule more and more until you’re able to climb out of that depression. Of course, if you’re feeling depressed, you should always seek the help of a mental health professional. If you’re feeling depressed, you may find yourself binge watching movies or TV shows or sitting at home eating all day or sleeping on the bed. Those are all signs that maybe it’s time to start talking to a friend or getting out once a day. It can often be helpful to talk to friends about what’s going on with us because they understand us well. They can help us learn what we’re doing and what we need to be doing in order to feel better. They may come up with suggestions on, hey, maybe if you try this, you might feel a little better, but keep in mind that talking to a friend is not a substitute for talking to a mental health professional. If you find your depression is lasting for most of the day, nearly every day, it may be time to consider seeking the advice of a mental health professional.

In a family, there are many different types of people and personalities that can contribute to fights or other issues. When that happens, it may be wise to seek the consult of a family therapist. A family therapist will help break down the systems of the family, as well as look at each individual person’s contribution to the family unit. By identifying patterns as well as working together to create systems that will help the family thrive as a unit, the therapist can really help a family become a more cohesive and harmonious family. Oftentimes in family therapy, parents can learn parenting skills on how to help control a child that may be a little out of control or overactive. Similarly, in family therapy, the therapist may work with the parents to strengthen their relationship as opposed to the relationship with either one of the parents and the child. Family therapy is very common and you can ask for a referral from your doctor or therapist. Sometimes individual therapy can be helpful in sort of understanding your contribution to a situation, but when it feels like it’s out of control and there’s too many people that are contributing to the problem, it may be time to seek a family therapist. Oftentimes, family therapists will be able to see the whole picture of the family. They’ll be able to look at this is what the child is contributing and looking for in the family relationship. This is what the father’s looking for. This is what the mother’s looking for. This is what any other individual in the relationship is looking for, and this is how they’re contributing to the family dynamic that’s creating problems, arguments, and other issues. Oftentimes people think, oh, I can just tough it out or deal with it myself, but that’s exactly the time when you should go seek a therapist to help you identify the things that you may not be able to identify yourself.

Being open with your family can be really difficult and it honestly depends a lot on your family. If you have a family that’s warm and open and inviting to sitting down and discussing emotions with you, that it can be a lot easier. If you do but you still feel anxious and nervous and you don’t want to just walk up to them and say Hey mom, I’m feeling terrible at school. I had an awful day. They were bullying me, etc. What I recommend is: you can take it down a notch. Maybe write them a letter and leave it on mom’s bedside table. Or you can send her a big long text and say: I don’t want to say this to your face, but I really want to tell you. I want you to know. Can we just have a conversation like this? Because I really think that once you get the conversation going, hopefully your parent will reciprocate and then they’ll help you out with it. Another suggestion that I’ve heard is talking to your parents in the car might be the best way to go because you don’t need to make eye contact. It sort of takes off the pressure when you’re not looking at each other. On the other hand, if you have parents who are not connected to you at all, they’re not the type of parents you go to for support, then you do need to find support somewhere else. This is really common. A good place to go looking for it is your guidance counselor at school or somebody from your church or even one of your good friend’s parents – they may be open to sitting down and talking with you about what’s going on. But it’s important that you try really hard to help yourself by finding another adult who can help you.

Unfortunately it’s fairly common to have thoughts of self-harm. Many people don’t act on them, which is a good thing, but some do. Generally, the underlying reason for self harm is when you feel so much emotional pain, you’re just going to explode and you’ll do anything to get rid of it – so you change the pain into physical instead. Physical pain is easier to feel than emotional pain. Typically that’s the idea behind cutting or scratching or burning or picking or something like that – the idea is you’re trying to turn your emotional pain physical. What you would want to do about it: when you have so much emotional pain and you feel like you’re crawling out of your skin, the best thing to do is try to get it out. You can get it out in multiple ways: you can talk to a friend about it. You can scream into your pillow. You can go to a boxing class – that really helps with anger. You can create something with art. Whether that means that you write a whole bunch of journal pages or you paint a picture that you’re trying to get intentionally, like how can I get this feeling that’s in me portrayed on paper? How do I get it out of me? If you’re not the type of person who wants to create anything, go looking at what other people have created. Look for music where the lyrics describe how you’re feeling. Look for music that matches your feeling – sometimes if you feel super amped up and you find amped up music, it makes you feel relaxed. Go looking for things that can help you get rid of the feeling inside your head. Another thing that you’d want to look at is if you do have a constant urge to cut – so you cut your wrists – not for suicide, but just across – you can put a hairband there and you can snap your hair band. That’s not my favorite go-to, but it can help if you do really have the urge of I need to do something that physically hurts.

When I was younger, I had a friend who was in a terrible relationship. He was really abusive to her and she knew that she should break up with him, but she didn’t want to. We had suggested – many of us had suggested to her – to go to therapy and her defense was: No, no, no, I can’t go. I know what they’re going to say. They’re just going to say break up with him. So I don’t want to go. I imagine this is a fairly common perspective or belief of what people think – if they went to therapy, the therapist would say hey, you need to do this, this, and this and all these things are bad for you. I want you to know that’s not true. A good therapist will not say do this. They will not judge you. Their main goal is to help you understand your own patterns and your own blind spots. They’re going to help you understand what it is in you that wants to be with the abusive boyfriend and why you’re drawn to him. They’re not going to say you need to break up with him – that’s not a therapist’s place. We do not give very concrete advice such as do this, we sit with you and help you think through the different aspects of yourself, the different sides of you (one side wants this, but one side wants this) and we try to help you resolve the conflicts. That’s sort of a general overview of therapy. If you get really specific: there are many different types of therapists and we all seem different sitting in the room. On one hand, you have what’s called Cognitive Behavioral Therapy. If you go see CBT therapists, they’re going to be much more active with you. They’re going to be coming up with ideas along with you and they’re probably going to give you homework. They’re going to say let’s figure out how to treat these symptoms in the most direct way possible. There’s tons of different types of therapists, but let’s go to the other end of the spectrum. Let’s go to, say, a psychodynamic therapist. Someone like that is going to sit down and they’re going to be much more laid back and their goal with you is to go over your life story – what happened in your life, things that happened before. Say your parents got divorced and your house was really upset for four years, but that happened when you were 14 and now you’re 18 – a psychodynamic therapist is really going to try to look at that and realize how that affected you. Let’s say right now your symptoms are: you tried drugs or you’re cutting or you’re depressed, you don’t know what you want to do with your life. They’re going to look at the whole big picture to say, Hey, you know what? I bet you that stuff back there really hurt and there’s a possibility that that has to do with your drugs right now. No therapist is going to look at your bad behavior and judge you for it. They’re going to see it as a defense and a band-aid for something that hurts underneath.

Thinking about suicide and death is actually much more common than you may think. Acting on it – luckily is not as common. What you want to do is if you have thoughts of suicide: you want to talk about them. You want to talk to a friend, a family member – anybody you can find to be honest, just get it out of you. Because when you have thoughts inside your head and you express them out loud (you can even write them down), they’re much less likely to be acted on. So the same is true with – it comes up a lot because of celebrities who have committed suicide lately or some of you may know people personally who have committed suicide, you maybe the parent of a child who has said that they’re suicidal – what’s very, very important to know is common instinct says: don’t ask those people because you don’t want to put the idea in their head. That’s false. One hundred percent false. You will not put the idea in their head. That’s not possible. You need to ask them so that if they are thinking about suicide, they’ll talk to you. The more you talk about something like that, the less likely you are to act on it. So I urge you: ask anybody you know who you’re worried if they’re potentially thinking about suicide.

If you’re having thoughts about death and dying, you should definitely go talk to your parents about them. They should be your first line of defense, especially if you have good parents that are available to you. Go talk to them because any thoughts you have inside yourself about suicide, you want to get them out, say them out loud, write them down. Anything you can do to get them out of you, will make you less likely to actually act on them. So it’s very, very important to go talk to your parents about those thoughts.

Social media is really difficult. I imagine we’re talking about Snapchat and Instagram – those are the two main ones that kids are using these days. If you’re using, say, Instagram: what I really recommend to kids is if you don’t want to delete your Instagram and you don’t want to delete your friends, make sure you are cognizant about who you’re following. Who you’re following creates sort of your Instagram life in your head. If you’re following a bunch of depressing quotes or deep dark black, black and white dark photos, that is going to get into you. If you’re watching and scrolling all day long about these dark things, you’re going to start to feel dark too. So all of the people you’re following that are not necessarily your best friends – make sure they’re positive. Make sure they are something else that you prefer – it can be art, it can be pretty pictures, it can be puppies – it doesn’t matter. But it’s very important that if you don’t feel well, delete everybody that’s giving off any kind of negativity because it really, really does change your world. Same thing with Snapchat. If you have, faraway, say third-tier friends who are posting videos of themselves being depressed or they’re doing this or that – remove them. If it’s your best friend – it’s a little bit different. You can go talk to them yourself. But if they are third tier, just delete them. You don’t want to see the negative stuff because it will bring you down.

There’s a feeling that people describe that’s not sadness – it’s something that they described as much worse than sadness: it’s empty. Like there’s no feeling there at all whatsoever. When clients describe that to me, I immediately start to think: okay, maybe this could be a depression. If you feel that feeling for say two weeks or more, you really do need to consider that you could possibly have depression. Let’s say you feel it right away and you want to know what to do. First thing you’ve got to look at is sleep. You have to try to sleep eight to nine hours a night. Next thing you’ve got to look at is exercise. Try your very best to exercise three times a week, three to four times a week for 30 minutes. You can go bike, you can go run, you can do a yoga video on YouTube – just something really basic is fine. Then if it still doesn’t work, I would recommend that you go see a therapist and if that doesn’t work, then I would look at some medicine from the psychiatrist.

If you’re feeling hopeless, like everything is going wrong and nothing’s going to get better – what I want you to do is get a piece of paper and start writing. Write out everything that’s going wrong. Make a list of it, get it all out of your head so you can see it. It’s all the same place. It’s all concrete right here. Then it doesn’t feel so overwhelming. And then what I want you to do is I want you to sit: today, I’m in ninth grade and I’m blah, blah, blah. This is what I have to do. What do you think comes next? What will high school be like? What do you want college to be like? What do you want your life after college to be like? Where do you want to live? What do you want to do? What kind of people do you want to be around? You know, what kind of job you want to have? Do you want to have grandkids someday? I want you to stretch it out into the future. When you take your vision more wide instead of right now, it’s easier to see: okay, right now life sucks, but clearly I won’t be in this exact same place forever. When you look into the future, then it becomes not quite so overwhelming or seeming like it’s going to last the rest of your life.

If you’re feeling angry and irritable most of the time, it can be a contributing symptom of depression. Depression in children looks like anger most of the time, so just keep that in the back of your mind. But let’s say you feel super angry because somebody did something mean and you just feel like you’re going to blow up or something else happened and you just feel really angry and you don’t know what to do with it. My best advice for that would be to workout. Do something that absolutely exhausts you. Whatever it is, whatever you have access to: go run, go to the gym, go to a boxing class, join martial arts. Do something that makes you feel like you can use all of the strength in your body and use it up until you’re exhausted. Burn up the anger. Another thing is to write it out. Write out everything you’re angry about and then edit it. Do it in the notes in your phone and you can edit it so that it gets to the most concise you can get it so you actually know how you feel. When you’re angry about something, you don’t want to tell the other person and drone on and on and off. They won’t hear you and your point will get lost. What you want to do is you want to be able to say it in the least words possible. So that involves a lot of editing and a lot of writing out how you feel, edit down less, less, less and less. And then you can know to yourself how you feel and be able to express to the other person how you feel and hopefully have a much higher chance of them hearing you.

I wish there was an easy answer or easy advice for feeling lonely. If there is, I don’t know of it. When I see clients in my office that feel lonely, we could say you should make more friends, you should go out more but to be honest with you: they’re already out with all their friends. They just are lonely while surrounded by a bunch of people. I think part of the reason this comes up (especially during adolescence) is because you’re recognizing who you are as a certain person and that may not be similar to the people you’ve been friends with growing up. You might feel disconnected, you might feel like you’ve outgrown your friends and that can lead to loneliness. Another aspect of feeling lonely could just be that you’re old enough now to recognize the existential crisis that we are actually all completely separate from other people and we are living our own life and not other people’s. So as far as feeling lonely, that’s a difficult thing that I usually work with in therapy over a course of many weeks and months to alleviate. It’s not something that I think I have a quick tip or advice for.

There’s a symptom of depression called Anhedonia, and what that means is when you lose interest in other activities that you used to enjoy. When you’re in adolescence, it can happen in a few different ways: maybe you’ve lost interest in those activities because you’ve outgrown them and you want to try on something new and that’s obviously not a problem. But if you feel like you wish you wanted to go dancing again, dancing still like you used to, but you just don’t – that’s more along the lines of Anhedonia. What you want to do is if you’ve lost interest in things like that, make sure you get enough sleep. Make sure you try exercising even if you don’t want to – it might spike your endorphins so that you can start getting back into the habit again. And if that doesn’t work, then talk to your parents and perhaps see a therapist or a psychiatrist because that does lead to more along the lines of depression.

Sorrow and despair can come from many different things. Some of the most common might be someone in your family passing away, your parents getting divorced, breaking up with your very first true love. I think at some point every adult knows the feeling of I cannot do this. I feel like I’m dying. My chest is so heavy, I feel so awful – so miserable. I do not know how I’m going to get past today. I’m just going to worry about today, one day at a time. What we do with those feelings is: you have to use up the sadness. You have to use up the grieving and you give yourself time. Depending on what it is, if it’s a breakup or if it’s a death, a death – it’s going to take a long, long time and it’s going to go up and down. Some days you’ll be fine. The next you’ll be super sad again and you just sort of have to sit back and watch your emotions process themselves. Don’t try to stop them. That’s the important part. Do not try to stop how sad you are. You have to keep functioning, but when you’re home or when you’re in the car, then it’s fine to cry and it’s fine to still talk about it with somebody else. If you are going through a breakup, then something similar is going to happen and what I recommend to do is set aside a couple hours every night – maybe not a couple, set aside one and a half – and say: okay, from 7:30-9:00, I’m going to sit and I’m going to talk about ex-boyfriend and I’m going to cry. This is the time I have to do it. Outside of that time I cannot talk about him. And then day after day you only have your hour and a half in the evening to talk about him, but you have to use the whole thing. You can’t stop early – that’s the trick. And after a couple of weeks, you will start to notice yourself being like, ah, screw it. I don’t want to sit here and cry anymore. I don’t want to sit here and be sad and talk about it anymore. And then you can stop. Otherwise, the sadness can sometimes take over your whole day. You’re in the bathroom crying at school when you should be sitting in class. That’s what I would recommend if you’re going through a breakup. If it’s something more severe, like I said, with somebody dying – you want to ask for help and just watch the emotions. Don’t try to stop them. Just keep going. After about six months, a year, a year and a half – it will start to get better.

Unfortunately a very common theme in our society is the idea that you could just snap out of depression. Sometimes this works, I guess, but then it wasn’t really depression in the first place. Real depression has a really strong grip on you and it gets a hold of the chemicals in your brain. When you don’t have enough serotonin or enough of the neurotransmitters created by your brain that you need to feel what we would call typical then that’s when you have depression. To snap out of it doesn’t make any sense because your brain would literally have to create more chemicals and we can get those chemicals sometimes by exercising or sleeping more or using healthy things for our body, but most likely you can’t just snap out of it. You probably need to process through why you’re depressed in the first place and go through all of the things making you sad and angry and go through that with somebody. Another thing is that many times with depression, you just have to have antidepressants. Nothing else has seemed to work and you could stay in that space for a really, really long time without the antidepressants to help you.

If you know someone or you’re seeing someone post disturbing images or suicidal notes on Instagram or Snapchat, etc. – if you don’t know them, probably don’t follow them. If you do know them, what you need to do right away is you need to call their mom, call their teacher, call her dad, call anybody you know, call your own parents who can try to figure it out – but you do need to contact an adult as soon as you can. It’s very important. Do not ever feel bad that you’re telling on your friend or your consulting parents when you don’t need to. If your friend is willing to post that stuff out in public, they should know that somebody’s going to get help for them and somebody’s going to call their parents. That is definitely my advice is to get ahold of somebody in control who can do a lot more than a kid can.

There’s many reasons your grades could be dropping and you don’t care. We’re looking at grades dropping, so we’re taking the assumption that your grades used to be good. Many different factors: the first thing that comes to mind is – what’s going on in your life? Have you started using drugs or smoking weed? That can really take down your motivation to focus on your grades. Have you joined a new social crowd? Have you been going out with your friends and trying to make new friends and social climb and grades have fallen by the wayside? Is something happening in your family? Are your parents fighting more? Are they yelling at you more? Or are there things going on that are distracting you from doing your homework? There’s a lot of different things that could be going on and I do really recommend that you try your best to figure it out. First line of defense should be to go talk to your teachers. They can help you if you are struggling with depression or things going on in your family and they may be more likely to give you an extension or grade you a little bit more lenient. If you have really good grades and you’ve had them every year up until now, you deserve to go advocate for yourself because I really, really hate to see GPA’s completely slashed because of something that happened in one semester in your life and it got wrecked. So please go advocate for yourself and try to figure out what you can do to keep your grades up.

If you’ve already hurt yourself many times – the best thing to do is to come up with a plan of what you’re gonna do instead next time when you’re calm. So right now maybe you’re calm, you need to come up with a plan of what you’re going to do next time when you get really, really upset and you feel like there’s way too much pain going on and you don’t really know what to do. You could plan to go exercise, you could plan to call a friend, you could plan to draw, you can plan to lay there and listen to music and sit on your hands. You can plan anything. But you need to come up with a plan when you’re calm. What I would recommend is that you play this sort of game with yourself – this is cognitive behavioral therapy: for every week that you don’t hurt yourself, you get a little gift or a prize or whatever encourages you. For every month that you go without hurting yourself, you get something else. The longer you go, the more rewards you get. Also, you have to think of it in your mind as I’ve been clean for a month, clean for two months, clean for three months from hurting myself so that you don’t think to yourself, I’ll just do it once and it doesn’t really matter. I don’t care. Also, if you’re already hurting yourself, you do need to go talk to your parents. You need to go talk to an adult. Especially depending on the severity – sometimes it’s very easy to cut too deep and need stitches. Also, we’re just talking about superficial hurting yourself. If you’re suicidal or you’re cutting your wrist to die, then you absolutely need to call 9-1-1 or go talk to your parents or go get help from anybody you can find.

If you’re experiencing physical pain or stomach aches or other things going on and you’ve been to the doctor and they don’t find any diagnosis, they don’t find any reason for it – probably they told you to see a therapist and they’re considering anxiety. A lot of times anxiety disorders can manifest in your physical body and we call that somatic disorders. And the best way to treat that is to go sort of far back and understand your whole life and your whole psyche and what could be making you anxious that you’re not consciously aware of. You usually can’t say I’m anxious because of this, so my stomach hurts. Sometimes you can, but not usually. So what you’d want to do is you’d want to go see a therapist and try to understand what anxieties are going on, what depression symptoms you’re having that are going on. And if we make them conscious and you talk about them, it generally starts to alleviate the actual physical symptom.

Another form of medical treatment for severe depression is what’s known as TMS or Transcranial Magnetic Stimulation. This is a newer form of treatment that is still being studied but is used quite frequently in the appropriate patient population. It works by generating magnetic pulses that are targeted at specific parts of the brain that are thought to help depressive symptoms. Unlike ECT, there is no seizure being induced and there is no need for general anesthesia, meaning that a person is not put to sleep during the procedure. It is usually performed more frequently than ECT. It could be even five days a week in an average course. The benefits relative to ECT are not fully established yet. Currently it is thought that it is not as beneficial as ECT is for severe depression, but it continues to be studied and developed. And this is something to ask your doctor about when you’re considering various options.

Ketamine is a molecule that has been used for years for surgical anesthesia, also been abused as a street recreational drug that some researchers are looking into for a rapid treatment of severe depressive symptoms. It is still largely investigational, largely being administered in research studies and protocols, but there is some preliminary evidence that it may prove beneficial for people in a severe depression. It’s thought not to produce a lasting effect, meaning that someone takes the medication and they remain depression-free for the rest of their life, but it is thought to perhaps jumpstart, if you will, that if someone is severely depressed, perhaps suicidal and they’re administered this medication, that those feelings and thoughts could lift very rapidly, pull them out of that rut if you will, and then other sorts of treatments could then be administered and kick in to try to help maintain them to stay well. There are some potential risks associated with ketamine, which are also still being explored, including the significant concern for addiction as well as effects on blood pressure. Hopefully we’ll know more about this as it continues to be studied.

Magnetic Seizure Therapy is an investigational medical non-pharmacological intervention for depression. On some level, it’s a little bit of a blend between electroconvulsive therapy (ECT) and Transcranial Magnetic Stimulation (TMS) in that it uses magnets to induce a seizure that is thought to help depression. It is not widely available and it is still being researched, but it is hoped that this may also provide some relief in the future for the appropriate patients. Nitrous oxide is an anesthetic that’s been around for years that is currently being explored at low doses to potentially help with the rapid treatment of depression. Repastinel is a medication that is being explored in research trials, hoping to work similar to ketamine

Insurance coverage and the treatment of depression is somewhat variable. Some psychiatrists take insurance, some do not. Some therapists take insurance, some do not. If you’re having a hard time finding a doctor who takes your insurance and it’s important for you to use your insurance, a good first step is to call the insurance and ask for a list of the providers who are in network for them (meaning the ones who are covered to the greatest extent) and you can then either ask other people you know if they recognize any of the names or try calling some of the doctors and see if they seem like a good fit. Hospital services will usually be covered by most insurances. Partial hospital programs will usually be covered by most insurances, residential programs – it may vary more. So obviously for each of these issues, it’s important to talk with your insurance ahead of time in order to ensure that it is indeed covered.

There are two things that we like to work with, which are the internal and external resources. Those are the positive things that a person has going on for them. For example, an external resource will be their support network – who is there for them? To support them, to help them thrive throughout life? Another one is the internal resources which are accessed through insight, and this is what therapy is so good. An example of an internal resource will be their communication skills or their perseverance or something else that they have going on for them that will help them thrive as well.