As the days get darker, colder, and shorter, it is a common phenomenon to experience the winter blues, or its more severe form, Seasonal Affective Disorder (SAD). What exactly does it mean to feel the winter blues or experience SAD? Symptoms of the winter blues can include the following: 

• Gloomy or sad mood
• Lack of energy, feeling fatigued
• Decrease in desire to be social

Whereas symptoms of SAD are more severe and can include:

• Depressed mood for most of the day, nearly every day
• Persistent fatigue and lethargy
• Problems with sleeping
• Social withdrawal or isolation
• Feelings of pessimism or hopelessness
• Loss of interest and pleasure in activities you typically enjoy
• Difficulty concentrating
• Thoughts of death or suicide

The winter blues are typically experienced when the seasons change toward fall and winter months and can persist through the winter season. SAD often has a similar presentation, with a winter-onset pattern most common. Those living in areas farther from the equator with a more drastic loss of daytime sun may be more prone to seasonal shifts in mood. Individuals who struggle with SAD may have decreased serotonin activity (mood regulator) and increased melatonin production (sleep initiator) due to changes in light exposure, resulting in the above symptoms (Melrose, 2015). Studies have shown that increasing daily full-spectrum light exposure can aid in quality sleep and maintenance of circadian rhythms (Figueiro et al., 2017), fighting jet-lag (Bunney et al., 2005), and of course, treating SAD (American Psychiatric Association, 2000) as well as even non-seasonal depression (Even et al., 2008). 
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Thankfully, there is a tool to use at home to help stave off or manage the effects of the winter blues or SAD: full-spectrum light therapy. This treatment has been found to be highly effective and with minimal side effects, and it is affordable and easy to use. You can purchase a full-spectrum light box for personal use online for under $30-$100, depending on the model and technological features. The light is most effective at a level of 10,000 lux bright-white fluorescence (with harmful UV rays filtered out), which is significantly brighter than typical lighting. Light exposure should take place first thing in the morning, within an hour of  waking up, and for 20-60 minutes per day during the months of the year when daylight is diminished. The light should be close to the face (16-24 inches away), but the user need not stare directly into it for the effect. Light therapy should be completed every day, even on weekends, and at a consistent time for optimal effects. It often can take some time of regular use to feel the effects of it, so it requires a consistent routine. Light therapy can become a foundation for a morning self-care practice of taking some time for yourself in the mornings before getting started with your day. You can have it by you as you have breakfast, check the news, knit, catch up on emails, or however else you like to start your day - just be sure to use it within an hour of waking up to not interrupt your sleep schedule. I am not affiliated with any brands or marketing, but I can personally attest to Verilux for quality light therapy products. 

Light therapy should be used with caution with certain medications or mental health diagnoses - always check with your medical providers and read manufacturer guidelines before starting any type of treatment. Some people may benefit more fully by using light therapy in conjunction with other treatments for SAD or depression, so it is important to explore all options for the care you need. 

To read more about light therapy, check out this overview from the Mayo Clinic. 

Have you considered, or have you tried light therapy yourself? Share your experience below. ​

I recently completed training in Eye Movement Desensitization and Reprocessing (EMDR) therapy, and it has already been a game-changer for my clients and many others struggling with trauma, anxiety, depression, and more. However, EMDR is a therapy that often seems mysterious or even confusing. Even as a psychologist, before I received specific training, I had very little understanding of what EMDR was, how it worked, and what it was like to experience it . This post will shed light on what EMDR is all about and how it could help you or someone you know work through trauma, depression, anxiety, and many other struggles. I also provide some resources to find your own EMDR therapist. 
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One fine spring day in the late 1980s, Dr. Francine Shapiro was walking on a sidewalk and thinking intensely about something that was really bothering her. Her mind kept perseverating on it, and she felt strong negative feelings as she focused on it. Oddly, a few moments of walking later, she suddenly realized her negative feelings had vanished and her thoughts had shifted, without any conscious effort on her part. Bewildered, she paused and considered what she had been doing while she was focusing on the distressing situation. In addition to walking, she had also been moving her eyes side to side while focusing on her distress. She became immediately curious about how the side-to-side movement of her eyes (as well as her feet) may have impacted her emotional and cognitive process.

Shapiro's discovery led to series of first informal and then formal clinical trials evaluating the effects of bilateral stimulation (BLS), which is the intentional, repetitive, back-and-forth stimulation of the left and right hemispheres of the brain, on distress. More and more studies,  which originally focused primarily on the veteran population with Post-Traumatic Stress Disorder (PTSD), began to suggest a powerful effect of eye movement BLS on the reduction of PTSD symptoms. From those findings, EMDR was born. Since those early years, EMDR has been found to be effective for a vast range of presenting issues, including:

• Trauma and PTSD
• Anxiety, phobias, panic attacks
• Depression and bipolar disorders
• Grief and loss
• Pain and chronic illness
• Eating disorders
• Personality disorders
• Addiction

EMDR treatment includes a series of stages, and despite being a fairly structured treatment, there are many ways it can vary client-to-client, so this is a very general overview. Before beginning, your clinician should explain EMDR to you in detail, answer any questions you have, and obtain your consent to move forward. Then, the first stage focuses on treatment planning. During this process, your clinician will explore with you what you hope to achieve by completing EMDR. I think of the planning like a funnel - starting with broad areas of concern, and then honing in on a more specific problem along with the core belief you hold about yourself related to the issues at hand. When we start to explore what negative beliefs (e.g., "I am incompetent") underpin the more surface-level symptoms (e.g., performance anxiety), the target for EMDR becomes evident. Once the negative belief is identified, your clinician will help you determine what positive belief you'd like to strive towards that counteracts the negative belief (e.g., "I am competent, regardless"). The last step of the planning process is to then identify specific incidents in the past, more recent present, and/or future, where the negative belief felt especially true to you. This creates an incident map of your negative belief, which will guide the EMDR focus. You typically then select a single incident from the map to focus on first during EMDR processing.

The second stage of EMDR is focused on resourcing. During this stage, your clinician works with you to build up your abilities to cope with and handle strong emotions or triggering memories. EMDR does have the potential to evoke intense emotions, so it is important that you have grounding and soothing skills to help you regulate your emotions if needed. These skills are also valuable outside of the context of EMDR, and can be used during any stressful moment. One of my personal favorites is helping clients develop a peaceful inner place. We use visualization and slow BLS to develop a vivid scene of a place, real or imagined, that produces a sense of tranquility. 

The third stage of EMDR is focused on desensitization and reprocessing. Once the plan and resourcing techniques are set, it is time to begin the application of BLS to work on the incidents and negative beliefs that have been identified. The clinician first takes you through a structured set of questions designed to activate the chosen incident (i.e., turn on your emotional response). Then, the clinician will instruct you to focus on the incident, belief, and associated feelings and sensations, and will apply a set of BLS for typically 20-45 seconds. There are many options for how the BLS can be applied - your clinician will review options with you and together determine the right choice:

1. Eye movement: this is the original BLS mechanism and involves following the clinician's hand as it moves left and right in front of your eyes. Some clinicians also may use a light bar, where the client visually tracks the light back and forth. For virtual meetings, a clinician may use a website or app to create the lateral motion, or they may use their hand on the screen if the client has a wide enough monitor.
2. Tactile: BLS can also be experienced through touch. Clients can self-tap their shoulders or biceps with crossed arms, or tap on their thighs. Some clinicians may also apply tapping on the backs of client hands or knees. Another popular option are "tappers," which are small vibrating electronic paddles that the client holds in either hand. The clinician can alter the speed and intensity of the tappers based on client comfort and need. BLS can even be achieved through movement, such as left-right punching, squeezing stress balls in each hand, walking/jogging, or even stepping the feet while stationary. Tactile BLS is another great option for virtual sessions.
3. Auditory: this option requires the use of headphones. BLS can be applied through auditory tones moving between each ear. 

The clinician will take you through 20-45 second sets of BLS. Between each set, they will check in with you, often asking, "what did you notice?". There are no "shoulds" or "supposed to's" with what you experience. The goal is to allow your brain, body, and mind to go where it needs to go during the set. The metaphor I tend to use is thinking about EMDR as driving down a highway, except you get off at each exit to check in before resuming your drive. Depending on the scope of the EMDR you agreed on with your clinician, as well as the emotionality and complexity of the focus, this stage may take a single session up to weeks or months to fully process through.

Your clinician will be actively tracking what you notice between sets to gain a picture of the healing process. It is common for clients to first feel their distress more acutely in the earlier sets, as their brains take them into the unhealed memory. However, as the sets progress, clients very often start to notice subtle changes indicating that healing is taking place. This is where your clinician's training and clinician intuition will come into place to guide the process. After it seems the unhealed trauma, negative believe, or incident has been fully addressed, the clinician will then instruct you on installing the new positive belief you had come up with together. Focusing on the positive belief along with BLS helps to deeply instill a new framework for seeing yourself in a more compassionate light.  Once the positive belief is installed, either EMDR is complete, or it is time to move to another incident or negative belief system and start again. 

After sessions, it is common to experience some residual effects of doing EMDR. These effects can vary greatly and may depend on what was addressed in the session, how activating it was, and whether it was resolved. Some clients report feeling more relaxed and present, better OR worse sleep, changes in dreams, body sensations, or in behavior (e.g., suddenly acting more assertive with others). Your clinician will check in with you about anything you may have  experienced between sessions. Once an area of concern is fully processed with EMDR, you should feel a notable shift in your emotional reaction to the incident that was addressed, in that you still remember it, but you don't feel distressing feelings or hold the same negative beliefs related to it. 
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I say think for a reason. Like most forms of therapy, we aren't exactly sure of the specific mechanism of why it helps people feel better. EMDR certainly stands out this way, because it can sometimes feel like magic when a client's strong negative feelings seem to evaporate into thin air. However, there are several compelling theories about why we believe it has such efficacy, and I'll share two of them here: 

1. The REM Theory: I find this theory to be the most fascinating. Brain and sleep research have indicated that Rapid Eye Movement (REM) sleep is integral for memory consolidation. During REM, our bodies and brains are most active, where it is common for eyes to dart around behind their lids and brains to be busy with dreams and memories. There may be an essential link between the back-and-forth eye movement of REM with the processing and storage of memories. However, when we experience something traumatic or even moderately distressing, our brains are not functioning at full human capacity. During times of fight or flight (e.g., in an active warzone), the most human part of the brain, the prefrontal cortex, is largely off-line, while the more mammalian and reptilian parts of our brain take over. In essence, we are governed more by instinct to self-preserve than conscious, rational thought. Perhaps what also takes place is that our memories of those experiences are then not processed, consolidated, and stored due to the shift in our brain functioning in this threatening context. Instead, the memories sit in our brain, wired into our neurons, affecting how we respond to familiar-feeling situations moving forward (e.g., hearing fireworks). BLS may, in effect, be a consciously induced REM stage to help create a processing, healing, and storage function for those memories that have stayed unhealed. 
2. The Distracting Stimuli Theory: A second possible theory for why EMDR works considers the use of distraction through BLS. Rather than enacting a memory processing change, BLS may instead be pairing a neutral distracting stimuli while the client intentionally focuses on a difficult memory. Perhaps the association of the distracting stimuli with the memory aids in soothing or shifting the previous negative emotional association of the event. 

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If you are wanting to try EMDR for yourself, there are a few places to look to find yourself a trained provider. Because EMDR is a specific form of treatment and often used for traumatic memories, it is important to ensure that your clinician is properly trained in the approach. Here are a few places to begin your search:

1. Directories
   1. Psychology Today: you can filter the search to include EMDR as a specific modality of therapy. https://www.psychologytoday.com/us
   2. EMDR International Association: https://www.emdria.org/find-an-emdr-therapist/
   3. EMDR Institute: https://www.emdr.com/SEARCH/index.php
2. Google search, "EMDR therapist near me"  
3. Word of mouth - consult with your other healthcare providers to inquire
4. Insurance company - check their website or call to get provider referrals

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I hope this post was helpful in demystifying what EMDR therapy is all about. Feel free to submit any questions or comments below, or contact me directly if you'd like to learn more. 

A few months back, I received an email from Lehigh (my PhD program and where I currently work as an adjunct professor) asking if I would be interested in teaching an eight-day course on group counseling for master's students in Kuwait. I paused and took account of my reactions to this question. Isn't it dangerous there? Would I feel uncomfortable as a foreign woman in the Middle East, alone? How would I connect with students from such a different culture, and within a society that has very different views on mental health? My stomach was performing anxious somersaults  imagining this experience. However, I also noted a familial tingle of excitement - a different part of me was reawakening - the part of me that loves a challenge, embraces having my comfort zone stretched, and thirsts for experiencing something new and different, especially related to culture and travel. After a week of pondering, I made the decision to go. 

I am currently on my fifth day here in Kuwait. I am curled up on a couch in the lobby of my hotel, sunlight and warmth streaming in from the big windows overlooking the city. I am feeling utterly fulfilled and refreshed as a professor of these brilliant, brave, and complex students. I am also feeling enriched and enamored with this country, the beauty of Kuwait City, and the vibrancy of the culture around me.

I felt some culture shock when I first arrived here. Kuwait does not have a big focus on tourism - and it shows. The airport had minimal signage for people new to Kuwait. The public transportation system is also limited and difficult to grasp if you don't speak Arabic. There is no hop-on-hop-off bus or tourism offices to plan your visit. Thankfully, I had some help with a meet and greet service at the airport to help me get my visa sorted and to transport me to my hotel. Lehigh also made sure I had contacts both at home and here in Kuwait to make sure things ran smoothly. Upon arrival, I was immediately struck by how urban it is here - the city is packed with tall apartment buildings, endless high-end shopping malls, busy roadways, and enough honking to rival NYC. The buildings are varying shades of sandy beiges and browns, bedecked with the visages of the Emir, smiling and waving. While the city is, in theory, walkable, it is not always pedestrian friendly, and crossing streets can be an extreme sport. 

On my second day, I got to meet two of my students who offered to take me out for coffee and dinner, and to show me around the city. While sipping on an iced matcha latte, I could already feel the warmth and generosity of the social climate. My students answered all of my questions about Kuwaiti culture, expressed curiosity about how it felt for me being here, and gave me great pointers on everything from how to cross streets without having my life flash before my eyes, to where to find top-notch knock-off perfumes at the Mubarakiya Souk (Arabic market).

My class includes nine students who represent as vast an array of cultural, religious, and lingual backgrounds as Kuwait City overall. Some hold very traditional and deeply held religious beliefs; others embrace more liberal and modern attitudes. Mental health here is in its infancy - there is deeply held stigma about mental illness and treatment for mental health problems. And yet, my students are defying stigma and opening themselves to learning about a topic that is not widely embraced within their culture. That takes courage. 

A significant aspect of our course is having an hour long experiential group that takes place during each class meeting. Students rotate being group leaders, and student members are themselves - no role playing or acting. I led the first group, but since that initial meeting I have been a group member as well. As each meeting has occurred, I have been able to see my students learn how to let go of their anxiety about the unknowns of what will happen in group, embrace the beauty of organic conversation and connection, and dig deep to share parts of themselves that they tend to keep hidden. Due to their diverse identities, this means something different for each student - however each one has taken courageous steps to find and embrace those common threads that hold us all together. These common threads are woven through sharing laughter, speaking in our home languages and explaining cultural sayings, discussing cultural values that shape our experiences and perspectives, and holding together shared emotions of anxiety, sadness, isolation, joy, empowerment, and connection that reflect a universal language. We are creating a tapestry as a group that is intricately textured, patterned, and infinitely colorful. 

I am already mourning the impending end of this teaching experience as it is already halfway to completion. However, I remain excited about where this journey will continue to go, and what other common threads will emerge along the way. 

It can be tough to make the decision to get help. There are many factors which can hold people back from beginning (or returning to) therapy. Some common hesitations I have heard clients struggle with prior to making that call include:

1. Are my problems really that bad?
2. There are plenty of people worse off than I am...so why should I go to therapy?
3. I really don't feel like spilling my life story to a stranger.
4. I've felt worse than this before - I'll be fine. 
5. How on earth can I fit therapy sessions into my already hectic week?

Why the hesitation? Well, it certainly can relate to the ongoing stigma regarding mental health and psychotherapy. There are deeply set stereotypes about therapy from well over a century ago that still persist today, including therapy being for "crazy people," viewing help seeking as a sign of emotional weakness, or that receiving therapy is something to be ashamed of. In addition to stigma, others may have a hard time recognizing their pain AND seeing it as valid, often undermining the importance of their own self-care and well-being. Still other sources of hesitation may reflect a lack of prioritizing individual needs, tendencies toward being more of a private person, or skepticism about psychotherapy. Let's unpack some of those hesitations. 

1. Are my problems really that bad? Psychotherapy is effective for all sorts of struggles regardless of type or severity. It is flexible, client-directed, and can be customized to fit your needs. It has utility for everything from time management skills, to understanding yourself better, to managing mood, anxiety, substance use, or schizophrenia. There is no required level of severity to warrant therapy; rather, if you are even asking that question, it's a good sign that you could benefit from it. Some of the many signs that it is a good idea to go include: your normal sources of joy and stress relief are no longer doing the trick; you're in a major life transition that is causing you discomfort; you're noticing symptoms of lasting sadness, anxiety, or lack of energy that are impairing your normal routines; you're falling into destructive habits; you're having problems in your relationships; or, you experienced a trauma or loss and are struggling to bounce back. Your pain is valid, and you are deserving of help. 
2. There are plenty of people worse off than I am...so why should I go to therapy? Similar to the first point, there is no required level of severity for therapy to be indicated. To be human is to struggle, and emotional distress is universal regardless of its cause. Depression, anxiety, and distress do not discriminate. 
3. I really don't feel like spilling my life story to a stranger. Yup, I get that. It can feel overwhelming and intimidating to be vulnerable with someone you've never met before. You may come from a family or cultural background in which privacy is a major value, or you may just be a more shy or private person. It can help to be informed about what to expect at your first session to dispel some anxiety about starting therapy. Also, know that your therapist is aware of how hard it can be to get started and can help you ease in at a pace that feels comfortable for you. 
4. I've felt worse than this before - I'll be fine. It is common for those who have experienced emotional struggles once to experience them again. Depression and anxiety often ebbs and flows with our environmental stressors, time of year, etc., and some may be biologically predisposed to experience mood symptoms. Many find it beneficial to revisit therapy for a short-term "booster" course of treatment if they have already done counseling before. Additionally, just because you have felt worse doesn't mean you need to keep suffering. Notice the patterns of your distress and seek help to find ways to intervene.
5. How on earth can I fit therapy sessions into my already hectic week? Yup, I get that, too. It can be hard to make space for therapy, whether from a financial perspective or carving out time in your schedule. We typically don't hesitate too much to get to the doctor's office for a physical complaint - why don't we value attending to our mental health to the same degree? Your emotional pain is just as important as physical discomfort, and seeking help can improve your well-being drastically. Many therapists may offer evening or weekend availability to meet the needs of busy schedules. There are also options for making therapy more affordable, so don't foreclose on seeking help too soon. Here are some strategies for finding a therapist. 

What other hesitations might you have before seeking help? Other stigmas you want to debunk? Share them below!