Mentally STRONG with Dr. B

Have you always been afraid to leave the house or is it just post pandemic? We were all forced to stay home for a long time and learn to like it and function. Agoraphobia is that fear of going out, fear of not being able to escape when you go out. Dr. B here with our series on demystifying the DSM and we're in the anxiety disorder categories and today we're going to talk about agoraphobia.

Oftentimes someone with agoraphobia experiences panic level anxiety when they are trying to do very specific things. For someone with agoraphobia, the core problem is a fear that they're not going to be able to escape.

So, in counseling we would really try to dig deeper than that, right? In the Thought Map, we might say, okay, we know that you have a fear of not being able to escape, but name a time when you weren't able to escape and tell me what happened, right?  And we would really keep asking and changing the questions if it doesn't come up right away, right?

One of my pet peeves in mental health in general is someone owning a diagnosis. Oh, I can't do that, I have agoraphobia. I will continue to challenge anybody that is a functional limitation. This is a symptom that you are dealing with. You can treat your agoraphobia. You can have insight into why you're experiencing those symptoms. You can map that out. You can find the core connections. If there's trauma, you can process and move forward from that.

Okay, and they're still very clear biochemical changes that happen in the brain that exhibit symptoms of any of these disorders, right? So, considering medication, if for any of you where this is a functional impairment, but what I challenge each and every one of you is not to own that. You are not agoraphobic. That is not who you are. It is a symptom which you are exhibiting.

Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
@drcristi_b
https://www.youtube.com/c/drbmentallystrong
https://www.linkedin.com/company/mentallystrong

Ketamine and Esketamine (Spravato) are approved for use in treating refractory or treatment resistant depression and suicidality. Have you been considering ketamine treatment and are wondering if it's safe, physically and emotionally?
Is Ketamine safe? 
Dr. B has experience administering ketamine for different purposes over a long period of time starting when she was 17 years old in the army. Watch this video to hear all about her experiences and her opinion on whether the drug is safe for treating refractory depression.

Ketamine treatments available at Mentally STRONG in Colorado Springs
719-493-9555
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
@drcristi_b

Watch this video if you are interested in learning more about the Healing Through the Mentally STRONG Method live course in Colorado Springs.

Next Course Date: Friday, July 15th 2022 - 9 am - 5 pm
Register: mentallystrong.com/events

8 CEU credits available for licensed professionals.


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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
@drcristi_b
https://www.youtube.com/c/drbmentallystrong
https://www.linkedin.com/company/mentallystrong

PANIC DISORDER - Using the Mentally STRONG Method, we would take a Thought Map and we would say: Panic anxiety, last time you had a panic attack. What was going on? What about in the past when you had a panic attack? What was going on? You know, when was the first time you had a panic attack and what was going on? Did you ever have a panic attack or even anxiety in your childhood, right? These are the questions that we would ask to kind of see what the patterns are that brings on that physical symptom, because oftentimes once you get to that panic level of anxiety, we need to use a medication to kind of bring you down. And what happened is because there's such a physical rush of symptoms you kind of forget maybe what the trigger was, right? And so, sitting down doing that Thought Map and trying to find patterns around it. Because once you know what the internal button is probably a core connection that is being pushed when that happens you will have more control of it. And it feels, a panic attack feels like you're out of control, and that is a scary place to be. Nobody feels good in a panic attack. It is possible to deep breathe your way out of a panic attack. I can do that. But oftentimes, if you haven't had therapy and insight, knowing how to do grounding techniques, knowing how to calm yourself down, it might be very difficult to talk yourself or bring yourself out of a panic attack. But that is the goal is to bring yourself out of it, but I think what happens is that the fear fuels the fire. The physical symptoms of the panic attack. The fear of the panic attack fuels that fire, and so then that panic anxiety just gets worse, worse, worse, worse instead of having some insight and knowing how to calm that down, so you definitely need if you are experiencing panic attacks, you definitely need to get with someone who can teach you mindfulness. Deep breathing, grounding techniques, stimulating the Vagus nerve which can help the physical symptoms. For example, you have the biggest nerves in your neck. If you hum, that vibration actually stimulates the Vagus nerve, which is the biggest nerve. Is what would help you calm down. It is also a physical nerve of a calming nerve. These are, there are multiple techniques out there for learning how to bring down or manage your panic anxiety. But also figuring out what your triggers are so that you can decrease the intensity and the frequency in which this occurs. You know, if you're unable to do those things, you might have an underlying also generalized anxiety that you would need to treat with typically an antidepressant medication to get more neurotransmission in your brain. The more we have floating around, the more we can utilize to help us have control of our brain, so that's panic. If you are experiencing it, I know it is super scary, but make sure that you're trying to treat it from every avenue, not just medication so you can do this. 
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com

What can you do when grief gets in the way of your Personal Vision?
Listen to this podcast to find out how Dr. B handles it when grief gets in the way.

www.mentallystrong.com/grief
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com

Do you think you have social anxiety? Does one of your best friends or someone you really care about have lots of anxiety or anticipation about going out into social settings? Listen to this video. All right Dr. B here with our series on demystifying the DSM and the next one is social anxiety. I often hear people say, “Oh, I have social anxiety.” But to have social anxiety, remember anything in the DSM, the first criteria is that there's an impairment in function, like you're not doing things that you want to do because of these symptoms, and it's based on feeling a fear of scrutiny, feeling a fear, fear of being embarrassed socially that somebody will judge you that somebody won't like you, that there will be some sort of social catastrophe that goes on if you're in these social situations. This is not an introvert who prefers to process internally and then does social things, but they might feel drained after those social things. Oftentimes, we see a combination of that. We see an introvert who also has social anxiety, so then it becomes very difficult to face those fears of social situations. Again, if these things are impairing your ability to do what you want to do, let's say when we do the Mentally STRONG Method, we talk about our Personal Vision. Let's say your Personal Vision is to have good relationships with friends, and maybe an intimate partner. And you won't go out socially and you won't go meet people. Then you are actually blocking yourself from your Personal Vision. You know we can kind of joke, oh, what do you think these people are going to come knocking at your door? But reality is, and this is why in the Mentally STRONG Method we always talk about Personal Vision. What do you want for your relationships? And is this social anxiety holding you back? Anxiety can be treated. Social anxiety can be treated, but probably with a combination. If you really have this deep embedded fear, you cannot face it, you have anxiety symptoms when you try to face it, then we could do an antidepressant. That's the first line treatment for anxiety, to kind of balance out those neurochemicals, but you still have to make a choice to face that fear. Because the fear is not going to go away with a pill. But it does, if you are prone to anxiety and you truly have social anxiety disorder, medication can increase those neurotransmitters give you the ability to kind of face those fears and handle whatever happens because something could happen, and you could be ultimately horribly embarrassed in that in the social situation.  But we would challenge you here to keep going into those social situations, continue to challenge yourself, so that we can reach those Personal Visions. We can meet people that we can trust. You don't have to be an extrovert who loves social situations right, but we all need human connection. We all need to have a tribe of people that we trust. In those outer circles where we don't know those people, don't trust those people. We still need to be able to interact with them at the grocery store, and COVID has been the worst thing for people with social anxiety because they didn't have to go in. They did not have to challenge themselves for almost 3 solid years, they did not have to challenge themselves. And now we're coming out of that, and it's really hard because you've gone these three years you were able to work from home, you weren't expected to go to social situations. But challenge yourself in most social situations and challenge yourself as we slowly open up. I know a lot of people are choosing to stay at home for work long term. If that's you and you have social anxiety, you have to challenge yourself in a different social situation. OK, so a combination here of the treatment of social anxiety. Medication can be helpful, but you have to challenge yourself. You have to choose to face your fear. OK, you can do it.

Do you or someone you know have a very specific phobia that isn't related to another diagnosis such as PTSD? Watch this video!
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Dr. B here with our series on demystifying the DSM and today, we're going to be talking about specific phobias, which is one of my fun topics that I talk about. But just to clarify, specific phobias are around a specific thing, not associated with another disorder, so not associated with post-traumatic stress. If you have a specific fear and it’s related to being triggered from a traumatic event, that's more PTSD. Specific phobias are usually something very specific and isolated with no real understanding as to why. Like claustrophobia, and people who are scared to fly. These are common specific phobias, and we often joke to just stop it. Just do it, face your fears, overcome it, and there's actually a type of therapy called systematic desensitization where you do that. But you don't just want to force somebody to go on the airplane who is very scared of going on an airplane, because if they do have a panic attack in the middle of the air, it's going to cause a lot of, at minimum, drama on the airplane. What you do is more of a systematic desensitization. Where you maybe go to a museum where you can sit in an airplane, you get yourself into closed spots. You ask your doctor, maybe, for an as needed medication to take while you go on a plane so that if you start to panic while you're in the air, that you can take that. That's one of the things that we would do here at Mentally STRONG. If it was just this isolated specific phobia, we would challenge you to try to do it without the medication, but having the medication there is your security blanket. If I do start to panic, I have something to take that panic away. What we don't like to do or what I don't like to do when I'm working with people is just give them something to use as needed and never really working on improving that, because we do know that we can control our anxiety. Sometimes that takes a lot of time and practice, and so we're not against giving medication for that in in specific times. But also, I'm going to challenge you if there's a functional impairment to this, I'm going to challenge you to do it. I hope my mom is not watching, but I'm going to use my mom as an example of being afraid of airplanes. And she literally would not get on an airplane to come visit me. She and her husband got an RV and they drove out to visit us. They would drive which was a 36-hour drive. They would rather drive 36 hours than be on a plane for four hours. I would always try to challenge her. And you know my mom is not going to listen to her daughter. But when Reggie died, she had to get on the plane. And she got on a plane, and she did use a medication to do that. What she said to me was very powerful. She said, the worst thing has happened. I can do this; I can get on that plane. Of course, I have to make everything emotional. Specific phobias, you should try to challenge yourself, but is not necessary until it is, right? If she would have refused to get on a plane that day, that would be a major functional impairment in her life, but she did it. She had to do it. She did it so, that's how you judge whether you need to really work on this. If there was a real emergency, could you do what you had to do to be with your loved ones or to support or to whatever the case may be? Specific phobias don't necessarily have to be treated. Sometimes it's, I'm scared of spiders, so you don't go camping right? But you know, think about it, examine it. Do you need to treat that? And if you do, challenge yourself to treat that.
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally St

SELECTIVE MUTISM – Are you wondering whether your child is showing signs of Selective Mutism? Dr. B discusses the diagnosis in the DSM-V. See below for a transcript of the video:

Dr. B here with our series on demystifying the DSM. Today I'm going to talk about Selective Mutism, which is also, I talked about with separation anxiety disorder, this is often a symptom of something else, but it does have its own diagnostic criteria because the treatment might be different. 

And it’s also super important, especially in children, to make sure that we go through the differential diagnosis and that there's not an actual communication disorder. They have been evaluated by a speech therapist or an occupational therapist, so that we know for sure that this is truly selective mutism. 

Just because a child will not speak in certain situations, it could be a choice, right? It could be a behavior. But if it's associated with significantly high anxiety and the child really doesn't feel like they have control of it, that is selective mutism, and it is, very specific to certain situations. Often, the school will notice it, and home will notice it.  

And it's treated with behavioral, some cognitive behavioral therapy. We can't really start cognitive behavioral therapy until the child is around 12. We can teach the concepts, which this is what I believe, we should be teaching the concepts of cognitive behavioral therapy so that our children know how to love themselves, talk positively to themselves and begin that process. But truly understanding the abstract connection between their thoughts and their choices is difficult for young children. 

So oftentimes the selective mutism happens at that age where we have to do a little more behavioral, reward-based therapy. You know and giving them time. It is an anxiety disorder. There's severe anxiety behind that, so look closely, because they probably also meet criteria for generalized anxiety disorder, which we should and can treat with medication, right? Because the theory behind both depression and anxiety is that there is low neurotransmission, right? We have 26 plus neurotransmitters and some you know we theoretically think are associated with depression and anxiety. But in general, if we can increase one or more of those neurotransmitters, all of them will follow. 

There are natural ways, with good food and exercise and sunlight, but if a person has gotten to the point of selective mutism, that anxiety is very very high and we should strongly be considering medication with either behavioral therapy or cognitive behavioral therapy, depending on the age and the ability of the child. But again, making sure that there's been adequate assessments from speech or occupational therapy to make sure that there's not an actual communication disorder which would be treated completely differently than selective mutism.

Dr. B here with our series on demystifying the DSM and we're going into anxiety disorders, which is a huge bucket or cluster of symptoms. Oftentimes, I'll be saying, we really need to be assessing and looking at what's going on because these really are not, many of them, are not isolated individual diagnosis. Okay, so the order, I'm going to just stick with consistency and go in the order of the DSM, but it's not necessarily in the order of importance or how frequently we're seeing it. But the next, or the first one in the anxiety disorders is separation anxiety. We often talk about this and see this in children, and it can be, it can actually be normal. So again, to meet criteria for a DSM diagnosis there has to be a pretty significant impediment in function. And it has to be persistent, so you know a kid going to school for the first time, or the first time that year, a new school, or something has changed in the child’s life, and you see this anxiety about getting up and going to school, that could be normal. And so, let's wait it out. Maybe talk to your pediatrician. Talk to someone about it, but it could potentially be very normal. If you do think that there is a significant anxiety, oftentimes we want to look very closely at, did something happen to that child? So, if they are now 10 years old, have never had separation anxiety before, and now there's pretty significant separation anxiety, something might have happened to that child. Nothing horribly bad, but we do want to try to investigate. And it is also very important when talking to children, remembering that they're very impressionable. You don't want to say statements like: did so and so hit you? You don't want to put in their mind what it could be, right? And a lot of professionals will use play therapy to allow the child to naturally reveal where the anxiety is coming from. Again, this could be anywhere from normal separation anxiety to something significant has happened or could be evidence that there's an underlying generalized anxiety disorder. But very specifically, to meet the criteria for separation anxiety disorder, there has to be a recurrent excessive distress, it's persistent. And there is persistence in its experiences in several locations. There’s a reluctance or refusal to go out of their way and separate in more than one location, so it's not just starting school. It would also be when trying to take them to daycare or toa house where they should feel comfortable. Any kind of separation there. And there is avoidance for that, and it lasts more than four weeks in children and typically more than six months in adults. If you are that adult and you are experiencing a separation anxiety to someone that you are close to, I challenge you. Often, there's something underneath. What is the real anxiety associated with? Because separation anxiety is often a symptom of something else. So again, it could be simple and normal, or it could be there's something seriously going on and this is a symptom of something deeper. And this is often a symptom of post-traumatic stress. There's been some sort of trauma, and now you are experiencing not wanting to separate, not wanting to be alone. Just having insight into that. A lot of these I don't like to even call a disorder, right? They’re a symptom of something that we can work through that we can use cognitive behavioral techniques to find what we call post traumatic growth and post traumatic growth is for any kind of stressor, not necessarily you know, severe trauma. But we all experience micro traumas and we all experience stress, right? How can we take that and grow from it? Think of separation anxiety as a symptom and that we can work through and be stronger because of it.

Dr. B here with Demystifying the DSM and this video is specifically on that cluster of other depressive disorders which I'm going to include, for all of us who experience depression. What can we do about that? The next several pages in the DSM talks about substance or medication induced depression. Again, anything that crosses the blood brain barrier: illegal drugs as well as even cannabis can cause depressive symptoms because it decreases neurotransmission and then there are depressive disorders due to medical conditions. I talk about this in the bipolar series, just making sure that we're looking at the whole picture here when someone is coming in with depressive symptoms. But we all experience, or many of us experience depressed mood.  So, what do I do? I personally believe strongly in cognitive behavioral therapy, so if you're in therapy with somebody, please talk to your therapist about using cognitive behavioral therapy. Learn the Mentally STRONG Method. This is a cognitive behavioral approach that you can learn to do on yourself, and it is four elements. The first one is mapping out that depressed mood. What's making me depressed right now and we can all list those, right? But what's made me depressed in the past? What has made me depressed in my childhood and how does this impact my spiritual relationship? These are the four questions we always ask because we can often talk about what's going on in our life. We know what's making us depressed, but if you ask those previous life questions you will actually bring up a pattern of what's going on in your life. And what makes you depressed or contributes to your depression. And oftentimes, it's that internal dialogue and so in the Mentally STRONG Method, we have 10 categories, one of which is your negative self-talk. And that really, really contributes to depression. If you heard someone, if you took your negative thoughts, right? And then you heard your child saying that to themselves or would you say that to your child? That's what I always ask. Why would you talk to yourself in a way that you would never say those things to somebody else? And you are with yourself all of the time. So, you are constantly, or hopefully not constantly, but you are feeding this internal dialogue of negative self-talk, and so I challenge you if you're struggling with depression, I guarantee you there's some negative self-talk in there. There are ten other categories, and you may need to actually learn the whole method to figure out where those things go. That negative self-talk is a good place to start. You've got to reframe that you've got to talk to yourself in a positive way. You've got to learn to love yourself. One of the things that I've been doing recently is just telling me I love myself. I love myself and I'm even getting a little teared up saying it because It's hard. Because sometimes I know there's so many things I don't like. There are so many things that I can say are wrong with me. But that doesn't matter. I'm not talking about your strengths and your weakness. Just like your child, you love your child for their strengths and weaknesses. We need to love ourselves as well and so I challenge you to change that internal dialogue and begin to love yourself and tell yourself that you love yourself. Because you deserve to be happy.
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
mentally_strong_
@MentallySTRONG4
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