DEPRESSION
According to Gallup, 29% of Americans will have depression in their lifetime and 17.8% of Americans currently have depression. Some of the most common characteristics of depression include:

• The inability to take interest or pleasure in activities (officially known as anhedonia)
• A change in eating behaviors, such as an increased or decreased appetite
• A change in sleeping behaviors, such as sleeping too much or too little
• A constant state of fatigue
• Low self-esteem
• Feelings of worthlessness
• Excessive or inappropriate feelings of guilt
• Recurring thoughts of death and/or suicide
• Difficulty thinking or concentrating

However, no two depressions are the same. Symptoms of depression vary drastically based on the individual and don’t lessen the struggle you’re experiencing.

Generally, women and people with estrogen-dominant bodies are more likely to feel sad whereas men and people with testosterone-dominant bodies are more likely to feel angry or irritable. While women have higher reported rates of depression, men are more likely to commit suicide – it’s assumed men and women experience depression at equal rates, but women are more likely to seek help compared to men.

Similarly, depression symptoms also vary by age group – but depression affects everyone regardless of age. Adults speak more often about feelings of worthlessness, sadness, and the inability to enjoy past hobbies while children tend to act out, express feelings of anger, and isolate themselves. Teenagers fall in between these two spectrums, with a focus on social withdrawal and isolation as well as feelings of worthlessness and low self-esteem. Additionally, children and teenagers are less capable of making life changes to improve their situation – if their depression is caused by bullying or abuse, they’re unable to make the changes necessary to improve their environment. These are also difficult for adults to do, but adults’ ability to seek help and make hard choices makes adult depression easier to confront.

Types of Depression-Related Conditions

• Major Depressive Disorder (MDD) is the most common and severe type of depression, also referred to as clinical depression or unipolar depression.
  • Treatment-Resistant Depression (TRD) is a subset of MDD or other depression disorders where symptoms fail to respond to at least two different antidepressants. Medical treatment for depression varies greatly on the individual and their brain chemistry, as well as environmental factors that may be affecting their mental health – but TRD occurs when traditionally prescribed SSRIs, SNRIs, and NASSAs don’t work.
  • Melancholia makes up about 25% of depression disorders and is difficult to treat since it doesn’t respond as well to SSRIs or counseling compared to MDD. Melancholia is characterized by slowed movements, thoughts, and speech worst in the morning.
  • Psychotic Depression is another subtype of MDD where clinical depression is combined with the symptoms of psychosis such as hallucinations, delusions, or a break with reality.
  • Prenatal Depression is a depressive mood disorder that develops during pregnancy. Approximately 10% of pregnant people will experience prenatal depression, influenced by the hormone changes during pregnancy.
  • Postpartum Depression (PPD) is a similar subset of MDD to prenatal depression but begins within four weeks after delivery. Roughly 16% of pregnant people experience PPD in the first three months after delivery which is linked to the chemical, social, and psychological changes associated with having a baby.
• Persistent Depressive Disorder (PDD), also known as dysthymia, is a long-term but less severe form of depression that lasts two years or longer. However, it is possible to have both MDD and PDD at the same time, referred to as “double depression.”
  • Atypical Depression is a subset of both PDD and MDD when traditional depression has atypical symptoms that do not meet the strict criteria requirements within the DSM.
• Disruptive Mood Dysregulation Disorder (DMDD) is a childhood depressive disorder diagnosed in people between the ages of 6 to 18, associated with frequent and intense anger outbursts and irritability.
• Stress Response Syndrome is the official term for “situational” depression, referring to the depression individuals feel while managing stressful or traumatic situations like death, divorce, or job loss.
• Bipolar Disorder is sometimes called “manic depression,” and has extreme swings of high energy to depressive periods. There are two types of bipolar disorder: Bipolar I consists of manic periods that last at least a week and regular depressive episodes; Bipolar II has less intense manic periods that last at least four days and need less depressive episodes to qualify.
• Cyclothymic Disorder is a relatively mild mood disorder with mood swings between mild depression and mania compared to bipolar disorder.
• Premenstrual Dysphoric Disorder (PMDD) is a mood disorder that regularly occurs alongside someone’s period. PMDD is different than premenstrual syndrome since it causes more draining emotional and physical symptoms.
• Seasonal Affective Disorder (SAD) is a type of mood disorder that occurs at the same time each year. While most people associate SAD with winter, it can also occur during the summer.
  

Want to learn more about depression? Suggested resources include the Anxiety & Depression Association of America, Depression and Bipolar Support Alliance, Postpartum Support International, Alexis Joy Foundation, International Bipolar Foundation, and Hope for Depression Research Foundation.

STRESS
Trauma and stress can create mental health conditions even if no other disorders manifest – although depression and anxiety often appear in people who have stress conditions. Stress-related disorders are tied to one’s environment and traumatic events and appear after shocking, scary, or life-threatening experiences. Some common symptoms of stress disorders include:

• Extreme feelings of fear or helplessness
• Anxiety
• Flashbacks or nightmares
• Feeling numb or detached from one’s body
• Avoiding situations, places, or other reminders related to the traumatic event
  

Stress disorders differ from anxiety disorders because they have a known trigger or traumatic event. While most anxiety disorders cause stress, they do not all have singular causes in the same manner. Like depression disorders, no two stress disorders are the same. The amount of stress needed to cause stress disorders or PTSD in one individual is completely different than the amount of stress needed for someone else – varied journeys do not lessen one’s struggle.

Types of Stress-Related Conditions

• Acute Stress Disorder (ASD) is a short-term condition that manifests within the first month after a traumatic event. ASD is shorter reaction lengths than PTSD since PTSD requires reactions to last four weeks or longer.
• Post-Traumatic Stress Disorder (PTSD) is a long-term disorder that develops after experiencing or witnessing a traumatic event. While most people associate PTSD with war, other experiences can also cause it – like abuse, bullying, death, car accidents, physical illness or disability, and natural disasters. The main difference between ASD and PTSD is not the traumatic event itself, but the length of symptoms.
  • Complex Post-Traumatic Stress Disorder (CPTSD) results from chronic trauma, like prolonged child abuse or domestic violence. CPTSD differs from PTSD because PTSD generally develops from short-term trauma and one-time events.
• Prolonged Grief Disorder (PGD), or complicated grief, is long-lasting grief that occurs after a loved one dies. For adults, PGD generally manifests within at least six months of death, whereas PGD shows up within 12 months for children and teenagers.
• Stress Response Syndrome or adjustment disorders are very short-term emotional and behavioral reactions to stress. Stress response syndrome doesn’t always have depressive symptoms – although some people may experience adjustment disorders such as situational depression.
• Reactive Attachment Disorder (RAD) is a childhood condition where a child does not form healthy emotional bonds with their parents or caregivers, often due to emotional neglect or abuse.
• Disinhibited Social Engagement Disorder (DSED) is a behavioral disorder that manifests in young children who have difficulty forming emotional bonds with others. Children with RAD are more withdrawn, whereas those with DSED are disinhibited and often impulsively social with strangers while unable to form deeper bonds.
  

Want to learn more about stress? Suggested resources include the American Institute of Stress, International Stress Management Association, Stress Management Society, Wounded Warrior Project, PTSD Alliance, National Center for PTSD, Gift from Within, GriefShare, and Center for Workplace Mental Health.

ANXIETY
For most people, anxiety is a normal emotion. Anxiety is a natural way for humans to react to stress, alerting us when there’s potential danger. People worry about health, money, family problems, etc. – anxiety disorders differ from everyday anxiety. They’re overwhelming, long-lasting, and interfere with daily life, typically worsening over time regardless of a ‘reason’ to worry. Some of the most common characteristics associated with anxiety include:

• Headaches, muscle aches, stomachaches, or other unexplained pain
• Sleep problems such as difficulty falling or staying asleep
• Excessive feelings of worry or dread
• Frequent or unexpected panic attacks
• Irrational worry, fear, or aversion to a specific object or situation
• Being easily annoyed or irritated
• Unjustified fear that people will judge you negatively
• Feelings of restlessness
• Feelings of low self-esteem or self-consciousness

Stress and anxiety disorders are the most common mental health conditions that cause physical illness in addition to emotional and mental distress. While stress and anxiety are helpful for specific situations, they damage the body if you remain stressed or anxious long-term.

Types of Anxiety-Related Conditions

• Generalized Anxiety Disorder (GAD) is associated with constant daily worry that’s difficult to control. GAD is a comorbid disorder that is often accompanied by other anxiety disorders like PD, OCD, or substance misuse.
• Panic Disorder (PD) is defined as when someone has had at least two panic attacks – a very sudden and physical feeling of fear that’s described as feeling like a heart attack or stroke. 1 in 3 people will have at least one panic attack in their lifetime, although only 3% of people have PD.
• Obsessive-Compulsive Disorder (OCD) causes repeated unwanted thoughts or urges that cause someone to do certain actions over and over again. OCD causes genuine distress and interferes with daily life, which is the defining of all mental disorders. Technically, OCD was reclassified in 2013 and no longer officially an anxiety disorder, although it is comorbid with anxiety disorders.
  • Obsessive-Compulsive Personality Disorder (OCPD) is not an anxiety disorder, but rather a personality disorder that causes individuals to be excessively preoccupied with control, perfectionism, and organization.
• Social Anxiety Disorder, also known as social phobia, causes immense stress in everyday social situations. Public speaking is uncomfortable for most, but social anxiety disorder makes daily interactions limited due to intense anxiety.
  • Selective Mutism is an anxiety disorder that causes total or near-total inability to communicate in certain situations. It is most common in young children, but can affect teenagers and adults – it’s different than deliberating choosing not to talk since it’s caused by stress that prevents the individual from communicating.
  • Separation Anxiety Disorder (SAD) is a childhood condition that causes someone to become fearful and nervous when away from home or separated from a loved one like a parent or caregiver.
• Phobia-Related Disorders create fear or anxiety that’s so severe that it consistently and overwhelmingly disrupts daily life. All phobias are anxiety disorders, although they generally do not have their own separate diagnoses.
• Substance-Induced Anxiety Disorder is a condition that develops as a direct result of substance use where anxiety forms after using drugs and/or alcohol. Even though substance misuse is comorbid with many mental illnesses, substance-induced anxiety disorder is a unique and separate anxiety condition.
• Sleep Disorders affect one’s ability to get the rest needed, influencing the quality of sleep, duration, and ability to fall asleep. The International Classification of Sleep Disorders categorizes various conditions, which are caused by both anxiety and physical conditions.
  

Want to learn more about anxiety? Suggested resources include Anxiety and Depression Association of America, National Social Anxiety Center, International OCD Foundation, and National Alliance on Mental Illness.

SUBSTANCE MISUSE
Also known as drug addiction or substance use disorder (SUD), substance misuse is a condition where an individual is unable to control their use of a drug – legal or illegal. Once addicted, you continue using a drug despite the harm it causes your physical and emotional health. Some of the most common symptoms of SUD include:

• Intense urges or desires for a drug
• Needing a larger dosage of a drug to get the same effect
• Taking larger dosages of a drug than you intended
• Feeling you must use a drug regularly, such as daily or several times a day
• Spending money on a drug, even if you can’t afford it
• Making sure you always have a supply of a drug
• Failing to meet social, recreational, or work responsibilities due to drug use
• Continuing drug use despite the problems it is causing in your life or physical and psychological health
• Doing behaviors that you normally wouldn’t do to get a drug, such as stealing
• Doing risky behaviors while under the influence of a drug, like driving
• Failing in attempts to stop using a drug
• Experiencing withdrawal symptoms when you attempt to stop using a drug.
  Symptoms of withdrawal include:
  • Depression
  • Anxiety
  • Irritability and agitation
  • Trembling and/or tremors
  • Muscle pains and aches
  • Loss of appetite
  • Fatigue
  • Sweating
  • Nausea
  • Vomiting
  • Confusion
  • Insomnia
  • Paranoia
  • Seizures

SUD exists on a spectrum and may be mild, moderate, or severe – no matter where you are, know that SUD is treatable and you are worth getting help. Addictions and SUD occur due to how drugs fundamentally change how your brain functions over time. Most drugs release dopamine, a naturally occurring chemical that’s great in small amounts but becomes problematic when substances overexpose your brain and body to it. Due to the symptoms of withdrawal and how difficult it is to overcome SUD, professional help is almost always required.

Want to learn more about substance misuse? Suggested resources include United States Substance and Mental Health Services Administration, National Institute on Drug Abuse, Shatterproof, Pride Institute, Partnership to End Addiction, Harm Reduction International, and the National Harm Reduction Coalition.

PSYCHOSIS
Less people are as familiar with psychosis disorders as they are with depression, anxiety, and substance use disorders. They’re often described as “losing touch with reality” where an individual has difficulty recognizing what is real and what isn’t. Psychosis may be less understood, but that doesn’t mean you aren’t worthy of support. Common characteristics associated with psychosis disorders include:

• Delusions, or false beliefs that you cannot recognize as false
• Hallucinations, or sensory experiences you cannot recognize as false
• Disorganized thinking or speech, especially when not linear, goal-directed, or logical
• Disorganized, unpredictable, or inappropriate behavior
• Decrease or loss of normal functioning, like expressing emotions or talking

Mental health conditions are most often comorbid, referring to the increased likelihood you will develop additional disorders due to already having a condition. This is similarly true for psychosis disorders – however, unlike other mental health conditions, psychosis disorders have a strong genetic or biological base compared to depression or anxiety disorders.

No two psychosis disorders are the same, and the symptoms someone may have can change over time. While counseling is a primary intervention in other mental health conditions, medications like antipsychotics are the main intervention for those struggling with psychosis conditions.

Types of Psychosis-Related Conditions

• Schizophrenia is the most common psychosis disorder where an individual struggles in daily life due to delusions and hallucinations. Previously, schizophrenia used to be categorized as either paranoid or catatonic – but today, it’s seen as a spectrum of conditions like the ones below.
  • Schizophreniform Disorder is a short-term psychosis disorder that lasts fewer than six months. The deciding difference between schizophrenia and schizophreniform disorder is that schizophrenia is a chronic and life-long condition whereas schizophreniform disorder subsides in six months or less.
  • Schizoaffective Disorder combines the conditions associated with mood disorders and schizophrenia – people with schizoaffective disorder experience depression and mania in addition to their psychosis.
  • Schizotypal Personality Disorder (STDP) is a personality disorder associated with intense discomfort with social interactions while also holding distorted views of reality. However, unlike schizophrenia, people with STDP do not have psychotic hallucinations and delusions but still struggle with recognizing reality.
• Brief Psychotic Disorder (BPD) refers to psychotic symptoms that last for a very short amount of time, usually spanning a month or less. BPD can be triggered by an obvious stressor, postpartum, or without a known cause. It consists of the same hallucinations and delusions that impact other psychosis disorders, with individuals typically recovering completely afterward.
• Delusional Disorder is a psychosis condition that only has delusions manifest – other symptoms associated with psychosis like hallucinations and disorganized thinking, speech, and behavior aren’t present in delusional disorder.
• Medical Condition-Related Psychotic Disorder occurs due to another medical condition, the major symptoms of delusions and hallucinations appearing alongside someone’s illness. This type of psychosis can happen from a variety of illnesses, but the most common are:
  • Parkinson’s Disease
  • Alzheimer’s Disease and Dementias
  • Delirium
  • Head Injuries
  • Brain Tumors
  • Stroke
• Substance-Induced Psychotic Disorder or drug-induced psychosis is a condition where any psychotic episode is triggered after the use of a substance. This can include taking too much of a certain drug, having an adverse reaction, experiencing a withdrawal, or if the individual has underlying mental health issues.
• Postpartum Psychosis (PPP) is a mental health emergency that causes hallucinations, delusions, paranoia, or a break from reality within six weeks after giving birth. PPP is reversible but dangerous due to the high chance the individual may harm themselves, others, or their child.

Other conditions that can include short to medium-term symptoms of psychosis include major depressive disorder, bipolar disorder, obsessive-compulsive disorder, body dysmorphic disorder, post-traumatic stress disorder, and communication disorders as well as Autism.

Want to learn more about psychosis? Suggested resources include Schizophrenia & Psychosis Action Alliance, CURESZ Foundation, Schizophrenia International Research Society, and the American Psychiatric Association.

EATING DISORDERS
Behaviors that create unhealthy relationships with food are referred to as eating disorders – mental health conditions that cause severe and persistent emotional distress around eating. If unresolved and untreated, eating disorders can be life-threatening. There are several types of eating disorders that cause people to eat large amounts of food, eat non-food items, throw up after eating, count calories, limit food groups, and excessively exercise. Common characteristics associated with eating disorders include:

• Restricting food and/or calorie intake
• Eating large amounts of food in a short amount of time
• Eating non-food items like chalk, dirt, or paint
• Avoiding or restricting food groups
• Purging eaten food by vomiting, using laxatives, or exercising excessively
• Fear of gaining weight
• Having a distorted self-image
• Hiding food or throwing it away
• Withdrawal from friends and social activities

Due to the nature of eating disorders, they also present physical or medical symptoms if untreated. Physical signs include:

• Mood swings
• Fatigue
• Fainting and/or dizziness
• Thinning hair or hair loss
• Drastic weight changes
• Hot flashes
  

Disordered eating causes people to believe that food is an enemy and shameful. Some people develop eating disorders because their food intake feels like the only thing they can control, others perceive themselves as fundamentally flawed because they aren’t a certain body size. Historically, eating disorders were associated with only white women and girls – but disordered eating can affect anyone regardless of gender identity, sexual orientation, race, ethnicity, age, or background. Unrealistic cultural standards put pressure on everyone to fit in – women are more associated with traditional disordered eating behaviors like restricting food intake, binging, and purging, while men’s disordered eating is more associated with excessive exercise.

Types of Eating Disorder-Related Conditions:

• Anorexia Nervosa is the most well-known eating disorder, which has a primary focus on restricting the amount of food or calories as much as possible. In addition to mental health, the dangerous complications associated with anorexia are malnutrition – which can cause irreversible organ damage, loss of bone mass, and cardiac arrest.
• Bulimia Nervosa prompts individuals to both consume large amounts of food in a short period and purge the food through vomiting, laxatives, diuretics, diet pills, and excessive exercise. While most people with bulimia appear to be healthy and have a normal weight, it manifests differently in each individual – some people have a larger binging aspect, while other individuals may believe they are ‘binging’ despite eating a normal amount of food. Common complications associated with bulimia nervosa include erosion of the teeth and throat lining as well as gastrointestinal problems.
• Binge Eating Disorder (BED) is the most diagnosed eating disorder, even though most people do not recognize BED as disordered eating. BED is characterized by chronic and compulsive overeating that interferes with your mental, emotional, and physical well-being.
• Other Specified Feeding or Eating Disorder (OSFED), previously known as Eating Disorder Not Otherwise Specified (EDNOS) is a catch-all classification for serious eating disorders that do not neatly fit into the above diagnoses. The following is a list of OSFED examples:
  • Atypical Anorexia Nervosa, which meets all of the traditional criteria for an anorexia nervosa diagnosis other than the individual being at or above an “average” weight.
  • Low Frequency/Limited Duration Binge Eating Disorder, which meets all of the traditional BED criteria for diagnosis but manifests at a lower frequency and/or for less than three months.
  • Low Frequency/Limited Duration Bulimia Nervosa, which meets all of the traditional criteria for a bulimia nervosa diagnosis other than manifesting at a lower frequency and/or less than three months.
  • Purging Disorder causes recurring purging behaviors through vomiting, laxatives, diuretics, diet pills, and excessive exercise but does not manifest as binge eating. Purging disorder is similar to bulimia nervosa without the binging or overeating aspect.
  • Night Eating Syndrome causes recurring episodes of excessive food consumption at night, such as after being awakened from sleep. Night eating syndrome is similar to BED but only occurs at night.
  • Unspecified Feeding or Eating Disorder (UFED) is the general diagnosis given to individuals who present with disordered eating behaviors but do not meet the criteria of any other traditional or OSFED criteria.
• Avoidant/Restrictive Food Intake Disorder (ARFID) causes an individual to limit the amount or type of food they consume, also referred to as ‘selective eating disorder.’ Unlike other eating disorders, ARFID is not often associated with distorted self-image or attempts to lose weight but instead anxiety about the consequences of eating like choking.
• Orthorexia creates an excessive fixation with the quality of one’s food as one focuses on “healthy” and “cleaning” eating by avoiding artificial additives and specific ingredients. The DSM does not officially diagnose orthorexia as its own diagnosis, although it has many of the same negative complications as disorders like anorexia, bulimia, and BED.
• Rumination Disorder or merycism is a feeding and eating disorder where an individual regularly regurgitates undigested food. Unlike bulimia nervosa, the food is then chewed, swallowed, or spat out and does not involve any nausea or retching. Rumination syndrome can be both an intentional and learned action as well as an unintentional motor condition.
• Pica is an eating disorder where an individual compulsively swallows non-food items that have no nutritional value or purpose. It is often harmless but poses severe risk if certain items are swallowed if they are dangerous or toxic.
  

Want to learn more about eating disorders? Suggested resources include National Eating Disorders Association, National Association of Anorexia Nervosa and Associated Disorders, National Alliance for Eating Disorders, the Eating Disorders Foundation, and Beat.

Support Groups

Compared to other professional help options, support groups are often the most cost-effective or cheapest. Support groups are recurring gatherings of people who are experiencing common issues like depression, substance misuse, grief, etc. Over time, support groups give people the ability to share their experiences while getting support, encouragement, and comfort from the group.

• Mutual Support Groups are peer-led, where the groups are led by some of the members trained to be facilitators but don’t give professional advice. These groups allow individuals to share their experiences and what is working best for their mental health issues, inspiring others to do the same. Mutual support groups are almost always free to join.
• 12-Step Programs use the support group formula developed by Alcoholics Anonymous, where people struggling with substance misuse form peer-led groups. Like mutual support groups, 12-step groups are free – however, unlike mutual support groups, they utilize religion as a core aspect of their programming.
• Therapy Groups are led by a mental health professional who brings together a group of people who are struggling with similar mental health issues. Unlike mutual support groups and 12-step programs, therapy groups provide professional advice and counseling in a group setting. Some therapy groups may be free, while others may have a cost – the cost of therapy groups is typically lower than individual sessions.
• Online Support Groups provide the same services as mutual support groups and therapy groups in an online format through video calls and messaging. Mutual support groups often provide services for free, while online therapy groups may require a small cost to offset the professional care provided.

Support groups offer safe places to learn coping skills with a focus on self-care – however, they’re not for everyone. Each support group is run differently, but all groups should have clear rules and personal boundaries to allow everyone (regardless of whether you’re a regular or a first-time) to share, feel at ease, and stay on topic through the facilitator.

Looking to get started with a support group? Find one near you with one of the following tools: AFSP, NAMI, DBSA, ADAA, HeyPeers, Hero Journey, Narcotics Anonymous, Alcoholics Anonymous, SMART Recovery, Fireweed Collective, Rest for Resistance, BEAM, and Psychology Today.

Professional (Virtual) Counseling

Previously, you had to have access to in-person therapy to get mental health support – that’s no longer the case. Today, you can receive professional counseling without leaving your home from the comfort of your phone, computer, or any other device connected to the internet.

Virtual counseling is a type of telemedicine, treatment is provided remotely through phone calls, video calls, messaging, and tracking monitors. Users connect to a provider through an app or software for one-on-one counseling sessions with a trained professional. While there are online support groups, this section focuses on individual therapy – see the above section for support groups.

Like all forms of counseling, web-based therapy isn’t for everyone. For the most budget-friendly option, peer-led support groups are the best option. Some online therapy platforms accept health insurance to cover costs, but it’s often more challenging to get your insurance company to reimburse virtual counseling. The quality between virtual and in-person counseling is drastic – which is why the research hasn’t shown whether web-based therapy is right for everybody. Lastly, online therapy programs are more likely to have unlicensed providers – these may have lower costs, but there is always liability in receiving care from someone without a proper license.

Looking to get started with virtual counseling? Find one that suits you with one of the following platforms: BetterHelp, Talkspace, TherapyDen, 7 Cups, Talkiatry, Cerebral, and Brightside.

Professional (IRL) Counseling

There are several ways to find a therapist near you – but not all of them will get you relevant results with licensed, qualified professionals. Generally, when beginning the search for an in-person therapist, you’ll want to keep these things in mind:

• Licensure. Every state has a list of requirements that therapists must complete to become licensed.
  • You can find counselors that practice without licenses – but it’s unadvised since licensure promises that your therapist is qualified and up-to-date on inclusive and effective therapeutic methods.
  • Healthcare insurance companies, as well as Medicaid, require counselors to be licensed to provide coverage.
• Insurance Coverage. If costs are a factor in your search, you’ll want to keep your healthcare insurance or Medicaid plan in mind while looking for a counselor.
  • The American insurance industry is a mess to navigate – insurance plans don’t cover every provider, so you’ll have to go through your plan to find out what counselors are considered “in-network.” Most therapists will list what insurance providers they accept, but that doesn’t mean your insurance will consider that therapist “in-network” and applicable to actually covering costs.
  • More restrictions may apply – insurance plans might only cover a set number of sessions or just pay part of the fee.
  • Without insurance coverage, you will be expected to pay for each visit. Some therapists and agencies offer sliding scales for those paying without insurance, cutting down the cost significantly.
• Relatability. Most people value connecting with their therapist – which applies to virtual counseling as well.
  • Therapists will tell you upfront about the type of counseling they provide (CBT, humanistic, mindfulness, psychotherapy, etc.) as well as their specialties, such as if they focus on religion-based approaches, LGBTQIA+ issues, people of color, or children. There are hundreds of mental health issues, and there are just as many ways to practice therapy.
  • Some counselors have more experience with grief and depression, whereas others may be more experienced with anxiety and PTSD.

A lot of people still misunderstand self-care – despite what social media has led you to believe, self-care isn’t just treating yourself. It’s an active commitment to take care of yourself, which is harder than it sounds. If you don’t take care of yourself, you’ll eventually burn out.

Remember that health isn’t just the absence of being sick. Health is the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity – so self-care is the act of taking care of all aspects of your health. Self-care looks different for each person, based on what your mind and body need and your background, culture, and experiences. Fancy chocolates and bath bombs might be self-care for one person and totally not work for someone else – that’s normal!

Having a self-care plan helps ensure good mental health, even if you’re unable or don’t want to seek professional help or a support group. Since self-care is a personal practice, it’s a more ‘DIY’ approach to mental health.

• Physical self-care focuses on taking care of your body and medical health. You should get an appropriate amount of sleep each night, eat a balanced diet, drink enough water, take your prescribed medications, and get out to exercise.
  • Feel like there’s something wrong with your physical self-care but don’t know where to start? This game/guide gives you easy questions to practice the basics.
• Occupational self-care refers to making sure you’re taking care of yourself while working. You need to know your limits – it’s perfectly okay to say no to things, so don’t overcommit and burn out. Regularly give yourself goals that you can realistically achieve, lend on others for support, and delegate as needed. Make sure you have set boundaries that keep your work and personal life separate.
• Environmental self-care centers on how your physical surroundings also influence your health – it’s difficult to stay healthy if you live in a heavily polluted neighborhood. Get involved with your community by volunteering, voting, or donating to a local cause, or practice self-care by cleaning up your living spaces to be organized, fresh, and greener.
• Financial self-care is whether you have the financial security to maintain your health – not being certain of your income causes a lot of stress. Individuals with low incomes are more likely to have health problems, but building a financial safety net is difficult. Check your spending trends, job benefits, set realistic money goals, and start saving. Give yourself time to think whether you need to pursue a different job or industry, or if disability is a better option for what you can do.
• Social self-care revolves around your relationships and whether you’re maintaining healthy connections with family, friends, and your community. Set boundaries and think about whether any of your relationships are toxic. Make plans to purposely spend time with others, regardless of it’s online, at home, or doing something fun like a workshop or game night. Remember that social media isn’t bad – it’s a very real way to connect with people virtually, but is only helpful in moderation.
• Intellectual self-care builds your skills and keeps your mind active. Read about topics that interest you, watch some new documentaries, research new podcasts to listen to, or commit to taking one of your hobbies to the next level. Intellectual self-care is all about creative and critical thinking!
• Emotional self-care is the most known type of self-care other than physical self-care – meditate, talk to a mentor or friends about your struggles, or go for a walk. Emotional self-care might be practicing mindfulness, but it can also be playing video games or watching a comfort movie.
• Spiritual self-care refers to the sense of purpose that most people need to connect with their inner values and goals. Even if you’re not a religious person, you can practice spiritual self-care by purposely self-reflecting on where you are right now in life, whether you’re content, and where you want to be in the future.
  

Another important aspect of self-care is finding things that calm you – most people will suggest journaling, but it can be anything including listening to music, drawing, making bracelets, watching your favorite TV show, or playing video games.

Make a list of your current coping skills, and expand it while also cutting out negative mechanisms. Coping skills are the strategies we use to deal with stressful situations – so we all have some. Common unhealthy coping skills range from substance abuse and anger outbursts to overworking and self-harm. There are five main types of coping skills, but there isn’t one that’s superior or better for you – it’s good to learn about them all and add those that work to your mental health toolbox.

• Problem-based coping has you take things into your own hands – it’s an active approach where you identify exactly what’s stressing you, come up with ideas to change your circumstances, and take action with a reasonable solution.
• Emotion-based coping focuses on processing emotions and reducing your internal distress. These skills reframe your thoughts and are helpful when dealing with situations you can’t control.
• Religion-based coping uses rituals like prayer to deal with stressful circumstances, using the feeling of connecting to a higher power to relieve anxiety. Like meaning-making coping, religion-based coping is great for extreme situations to give us purpose in grim times.
• Meaning-making coping has you reframe the situation to look for silver linings, especially useful like religion-based coping to deal with especially grim circumstances like natural disasters. By finding meaning in your experiences, you’re given purpose despite the threats you’re facing.
• Social support coping connects you to mentors, friends, and peers to get through your current struggle. Talking to a mentor about your stress reduces the anxiety you’re experiencing, going to a support group makes you feel not alone, and cooking meals for a neighbor can make you feel valued.
  

It’s important to have a range of coping skills. There’s no singular type of coping skill that’s superior to the others, and they can become negative if not practiced in moderation. Too much problem-based coping will likely lead to you creating additional problems; too much emotion-based coping makes you too reluctant to change circumstances where you can make a difference. Religion-based coping can become negative if you’re putting off dealing with situations for the sake of saying it’s God’s will; too much mean-making influences you to become too optimistic in a world where a dose of rationality is needed to make change.

EXAMPLE OF COPING SKILL APPROACHES
Tristan opens up his email to find his annual performance review. He’s surprised to see that the review states he is below average in several areas, even though he had thought he had been performing well. As a result of this email, Tristian is anxious and frustrated.

• By taking a problem-based coping approach, Tristian goes to his boss to talk about what he can do to improve his performance. It makes him nervous to talk to her directly about it, but they develop a clear plan and Tristian feels confident about his ability to succeed.
• Tristian opts for an emotion-based coping approach, spending his lunch break reading a book to distract himself from making catastrophic predictions that he’ll be fired. After work, Tristian exercises and plays video games as a way to feel better – allowing him to think about the situation more clearly.
• For a religion-based coping approach, Tristian goes to his local church after work to pray. He reflects on his purpose and relationship with a higher power by talking to his pastor, reducing his anxiety.
• Tristian pursues a meaning-making approach, looking for silver linings in his situation after work. He reflects on the meaning of his work and whether it makes him feel fulfilled. Thinking about his job options gives Tristian hope, empowering him to make new decisions to impact his life.
• A social-based coping approach has Tristian meeting up with friends after work for dinner, where he vents about the review and the emotions he is experiencing. His friends alleviate his fears of being fired and give him advice to improve his performance.
  

When practicing self-care, it’s important to regularly set goals and priorities. What do you want to accomplish right now? What about in the next year, or the next decade? Having both short-term and long-term goals is good for your emotional health – as long as they’re realistic enough that they can be completed with a bit of work.

Figure out what you’re feeling. There are hundreds of emotions, so don’t just label it as ‘bad.’ Some emotions feel bad, while others make us feel good – but there’s a purpose in each emotion and a need for us to feel all of our emotions in some capacity. To process what you’re feeling, you have to take a moment and really think about what your mind and body are experiencing – take a walk, journal it out, or talk to someone you trust.

Make a list of people you trust. Everyone should have at least two or three people in their life that they can talk to in an emergency – someone you wouldn’t be embarrassed, uncomfortable, or self-conscious telling you were having anxious, angry, or suicidal thoughts. These people need to be there when you need to vent or sort out your feelings – which is why they’ll be in your support system, as mentioned later.

And yes, treat yourself. Every so often, take the time to get yourself something that you’ve been wanting – whether it’s your favorite snack, a video game, or new art supplies. Rewards help motivate us and give us something to look forward to.

Recommended self-care apps and tools include Finch, Daylio, Calm, GamifyRoutine, Goblin.Tools, Sensa, Headspace, The Safe Place, Fabulous, Happify, Youper, Suicide Safety Plan, SAMHSA, and the Mental Health Coalition.

Safety plans are pre-written strategies for when you’re struggling with your mental health. It can be difficult to think of healthy coping mechanisms when you’re having suicidal thoughts or urges to self-harm, but not enough people take the time to make a plan of their own. Here’s a generic safety net template, provided by Vibrant Emotional Health. Continue reading and I’ll break down each section.

Before beginning, there are three key things to keep in mind:

1. Keep your safety net doable. Don’t put warning signs that are too difficult for you to recognize, don’t include strategies that will be too overwhelming and hard while in crisis, and don’t put supports that you won’t feel comfortable talking to about your crisis. For your safety net to work, you have to keep it tailored to what suits you.
2. It’s not written in stone. Skills being written down don’t mandate to you do them as soon as a crisis hits – remember that your safety plan should be flexible. You can add and change items as needed.
3. You don’t have to finish your safety plan in one sitting. These take a lot of emotional energy, so it’s natural to need to take a break before completing your safety net. Complete the parts you can, and come back to it later.
   

STEP #1: WARNING SIGNS
How will you know when to use your safety plan? Prevent yourself from a full mental health spiral by thinking about the emotions you feel as you get overwhelmed. What thoughts, actions, or places trigger those feelings? Write down as many as you can think of – here are some common ones:

• Feelings of hopelessness
• Feeling the urge to cry
• Feeling the urge to self-harm
• Isolating yourself
• Having intrusive thoughts
• Not eating
• Racing heart and/or shaking
• Mood swings, anger, and agitation
• Increased alcohol or drug use
• Neglecting personal care or hygiene

The key here is to hone in on how you feel right before you feel suicidal or have the urge to self-harm. That’s easier said than done, so take caution in avoiding overwhelming yourself as you complete this step.

STEP #2: COPING STRATEGIES
What can you do to keep yourself safe? These actions are things you can do on your own to feel better in the moment, no matter how small. Your safety net’s coping strategies should include healthy coping mechanisms, which may require research on your part if you’ve never thought about what coping skills are best for you.

For times of crisis, emotion-based coping approaches work best compared to problem-solving ones – most of these skills involve distracting yourself to reduce the amount of distress you’re feeling, whereas most problem-based coping skills cause short-term stress as you tackle your problems head-on. Like step one, write down as many as you can think of. Some common healthy coping strategies include:

• Watching funny or inspirational videos
• Journaling or writing poetry
• Listening to music
• Doing a puzzle
• Playing video games
• Drawing, painting, or doing an artistic skill you enjoy
• Going for a walk or run
• Spending time with a pet
• Writing down positive affirmations
• Mindful meditation with breathing exercises

There are are hundreds of coping skills – pick out at least ten that revolve around hobbies and activities you genuinely enjoy. Most of these coping skills will distract you in some capacity from thinking about your trigger – although some might focus on it, reframe the situation, or just reflect. However, remember tip #2: keep these skills doable, since you’ll be attempting them while potentially having a mental health crisis.

STEP #3: DISTRACTIONS
What people and places take your mind off of your problems? A critical note here is that these should distract you from your overwhelming thoughts in the event that Step #2 is no longer possible. Unlike Step #4, these people can be anyone – they don’t need to know what you’re going through or if you’re having thoughts of self-harm unless you want them to.

Write down at least three people or places. These people might be friends that are fun to hang out with, whereas places here might be good at distracting you like playing at a video game arcade. Make sure you write down the contact information (ex. phone number, social media @) for anyone listed and the addresses for any locations.

STEP #4: SUPPORTS
Who do you feel safe and comfortable enough to tell when you are having suicidal thoughts or the urge to self-harm? These are people you shouldn’t feel embarrassed to have these discussions with since you’ll likely be past steps two and three at this point.

List at least three people who will be supportive of you in a time of need – like a mentor, close friend, partner, family member, or even a higher power. Don’t list people that lower your mood, so prioritize individuals that are supportive and make you feel better even if they’re less fun than those in Step #3.

It’s important to include more than one person in case they’re not reachable. Like step #3, make sure you write down their contact information – in the worst scenario possible, you might be borrowing a cell phone or computer to reach out to them so you won’t have your saved details.

STEP #5: PROFESSIONALS
Who are the mental health professionals and agencies that you trust to take care of you? These are your last resorts, assuming that steps #2-4 didn’t work and you’re still in crisis. These folks are therapists, crisis hotlines, and urgent care teams.

At this point, you may be at risk of being hospitalized if you’re in danger of harming yourself or others. Some hotlines don’t use nonconsensual rescue, but most do since suicide prevention agencies will use law enforcement when needed if they genuinely believe you may kill yourself. The most common agency to list here is 988, or the National Suicide Prevention Hotline – although there’s more listed in TSP’s resource section. Write down the contact information for any local therapists or mental health agencies around you, as well as the phone numbers, text lines, and websites of any national agencies.

STEP #6: ENVIRONMENT

Unlike the previous five steps, Step #6 is actually done ahead of crisis. What can you do now to limit your access to danger later? Reflect on what items you regularly have around you that could be used to harm yourself.

Common tactics here include limiting access to firearms, sharp objects, lighters/matches, and drugs. It’s also a good idea to have a method listed to reach out to someone listed in Steps #4 and #5, like a backup phone or wifi spot. If possible, be open with those you live with that you want to take an active approach to your mental health by creating this safety net – and let them know to check in on you in case you go into crisis.

BONUS STEP: OTHER EMERGENCIES
Your safety net is versatile, so consider also adding other factors for non-mental health crises. At the very least, make sure you have the 988 number for the Suicide and Crisis Lifeline on your safety net as well as 911 for other major emergencies – or the relevant hotlines for the country you’re in.

This is also a great place to include the nearest homeless shelters near you – list at least three, putting in the research ahead of time in case something were to happen in a potential worst-case scenario. Information like fire department, law enforcement, and medical emergencies will be transferred when dialing 911, so it’s your discretion to add them or not. Each person is unique, so your potential crises are too – take time now to think about the potential emergencies you could encounter and how you can fit them into your safety net.

Lastly, write down at least five reasons for living. These can be goals, photos, or objects and it doesn’t matter how ‘small’ they seem. Any reason that keeps you alive is worth writing down, regardless of whether it is a person or pet you love, a TV show you want to finish, or a concert you want to see one day.

Once finished, download an electronic copy of your safety net and keep it on your phone in an easy to access to place. Consider keeping additional copies on a computer or online like Google Drive or iCloud. Then, keep a physical version of your plan in a wallet or other place you have regular access to.