I stepped down into the pool. Cold. Nice. I had a lot on my mind.

I started justI started just focusing on the motions. Up, down, side. “Am I doing this right?” “Do I care?” I thought about my worries. My hopes. People in my life. Back and forth. Thinking. Sending well wishes. Processing. As I left, my mind felt clearer, ready to greet the rest of my clients for the day.

Swimming is a nice mix of strategies. For me, it is exercise, a mindfulness practice, a way to let go of tension, and a way to process. To my knowledge, there is no research investigating this particular application. Still, as a therapist who practices eye movement desensitization and reprocessing (EMDR), I have sometimes wondered if the back-and-forth motions of swimming can mimic the bilateral stimulation (the eye movements, tapping, or other sensory pieces) that facilitates processing EMDR. Who knows. Anecdotally, I can say it helps me out.

Swimming as a Wellness Tool

People have probably used swimming as a wellness tool since we met water. It is naturally relaxing and enjoyable. Research has shown multiple benefits to swimming. A study of 33 children diagnosed with attention deficit hyperactivity disorder found improvements in stress, depression, and selective attention after an eight-week swim program.

Similarly, research investigating an intervention of twelve swim situations of adolescent girls’ self-concept found significantly greater improvement when compared to a control group in multiple areas of self-concept (Tavakolizadeh et al., 2012).

Research has also explored the effects of swimming in natural bodies of water on mental health. A review of 14 studies found repeated positive effects relating to swimming in nature, ranging from improvements in mood to mindful presence (Overbury et al., 2023). Few would argue that swimming, on its own, has some merit as a wellness tool, just like hiking, writing, or dancing.

But what about its use in psychotherapy?

Swimming as an Experiential Therapy

A Confucian proverb states, “What I hear, I forget. What I see, I remember. What I do, I understand.” This is the philosophy of experiential therapy. Experiential therapies integrate activities such as interaction with animals, movement, arts, and ropes courses as a part of intervention. Often, a piece of the intervention is learning through the process.

These types of therapies are common within residential treatment, wilderness programs, and other settings where individuals are receiving intensive therapeutic intervention on an inpatient basis. These are less commonly available on an outpatient basis.

Swimming can be integrated into traditional evidence-based practices, such as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). For example, it can be used as exposure therapy for someone with a swimming phobia or to enact a metaphor in ACT. I spoke with Rebecca Brand, a licensed clinical professional counselor in Illinois, who has provided this kind of therapy.

Rebecca shares, “It is overcoming a trauma. Mastering a skill. It’s empowering to know the water will keep me up, not to be afraid.” Indeed, trauma expert Van der Kolt shares the need for somatic, experiential intervention in healing trauma in his book, The Body Keeps the Score: Mind, Brain, and Body in the Healing of Trauma. The act of swimming itself is a building of mastery and getting unstuck.

There is also a limited number of structural approaches using swimming in therapy. Among these is aquatic relational experiential therapy (ARET), a therapy utilizing swimming in a multidimensional way to assist in improving one’s relationships with self and others (Garaglass et al., 2022).

In Closing

Swimming can be therapeutic, particularly when combined with other evidence-based practices. While experiential therapies of this kind are most frequently used in residential settings, swimming also has a place in outpatient therapy.

References

Garzaglass, M. R., Garza-Chaves, Y., Williams, M. P., Fauster, L. K., & Freeney, L. G. (2022). The buoyant self: A conceptual journey of aquatic relational experiential therapy. The Humanistic Psychologist, 50(4), 607.

Overbury, K., Conroy, B. W., & Marks, E. M. (2023). Swimming in nature: A scoping review of the mental health and wellbeing benefits of open water swimming. Journal of Environmental Psychology, 102073.

Silva, L. A. D., Doyenart, R., Henrique Salvan, P., Rodrigues, W., Felipe Lopes, J., Gomes, K., & Silveira, P. C. (2020). Swimming training improves mental health parameters, cognition and motor coordination in children with Attention Deficit Hyperactivity Disorder. International journal of environmental health research, 30(5), 584-592.

Tavakolizadeh, J., Abedizadeh, Z., & Panahi, M. (2012). The effect of swimming on self concept’s girl high school students. Procedia-Social and Behavioral Sciences, 69, 1226-1233.

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

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KEY POINTS

• Exposure therapy is not right for all types of anxiety.
• Exposure therapy can look very different, depending on the source of the anxiety.
• Sometimes a way of coping with anxiety is a safety signal and sometimes a safety measure.

I recently published a post on myths about exposure therapy. As soon as it went live, I remembered several other myths I’d forgotten. But this happens to everyone. This post will cover those additional myths.

First, I see a lot of assumptions that exposure therapy should be used for any type of anxiety. This is not true. Anxiety is a normal part of life but becomes a problem when it becomes too intense or so frequent that it interferes with what a person wants to do. The everyday anxiety that most people experience does not necessarily need treatment. Anxiety can also be realistic or unrealistic. Realistic anxiety does not need exposure therapy. Unrealistic anxiety could benefit from exposure therapy, depending on the situation.

Whether anxiety is realistic or unrealistic is highly individual. A person who is perfectly healthy with no medical conditions and no risk factors for heart disease might have anxiety about exercising because it raises their heart rate. For this person, their anxiety is likely unrealistic. However, for people with severe heart disease, their anxiety about exercising too intensely could be realistic. It can be tricky to figure out if anxiety is realistic or not but looking at the evidence, similar to the cognitive side of cognitive behavioral therapy, can help.

In my previous post, I mentioned that exposure therapy involves a hierarchy of feared situations that are then slowly and gradually faced. Often patients might assume that once they have cleared a step in the hierarchy, they shouldn’t feel anxiety in that situation again. Backsliding or having to revisit a step on the hierarchy (or a revised step) is common, especially when someone is experiencing more stress in other parts of their lives. The improvement with exposure therapy is not always a straight line.

Exposure therapy can also take many forms. Sometimes it can be what is called in-vivo, meaning in real life, and includes engaging with the feared situation directly. But the actual feared situation or object might not be available. Sometimes it is because the fear is about something hypothetical and sometimes it is in the past or hard to find. In these cases, imaginal or written exposure might help. Imaginal exposure, as the name implies, means imagining the feared situation for a set period of time. Written exposure has the person write about the feared situation for a set period of time. It’s one of the reasons why journaling can be helpful; journaling can sometimes function as a form of written exposure, helping people engage with a feared situation. The different forms of exposure therapy can also be used to form a hierarchy. A person might be ready for written exposure but not imaginal or in-vivo exposure. After written exposure, they may then feel ready to try imaginal or in-vivo exposure. This is why working with a mental health professional, trained in exposure therapy, is key; it helps people discover which situations and forms work best for them.

The last myth I would like to tackle is about something called safety signals. These are sometimes called safety behaviors and are signs to the person with anxiety that they are safe but do not actually provide a significant amount of safety. Examples include anxiety medication, always having someone else present, or having some special object. The problem is that these safety signals prevent people with anxiety from fully facing their fears. This doesn’t mean that the person has to go headlong into a situation without them. Usually, a person can try facing fear with the safety signal and then try facing it without the safety signal.

There is a major exception to safety signals. What might look like a safety signal to others might actually be a safety measure. Safety measures are actions people take to reduce risk and are perfectly reasonable. In fact, we would not want people to go into certain situations without appropriate safety measures. Let’s take a nurse caring for a tuberculosis patient as an example. Tuberculosis is highly contagious and these patients are usually kept in a negative pressure room that prevents tuberculosis from leaving the room and infecting others. We would never want the nurse (or any health care personnel) to care for someone without this because it is a safety measure. Also, what is a safety signal versus a safety measure can vary for each person. Let’s take dairy allergies and lactose intolerance as examples. The person with lactose intolerance might just need an ingredient list without dairy as a safety measure but having something made in a dairy-free facility could be a safety signal. The person with a dairy allergy, however, would need food made in a dairy-free facility as a safety measure. It is important to not make assumptions about others, especially when you do not know their full health and situation, because what is a safety signal (or irrelevant) to you could be a safety measure to them.

I would like to reiterate my previous disclaimer that exposure therapy should only be attempted in collaboration with a mental health professional with training and experience in exposure therapy. Exposure therapy or similar tactics should never be forced on a person without their consent and people should not be coerced into exposure therapy. When conducted with an experienced mental health provider, exposure therapy can be quite helpful for those with anxiety.

To find a therapist, please visit the Psychology Today Therapy Directory.

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It’s that time of year again, when the air and leaves are crisp. It’s a colorful time for many and winter is fast-approaching. Halloween is almost here which means Thanksgiving and Christmas will be here before you know it! This Halloween let’s try a festive art activity. But first a little refresher on the history of Halloween.

The History and Origin of Halloween

Halloween is on October 31 of every year. It was originally meant to honor the dead and was previously known as All Hallows Eve, dating back over two thousand years ago.

The most consistent origin, and probably the most well-known, refers to Halloween as a way to honor the dead. It also signifies the end of summer, the end of the Celtic year, and the beginnings of a new one.

People were very superstitious in years past and thus arose the idea that souls of the dead frolicked the streets at night. To keep the bad spirits at bay, treats were left outside to pacify the evil spirits. This led to how it works now, otherwise known as trick or treating

A Halloween Art Therapy Activity

Let’s start by thinking of all the negative energies or influences in your life.

1. Think about any negative people, events (recent or otherwise), or anything else that has had a negative impact on you recently.
2. Take all these negative “pieces” and imagine each of them has a spirit.
3. Take a moment to forgive these negative spirits in your life, if only for a short period, and focus on what you would offer these spirits as a peace offering, or a “treat” if you will.
4. Ideally you create something that you can give to each negative spirit, but if you have too many negative spirits to treat, then think of something you can give to all of them.

Alright, now feel free to be as creative as you like. I might suggest trying something different and going with a Halloween-ish theme for your creation…maybe using pumpkins, leaves, or construction paper and crafts, or even just incorporating the colors of fall. But if you’d like to draw or paint in pastels, that’s good too! Those are just a few ideas, but whatever fancies you is what you should create.

When you’re done, you can place your “treat” outside on the porch, patio, front door, etc. Or if you’re worried about anyone seeing or taking it, then leave it inside the house.

Good luck forgiving those negative spirits and Happy Halloween from HereNOW Help!

Image credited to the artist https://www.laurahoerner.com/

The post A “Creepy” Art Therapy Activity for Halloween appeared first on My Blog.

– March 6, 2021

 Written By Ben Lesser

 Medically Reviewed By Nina Köhler And Ralf Dietrich

Last Updated on May 25, 2021 by Ben Lesser

Mental illness and substance abuse are directly or indirectly connected to the other with adverse effects to the user. Why might a person be drinking heavily when they are mentally ill? Neither the degree of correlation between the two terms is disputed by any informed party. The association between mental illness and substance abuse is apparent to the layman and visible to the professional. There are different types of mental illnesses with varying degrees of severity. Psychiatrists and substance abusers are often found in the same patient population. There might not be an explanation for this, but it might be the most peculiar thing about cases of mental illness, regardless of how vague the symptoms may be.

A study published by the National Bureau of Economic Research (NBER) published in the journal Science Focus, a relationship between mental illness and the consumption of addictive substances was demonstrated. It was observed that individuals suffering from a mental health disorder were more likely to abuse drugs and alcohol, including:

• 40 per cent of cigarettes in the market
• 44 per cent of cocaine
• 38 per cent of alcohol retailed

The report also states that people with medically diagnosed psychological disorders consume alcohol and other drugs through addiction at some situation in their everyday lives, with the following proportion:

• 68 per cent of cigarettes
• 69 per cent of alcohol
• 84 aper cent of cocaine

It’s common knowledge that substance abuse and mental disorders go hand in hand. Different combinations of causes and symptoms can occur, each leading to its own set of treatment options and Dual Diagnosis treatments. Can you help your loved one make the best choice for dual diagnosis treatment?

Inhaltsverzeichnis show

What Leads to Mental Illness and Substance Abuse?

Since we have authenticated that mental illness and substance abuse are related, let’s understand why. Mental illness is present when one’s mental state is not in its deemed standard form. A mental disease depicts any condition which causes severe disorder in a person’s behavior or thinking. Reactions to circumstances are more likely to be imbalanced or far from the norm.

Some Examples of Mental Illnesses Include:

• Depression
• Eating disorders
• Schizophrenia
• Obsessive-Compulsive Disorder
• Dissociation
• General Anxiety disorders
• Tourettes Syndrome
• Bipolar Disorder
• Phobias
• Mood Disorders

Mental illness and substance abuse mainly happens when a patient takes medication, alcohol, or toxicants without a prescription to attain the desired feeling. Most people abuse substances for recreational purposes. Once started on continuous use, they cannot do without regular doses. Most of these substances have addictive ingredients that cause abuse, like Nicotine in Tobacco.

Examples of Some Abused Substances are:

• Pain Killer Medications
• Marijuana
• Sleeping Medications
• Alcohol
• Cocaine
• Heroin
• Meth
• Ecstacy
• Crack

When a mentally ill person is most reasonable, they are aware of their illness. This awareness drives them to crave a feeling of behaving better. There becomes a growing need to overpower a mental illness with or without professional input. Inherently, patients seek various intoxicants or substances that can make them feel in control of their mental state. Hiding mental illness from people around, including your doctor, also makes substance abuse inherent.

Taking Self-Medication

Continuing the theme of the connection between mental illness and substance abuse, it is understandable that patients will seek out narcotics and alcohol to medicate their mental illnesses. This problem has been observed in some instances, including:

• People who are depressed frequently use marijuana to block out those negative feelings. A person who consumes marijuana is more likely to feel euphoric or relaxed. In that case, it would help relieve depression.
• Another example of social anxiety is a patient who drinks in social situations to feel comfortable. Alcohol is a proven nerve relaxer for every drinker. Drinking alcohol can exacerbate social anxiety.
• A benzodiazepine like Xanax and Valium may help anxiety attack patients calm their symptoms when they occur or shut off the attacks entirely by stopping anxiety attacks from starting in the first place.
• However, a patient who takes the stimulants Adderall, crystal meth or cocaine to increase energy lacks motivation.
• Sleeping pills are abused by some sleep-deprived patients who are aware of them and know they will enhance sleep.

A patient who does not learn to avoid these situations might eventually be driven to self-medicate. The notion of substance abuse implies that someone has been self-medicating in the strictest sense of the term. In this way, substance abuse will soon manifest itself in self-medication. It has been observed that self-medication is rather prevalent among people with a mental illness.

Increased Chances of Self Medication

Once a patient begins to see their medical issues as an opening to determine their treatment, it is only a matter of time before they start abusing substances that work for them. Whatever category a mentally ill person falls under, finding these substances to self-medicate is more detrimental than helpful. Alcohol, drugs, nicotine, marijuana, etc., are just temporary fixes. Underlying mental health symptoms can only get permanent solutions from professional medical treatments.

These medications do not address the underlying psychiatric difficulties because their effects are only instantaneous. Once the patient has reached this stage of development, she or he is more vulnerable to develop new health issues that will affect her or him in the long term. As a result, the severity of the mental health symptom or symptoms will be exaggerated, leading to a greater likelihood of severely manifesting the symptom.

Substance Abuse Effect as A Trigger of Mental Illness and Substance Abuse

It Is Possible to Display Different Symptoms of Mental Health Conditions Because Some Mental Health Issues May Appear when They Are Not Present. Among Other Substances, One Can Abuse Any of The Following Common Substances. It Is Also Known that People Who Abuse Substances for A Long Period Gradually Develop Mental Illnesses. Other Drugs May Cause Psychological Symptoms to Arise Similar to Those Caused by Prescription Drugs.
It is often the case that diseases such as mental illnesses are caused by a combination of factors, including genetics, in addition to substance abuse.

Some Other Triggers of Mental Illness are:

• Stress
• Abuse
• A traumatic event
• Family history

One Disorder Can Bring on The Symptoms of The Other

These substances can be toxic or contain toxic chemicals. Until recently, people thought they were eating regular food and were not getting any vitamins. Symptoms of an underlying illness may show up more intensely if the person can be under the drug’s influence. There have been cases where the abuser will possess symptoms of their disease due to the substances he or she abuses.

“However, other substances such as vitamins and minerals can eliminate these symptoms. After consuming alcohol, an anxious person is calmed down and able to deal with social situations. Intoxicating substances are dangerous when they wear off. When a patient goes sober, anxiety symptoms may be at full force.”

As a result of this information, we can see that these symptoms exist due to the co-occurrence of mental health disorders. Medical professionals use methods and forms that do not involve using these substances to treat mental illnesses and substance abuse can lead to many detrimental situations, even when used as a treatment for mental illness.

It Is Possible that This Could Happen in The Following Circumstances:

• The likelihood of being harm by drugs and alcohol increases. The traumas associated with these events can lead to IBS, eating disorders, depression, and more.
• Drunk patients may make bad decisions, harder for them to handle, and struggle with panic
• Many substances have the side-effect of reinforcing sexual desire, which can result in unprotected sexual activity or needle sharing. AIDS or Hepatitis can be passed on from someone else to the patient, putting the patient at risk. In addition to being crushed under severe depression as well as grief, it will also be accompanied by a struggle to deal with the life-altering consequences of contracting various other diseases.
• It is common for depression symptoms to emerge from the effects of some drugs, and over time, they may become evident enough to cause persons to notice they are suffering from this illness.

Understanding Dual Diagnosis and Getting Treatment

Treatment of substance abuse and mental ill-health are inherent aspects of some patients’ treatment that need to be accommodated. Dual diagnosis refers to a condition in which an individual has both mental health problem and substance abuse problem, such as someone diagnosed with dual disorders. This further strengthens the connection between the two illnesses, which function as a pair to alleviate those who suffer from them.
The patient must be aware that both afflictions must be treated simultaneously to treat them effectively. In case a patient is being treated for one disorder after another, the treatment for one will leave the patient with the symptom of the depression disorder. Left untreated, psychiatric disorders like depression are more likely to induce substance abuse or lead to death. Mental health diagnosis of substance abuse (ADD/ADHD) could render mental health treatment ineffective.

Connection Between Substance Abuse Treatment and Mental Health Treatment

It is important to note that Mental illness has different treatments than substance abuse disorder treatment. When a mentally ill person begins to self-medicate, the medical professionals have separate health issues to tackle.

“Also notable is that the disease combinations developing from mental illness and substance abuse are quite a number. These combinations will progress from their unique causes to their symptoms. If a patient is depressed, he may indulge in sleeping medication to stay unconscious more of the time. Another depressed patient may choose to take a Crack dose to boost their mood and energy level.

However, other substances such as vitamins and minerals can eliminate these symptoms. After consuming alcohol, an anxious person is calmed down and able to deal with social situations. Intoxicating substances are dangerous when they wear off. When a patient goes sober, anxiety symptoms may be at full force.”

If you or someone you care for is suffering from Dual Diagnosis, don’t wait to call for help they definitely need. Even if you are dealing with either mental illness and substance abuse, we’re here to help you. Our medical professionals can help determine the proper treatment. Every case is peculiar, and the combinations of programs, treatment, and medication for recovery will differ. Contact us via 615-490-9376 today. Remember, the longer you wait, the deeper the menace of mental illness and substance abuse afflicts the body.

Ben Lesser

Ben Lesser is one of the most sought-after experts in health, fitness and medicine. His articles impress with unique research work as well as field-tested skills. He is a freelance medical writer specializing in creating content to improve public awareness of health topics. We are honored to have Ben writing exclusively for Dualdiagnosis.org.

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