The Hemp Connection [Search results for coping skills] 

(Note from Monika: Dr. Gretchen will be offering counseling from our Santa Monica office. She has a few spaces left in her"pay what you can" introductory offer for Friday, September 16. If you're interested, email monika at afterthediet dot com for more information)

One of the purposes of the “Mental Health Monday” feature of this blog is to acquaint you with some of the psychological aspects of PCOS, and how mental health issues are impacted by the condition. There are also coping skills, insights and ideas about ways to help yourself, and education about how to create change.

You may have some vague symptoms that seem like something a therapist would know about, but you’re not really sure when or if it’s appropriate to have a consultation or session with me or some other health psychologist or therapist. My specialty, health psychology, focuses on medical conditions and how they impact our mental well-being.

PCOS causes or contributes to a variety of mood disorders, and can either mask or mimic some other physical conditions. It can be challenging to sort out which symptoms came first, and what your treatment priorities are. Here are some of the symptoms you may be experiencing that indicate a need for psychological evaluation and treatment, and that may be connected to your PCOS:

• Difficulty sleeping, or sleeping far too much
• Physical aches and pains
• Unexpected weight gain or weight loss
• Uncontrollable food cravings, especially for carbs
• Panic attacks, or anxiety attacks
• Feeling jittery all the time
• Mood swings
• Thoughts of suicide
• Constant irritability
• Trouble relating to other people
• Isolating yourself
• Pain issues that don’t seem to be connected to injury
• Feeling overwhelmed
• Difficulty coping with your diagnosis
• Having a new diagnosis
• Infertility issues
• A recent loss
• History of trauma, domestic violence, or other acute stressors
• Developing complications, such as diabetes

Additionally, you may want to receive education about PCOS and related mental health issues, identify a medical and psychological treatment team or plan, and work on developing coping skills and strategies for managing your PCOS. These are all things that health psychologists do, and that could be part of your reasons for consulting a health psychologist.

It can be scary to contemplate calling a psychologist, but at the same time, simply taking the first steps to get help may also result in improvement. Knowing that you’re doing something good for yourself, and that there ARE experts who can help, will often jump-start the healing process. You may be inspired to improve your self-care practices. You may also start practicing the self-care skills that you have, but haven’t been using often enough.

In a future “Mental Health Monday” post, I’ll address what actually happens in a therapy session, so you can learn more about what to expect, if you haven’t already experienced therapy.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

Dr. Gretchen Kubacky will be the featured expert this week on the PCOS Challenge Expert Webinar series.

Here is a description of her upcoming presentation:

Depression, anxiety, suicidal thoughts, infertility, and many other disorders are much more common in women with PCOS. In this PCOS Challenge Expert Series workshop, Dr. HOUSE will address the psychological issues and coping skills necessary for thriving with PCOS. Dr. HOUSE will also explain how to identify the most common conditions, suggest ways to find sources for help and support, and describe how to proactively manage your mental and physical health and relationships.

In this workshop, you will learn:

What a mood disorder is and what it looks like.
Signs that you might be feeling suicidal.
What every PCOS woman needs to know about infertility.
Coping skills for relationships, medical treatments, and body image issues.
How to be a proactive patient and get the help you need now.

Click here for information on registering:

You’ve no doubt noticed the onslaught of pharmaceutical company sponsored advertising flooding television commercials and magazine inserts. You can hardly glance at the media without hearing about side effects such as 36-hour erections (okay, we don't have to worry about that one!), loose, oily stools, nausea, cramping, bouts of mania, and unexplained bleeding. These same ads proclaim the medication’s benefits even more loudly – freedom from migraine headaches, depression, obesity, and erectile dysfunction. The message seems to be that there’s a pill to fix anything that ails you. Sometimes it seems like every kid you meet is on ADHD medication, and half your friends are on some form of anti-depressant – and it’s true that these medications are prescribed with far too much ease and far too little deep consideration. Yet on the other side, there’s a backlash from those who claim that the body is a self-regulating mechanism; that diet, supplements, and yoga can cure anything up to and including cancer; and that all drugs (prescription medications) are poisons that disrupt the system.

As a psychologist treating primarily patients who are dealing with a chronic or acute illness or medical condition, particularly PCOS and other endocrine disorders, my interest in pharmaceuticals relates to both the psychotropics (medications used to treat mental conditions) as well as the medications prescribed by my patient’s physicians to address the physical symptoms of their conditions. Very few of us actually want to be on medication, but there’s a special stigma still associated with the medications we use to treat our brains. People report feeling weak, broken, damaged, crazy, and worse when it’s suggested that psychotropic medication might be helpful in addressing their depression, anxiety, bipolar disorder, or other condition. Consequently, they often refuse to try the very medication that provides them with the support they need so that they can really achieve something meaningful in their psychotherapy.

The truth is that the mind and body are inseparable, and many mental disorders have a biological base – there is literally a chemical imbalance in the brain, and it can be helped with medication. Just like insulin helps the diabetic, or synthetic thyroid replaces thyroid hormone for someone with hypothyroidism, medications that enhance neurotransmitter functioning can fill in the gaps in brain functioning. Non-pharmaceutical approaches such as nutrition, supplements, and mindfulness meditation practices can be useful, but are often not inadequate, or work too slowly. They require dedication and persistence to work, and many patients suffering from a period of depression or facing significant stressors may not have enough time to implement these methods. Sometimes the"medication" you need to consider is something non-pharmaceutical — Chinese herbs, Sam-E, or St. John's Wort, for example.

My perspective is that medication can serve as a support for the brain while you’re learning better coping skills, allowing the brain to rebalance, and getting relief from your worst symptoms. Yet we continue to demonize Big Pharma as money-grubbing, disrespectful of natural processes, and potentially harmful when it is true that even natural substances can be harmful or fatal – to the patient who is allergic to peanuts, a taste of peanut butter may be far more harmful than a large dose of a medication, and in fact, it’s medication that may save that person’s life. For me personally, medication is always a last resort (unless I've got a serious infection, or acute pain, in which case, I say"bring on the meds — and pronto!"). If my clients are stable enough, I also support their trying other things first. But I feel like Big Pharma's part of my tool box — there when you need it, and I'm quite grateful for it when it lifts someone out of a long-term depression, alleviates suicidality, or decreases life-disrupting levels of anxiety.

Similarly, with pain, the old way of thinking is that you should suck it up, suffer, power through – anything but take painkillers. As it turns out, your body heals faster, your anxiety is lower, and there’s a lower incidence of depression when patients take painkillers as prescribed. For a limited time and a specific use, doesn’t it seem reasonable to use every tool at your disposal? I want my patients to feel better sooner rather than later, so we often have discussions about their ideas about taking medication, whether it’s for a medical or psychological condition. If you automatically reject the idea of medication, especially the psychotropic medications, I invite you to examine your attitudes to see if they’re outdated, impractical, self-destructive, or just flat-out wrong. As always, I advocate taking a proactive stance as a patient, whether that’s in your doctor’s office or the psychotherapist’s consultation room. Perhaps you’ll find that the enemy of wellness lies more within your own mind than in the face of Big Pharma.

Gretchen Kubacky, Psy.D. is a Health Psychologist in West Los Angeles, a member of the inCYST Network, and a frequent speaker and author on issues related to health psychology, women's health, PCOS, and other endocrine disorders. If you have questions for Dr. Gretchen, have a topic you'd like to suggest, or would like to learn more about her practice, please visit her website at www.drhousemd.com.

It's not uncommon to read blog posts, tweets, and chat room conversations in which women with PCOS describe their depression, and attribute it to the weight gain and appearance that their PCOS has promoted. It can be easy to blame the discomfort, fatigue, restless, and anxiety that depression provokes, on tangible and unwanted physical changes

A recent study helps to verify what I've believed all along…that depression, like hirsutism, weight gain, and infertility, is another condition that PCOS has potential to create. It is not the result of other symptoms associated with PCOS.

Here's the study.

Thirty women with PCOS and thirty women without PCOS participated in this study. All subjects had similar BMI's/weights. Only women who were not on any psychotropic medication were included. Women with PCOS scored higher on an anxiety scale than women without PCOS. They also slept less, worried more, and experienced more phobias than women without PCOS. Weight was not associated with any of the symptoms, except for sleep.

In other words, regardless of your weight, you can be depressed if you have PCOS.

If you attach or blame your depression on your weight, your appearance, or your infertility:

--you can set yourself up for an eating disorder…if you actually lose weight and discover it didn't change how you feel.
--you can feel even worse if you spend time and money on cosmetic surgery, only to realize you don't feel as good as you hoped you would.
--you can put yourself through the tremendous stress of infertility treatment, and get the baby, only to discover that you still feel depressed, and now you've got a baby who isn't sleeping through the night who is dependent on you.

That's the bad news. The good news is that the inCYST program is very helpful at reducing anxiety and depression. So in addition to helping you normalize your weight, reducing the progression of testosterone-related programs, and increasing your fertility, it helps you to feel better. It literally rebuilds your nervous system so it can reduce the influence depression can have. And in rebuilding the nervous system, it helps to balance hormones so that symptoms can lessen.

We like to focus on feeling better, since we know that in women who do, the other problems tend to fall into place. That's not to say that being anxious about your PCOS doesn't worsen when you focus on your symptoms, and that when you learn better coping skills you won't feel even better. Gretchen Kubacky has done a great job of discussing that here, on her blog, and on PCOS Challenge.

It's just that you want to be sure you're tackling the core cause of the problem, and not simply putting band-aids on the symptoms. Nothing can be more frustrating than investing all your time, resources, and money into diets and medical procedures, only to feel the same or even worse once you've done so.

Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

REFERENCE
E. Jedel1, M. Waern2, D. Gustafson2,3, M. Landén4, E. Eriksson5, G. Holm6, L. Nilsson7, A.-K. Lind7, P.O. Janson7 and E. Stener-Victorin8,9 Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

1 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden 2 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Rush University Medical Center, Chicago, IL, USA 4 Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden 5 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 6 Department of Metabolism and Cardiovascular Disease, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 7 Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 40530 Gothenburg, Sweden

If you’re a new reader of this blog, or you’ve got a new diagnosis, you are probably starting to realize that there are some changes you need to make if you’re going to be healthy while living with PCOS. Or perhaps you already knew that, or have had the diagnosis for a while, but you’ve been lurking here, just thinking about the idea of change, and not actually committing to change. That’s even an earlier stage in making change that is called pre-contemplation, where you haven’t begun to think about change (but typically, someone else, like your therapist, knows you need to change).

Change conjures up all sorts of feelings. For some, there’s a feeling of excitement and hopefulness. For others, there is sadness about leaving behind a lifestyle, a set of choices, some favorite foods, or a particular relationship or way of functioning. There may be fear about facing the unknown, lacking the knowledge to proceed in a healthy or effective way, or about how your life will rearrange as a result of the conscious changes that you’re making.

When it comes to the areas of exercise and dietary management, all of these issues and more may arise. If your situation is further complicated by depression, anxiety, or an eating disorder, it’s even more complicated. Depression may leave you lethargic and unmotivated; with your brain craving a rebalancing of serotonin, you may be consuming excess carbohydrates to try to fix the balance. Anxiety can escalate to such a place that any idea of change leads to fear and freezing; there seems to be safety in staying in one place, even if it’s an uncomfortable place. And of course, if you’ve got a history of eating disordered behavior, and it’s “working” for you, to keep your weight contained, then the trepidation factor may be enormous.

Here are some things about change that it may be helpful to think about, whether you’re in pre-contemplation, contemplation, or the actual process of creating the change:

• It’s your body, and your decisions. You own them; no one else does.
• You can change your mind at any time. If you’ve started down a certain path, and you really hate it, or it doesn’t appear to be producing results, it’s generally not a lifetime commitment (exceptions come to mind, like having a hysterectomy, or getting a tattoo).
• Medical, dietary, and psychological theory is continuously evolving, and you should be re-evaluating on an ongoing basis anyway.
• There’s no shame in trying. The shame comes from not loving yourself enough to never start trying.
• It really does take practice to produce change. Do some research on how to create that continuity. You may need to schedule exercise into your calendar at a certain time every day (when I was diagnosed with early onset Type II diabetes in 1998, I wasn’t exercising much at all, and I would literally schedule myself to walk for TEN MINUTES a day; every other week, I added five minutes to that time, until I reached 75 minutes a day, and had lost 72 pounds), join a group that meditates (they’ll teach and support you, and keep you accountable), or keep a food log (more accountability!) in order to adhere to whatever program of positive change you’ve devised for yourself.
• There are many people who will support you in creating the change you desire, and a number of them are found right here, at the inCYST community. Seek their help. You’ll be surprised how much support you can find online.
• If you’re trapped in a paralyzing fear, or find yourself repeating negative patterns, or quitting quickly time after time, there may be a deeper psychological issue at play. It’s worth a consultation with a health psychologist or other therapist to assess your behavioral patterns and choice-making skills.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

There are so many things in life to be afraid of or worried about: nuclear meltdown, the price of gasoline, whether or not you’ll have a job next week or next year, how on earth you’re going to get pregnant, the development of PCOS-related side effects, the potential demise of Social Security, and whether your children will develop enough skills to make it in this complex world.
And those are just some of the grand themes that elicit fear, anxiety, or even terror. There’s still the worry about being late to a date or a job interview, whether or not you actually cooked the chicken until it’s done enough to prevent food poisoning, the results of the labs the doctor ran yesterday, and wondering if you spell-checked the document you just e-mailed to 27 people. All day long, there are things both small and large to worry about, many of which bring up concern about the future.
Sometimes, anxiety is healthy. It makes you double-check the temperature of the stove, verify that there’s enough gas in the car, ask a friend to read through something, or hop on the internet and do a little research. This is the part of fear that’s an asset. You’ll be better prepared, more thorough, and more realistic. And frankly, some of us could stand to do a little more worrying about the future (setting up a savings account, changing your nutritional program, or going back to school, for example).
But anxiety and “what-iffing” can get out of control easily. If you find that you’re spending hours researching something over which you in fact have little control (come on, admit it!); squirreling away so much money that you’re running into problems taking care of your daily expenses; doubling up on the condoms (which, by the way, causes them to break MORE easily and therefore provides less protection); or having problems getting to sleep at night because your mind is racing with possibilities (all of them negative), then you need some help dialing it back because it’s no longer an asset – it’s a detriment to your well-being.
To make sure that your fear, anxiety and worry function to enhance your life, ask yourself the following questions:
· Am I being realistic? · Do I REALLY know everything I need to know about this? · Do I ALREADY know as much as I need to know? · What’s the worst possible outcome if I just let this sit and play itself out? · How much control do I have in this situation? · Am I deriving some sort of gain from being a bit of a drama queen about this?
Be honest with the answers. No one’s checking them for accuracy. If, after running through this list of questions, you find that you’re over-reacting or focusing on the wrong things, make efforts to correct your course, change your behavior, or get help. Worry and fear gone out of control produce endless stress on the already delicate systems in your body, and will cause a domino effect that just leads to more stress, decreased productivity, and even more worries.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in

West Los Angeles,

California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the

Los Angeles area, please visit her website at www.drhousemd.com , or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

Thought I would bring a psychotherapist's perspective to treating PCOS. In the past few months I have attended three scientific conferences and one practitioners conference on PCOS. The one unanimous and certain recommendation from every one of them was 'lifestyle, lifestyle, lifestyle'. But what does that mean? Does it mean eat less and exercise more? Does it mean feel shame when you indulge in holiday egg nog this season? No. Lifestyle to me means just that…style your life. Make changes to honor your life and take care of your chronic condition. Attached is an outline I wrote to help me explain and promote 'Lifestyle' to my clients.

Treating PCOS: Lifestyle for Success A Psychotherapist's Approach Stacy Korfist, LMFT
L is for the lifestyle change that is critical to make. No more diets, no more ‘someday’. Lifestyle change obviously includes nutrition and exercise, but it also includes stress management, adopting a new way of living, a new way of coping and a new way of playing that is essential.

I is for Identity. This is your sense of self; your self esteem. This includes facing anxiety and depression. Setting appropriate boundaries helps you to claim yourself. I is also for Integrity. No more broken promises to yourself or others. They only lead to self deprecation and more shame and depression. Be a person of your word.

F is Food & Feelings. Eat when you are hungry; stop when you are full. Understand the thoughts and ideas which fuel eating behaviors. Learn all you can about insulin resistance. Don’t be fooled into another diet that is too difficult to sustain. See a dietitian that knows about polycystic ovarian syndrome.

E is the Education and knowledge that you must obtain in order to take care of yourself. PCOS is a chronic condition, not one that requires only medication. YOU must be your own case manager. PCOS involves almost every organ in your body. Learn about lab work and what your results mean. Don’t assume your treatment team is aware of your ‘whole self’. Trust yourself. Don’t be afraid to speak up. Remember, PCOS is a syndrome, a squirrely disorder which pops up in many places.

S is for Support and Healthy Environment. Surround yourself with encouraging people and rid yourself of as much conflict and chronic stress as possible. Pay a little more for organic food and avoid false estrogens in plastics and cleaning products.

T is Teamwork. You can’t do this alone. Ask for help, make plans ahead and let others help you. Being strongly-weak will get you so much farther than being weakly-strong. Assess your treatment team. Are you being seen by too many providers; broken up into too many pieces? Are you taking too many medications?

Y is for YES! Yes is the attitude to have. In order to avoid deprivation backlash, it’s important to focus on what you can have versus what you cannot have. Live with full passion. Y is also for Yesterday. Let go of yesterday and focus on today and tomorrow. Having a positive future-focus will help achieve successful endeavors.

L is for Lower Threshold, not lower calories. Although weight loss is important for some, reducing calories too much can prove counter-productive. People with PCOS can have a lower threshold for oxidative stress. It doesn’t take as much to put the body in stress mode. Exercising too much or restricting too little are stressful on the body. When you do this, you often experience backlash and yo-yo weight gain.

E is for Energy and Experiential Therapies. Learn mindfulness skills. Occupy your body. Achieve mind-body congruity. Change requires an awakening. We awaken in movement, awaken in relationship and awaken in journaling and art. This allows us to be with ourselves, in our own space. It teaches us self monitoring and self regulation, which slows down reactivity.

Stacy Korfist, LMFT
Redondo Beach, California
(310) 720-6443
info@pcosnetwork.com