Progressive muscle relaxation is a method that helps relieve that tension. In progressive muscle relaxation, you tense a group of muscles as you breathe in, and you relax them as you breathe out. When your body is physically relaxed, you feel less anxious.

Follow along with our guided Muscle Relaxation!

1. Feel your feet. Feel the weight of your feet. Feel your feet relax and sink into the bed. 
2. Feel your lower legs. Feel the weight of your lower legs. Feel your lower legs relax and sink into the bed. 
3. Feel your knees. Feel the weight of your knees. Feel your knees relax and sink into the bed.
4. Feel your upper legs. Feel the weight of your upper legs. Feel your upper legs relax and sink into the bed.
5. Feel your hands. Feel the weight of your hands. Feel your hands relax and sink into the bed.
6. Feel your lower arms. Feel the weight of your lower arms. Feel your lower arms relax and sink into the bed.
7. Feel your elbows. Feel the weight of your elbows. Feel your elbows relax and sink into the bed.
8. Feel your upper arms. Feel the weight of your upper arms. Feel your upper arms relax and sink into the bed.
9. Feel your buttocks. Feel the weight of your buttocks. Feel your buttocks relax and sink into the bed.
10. Feel your back. Feel the weight of your back. Feel your back relax and sink into the bed.
11. Feel your pelvic and belly area. Feel the weight of your pelvic and belly area. Feel your pelvic and belly area relax and sink into the bed.
12. Feel your chest. Feel the weight of your chest. Feel your chest relax and sink into the bed.
13. Feel your shoulders. Feel the weight of your shoulders. Feel your shoulders relax and sink into the bed.
14. Feel your neck, both front, and back. Feel the weight of your neck. Feel your neck relax and sink into the bed.
15. Feel your skull. Feel the weight of your skull. Feel your skull relax and sink into the bed.
16. Feel your mouth. Feel any tension in your mouth. Feel your mouth relax and any tension slide off
into the bed.
17. Feel your eyes. Feel any tension in your eyes. Feel your eyes relax and any tension slides off into the bed.
18. Feel your entire face. Feel any tension in your face. Feel your face relax and let any tension slide
off into the bed.
19. Mentally scan your body. If you find any place that’s still tense, relax it and let it sink into the bed.

Relaxation

1. Lie on your back.
2. Slowly relax your body, starting with your feet and moving through every part of your body until
you have reached-and relaxed-your face and scalp.
3. Do a quick check to see if you’ve missed any place. If so, relax in that area.
4. Slowly begin to inhale, first filling your lower belly, then your stomach area, and then your chest
and the top of your lungs almost up to your shoulders Hold for a second or two, then begin to
exhale. Empty the very bottom of your lungs first, then the middle, then finally the top.
5. Continue this breathing for 4 or 5 minutes. Don’t force your breathing; it’s not a contest to see how
much air you can take in. Just do it in a relaxed, peaceful manner.
6. After a while, imagine that you are resting on a warm, gentle ocean. The sun is shining peacefully
on your body. Imagine that you rise on the gentle swells of the water as you inhale and that you
slowly descend as you exhale.
7. Continue this relaxing breathing as long as you wish (hopefully, until you fall asleep).
Note: This is particularly effective when you do it after Progressive Relaxation-if you haven’t already fallen asleep!

Deep Breathing

A relaxed body is essential for sound sleep. This may sound like we're contradicting what we just said about our minds keeping us awake, but it's no contradiction. Eastern sciences (such as yoga) have known for thousands of years that the mind and body are connected (actually they're not just connected, they're one, but the idea that they're connected is sufficient for our purposes here.) So if the mind is not relaxed, the body is not relaxed. Conversely, the body has to be relaxed for the mind to be relaxed. It's a package deal.

So how do you relax your body? We've already mentioned milk, herbal teas, exercise, and avoiding caffeine. But there are techniques you can do directly with your body. Toe Wiggling is one of them.
Lie on your back (where you should be in the first place) and wiggle your toes up and down 12
Times, wiggling the toes of both feet at the same time. This will relax your entire body, inside and out. How does it work? According to the science of Reflexology-which has been around in other cultures for thousands of years-your feet are a kind of master control panel for the rest of your body.
" Meridians" in the body-which are those channels of energy treated by acupuncture-end up in the feet. So the ends of those meridians in your feet control it with every organ and every part of your entire body.
When you wiggle your toes, you are stimulating and thus relaxing your entire body. (Incidentally,
This is a good place to mention that you can be energized and relaxed at the same time. It's a matter of the quality of that energy. If it flows freely and smoothly, you will be relaxed. If the energy flow in your body is restricted or blocked, you will be tense. And toe wiggling helps to bring about relaxing, free-flowing energy.)

Note: This same exercise is also a great first thing in the morning before getting out of bed in order to energize the body.


Toe Wiggling

Relaxation Exercises

Progressive Relaxation

Learn about sleep hygiene and getting better sleep.

The rituals, behaviors, and norms you follow around sleep are referred to as sleep hygiene. Regularly pulling all-nighters, or sleeping in on the weekends so you can “make up” for lost sleep are both examples of poor sleep hygiene. Conversely, following a regular sleep schedule and avoiding caffeine late at night are good sleep hygiene practices. Improvements in sleep hygiene offer an “easy win” in the search for better sleep, and should be the first thing you go after when sleep troubles show up. In fact, sleep hygiene education is an essential part of the cognitive-behavioral therapy used to treat insomnia.

What is sleep hygiene?

Good sleep hygiene ensures you consistently enjoy higher-quality, more restful sleep for a sufficient amount of time each night. Bad sleep habits, on the other hand, lead to poor quality and inadequate sleep. You already know sleep is important. Otherwise, you wouldn’t be reading this article. Good sleep on a regular basis is critical to maintaining balanced mental, emotional, and physical health. It helps you stay focused during the day, regulate your mood, and feel more productive and functional on a daily basis.

Why is sleep hygiene important?

The most important elements of sleep hygiene require the following from your bedroom:

Temperature – neither too hot nor too cold
Darkness – the darker, the better
Quiet – the quieter, the better
A comfortable place to lie down and stretch out

If you have those things covered, great news: you are most of the way to good sleep hygiene.

What is good sleep hygiene?

The short answer: bad sleep hygiene is doing the opposite of any of the tips we discussed in the previous subsection. But the answer you’re probably looking for is this: if you’re waking up unrested each morning, waking up frequently during the night, feeling tired during the day, or having trouble falling asleep at night, there’s a very good chance that you have bad sleep hygiene that’s messing with your sleep.

What is bad sleep hygiene?

Introduction

If you’re going to change your habits to ensure you get enough sleep, it’s helpful to start by knowing exactly what “enough” is. Throughout our lives, our sleep needs change, but as a general rule, adults in good health typically require 7 to 7.5 hours of sleep. Infants, children, and adolescents need more to differing extents. You may need less or you may need more than the recommended amount. As you work through the following tips, set aside enough time for you to really get at least 7 hours of sleep. If you do this for a few days and still wake up feeling unrested, gradually increase the number. On the other hand, if you bound out of bed each morning after only 6 hours and still feel great, don’t worry about it. What’s important is that you feel well-rested – not that you get the “correct” amount of sleep. The one caveat to this is if you are regularly sleeping less than 6 or more than 9 hours and still don’t feel rested, you may have a sleep disorder.

Know How Much Sleep You Need

Once you know how much sleep you need, set and follow a regular sleep schedule that provides enough room for it to happen. Avoid bedtime procrastination at night, which is exactly what it sounds like. Set an alarm for the morning and get up the same time every day, even if you had a bad night with frequent awakenings. Keep your sleep and wake times consistent throughout the week – even weekends. Otherwise, you’ll find yourself experiencing an uncomfortable rebound effect come Monday. Using a sleep tracker app like NextStep.Healh or keeping a sleep diary can help ensure you’re actually following the sleep schedule you set.

Go To Bed At The Same Time Every Night

Your bedroom should be as quiet as possible. Some people find absolute silence uncomfortable, in which case white noise can be helpful for calming those anxieties or drowning out noisy neighbors or pipes. White noise machines are a bit passe, given the abundance of white noise apps, you can easily download for your smartphone. Choose from nature sounds, guided meditation, or classical ambient white noise. If you live in a noisy neighborhood or apartment building, read our article for tips on making your bedroom quieter. Strategically place furniture, invest in acoustical padding decor, or use more accessible items like earplugs, curtains, and pillows to block out noise. Sometimes the noise is closer – and furrier – to home. If your pet is waking you up with a jingling collar, scratching, or snoring, consider kicking them out of your bedroom and offer them a nice cushy bed somewhere else in the house.

Find a Quiet Place to Sleep

The best temperature for falling asleep is somewhere in the low- to mid-60 degrees Fahrenheit. Maintaining a consistently cool temperature helps your body thermoregulate during sleep. Keeping your bedroom dark also keeps it cool, by blocking out heat from sunlight in the morning. More importantly, the darkness convinces your brain that it’s still nighttime. If you live in a very light-polluted area (most cities fall in this category), get an eye mask and blackout curtains to aid in this goal. Small night lights and illuminated clocks might be okay, but some light-sensitive people may find them bothersome. Avoid turning on the full light if you need to get up and use the bathroom during the night. Even a short exposure in the middle of the night can make it harder to get back to sleep.

Keep Your Bedroom Dark and Cool

Having a dedicated place for sleep is psychologically important. We don’t think expensive mattresses and bedding materials are worth it, but having a comfortable place to lie down and stretch out is important. Find the best mattress for you, so you can’t wait to go to bed at night. Invest in comfortable bedding and supportive pillows, too. It is important to subconsciously connect being in bed with sleeping. Don’t read in bed or talk on the phone. Remove clutter and items that remind you of work from your bedroom as well, such as your computer. Instead, treat your bedroom as a haven for sleep.

Dedicate Your Bed to Sleep, and Nothing Else

Some people have televisions in their bedrooms, although watching TV right before going to sleep (or worse, during nighttime awakenings) is not a good idea. Looking up close at computer screens and tablets shortly before bed is actually detrimental to sleep. The light from those screens tricks your brain into thinking it’s daytime again. The problem with these devices is that they all use blue light, the strongest wavelength of light that your brain perceives as sunlight. Besides the intensity of the light, many of these devices find ways to either stress or excite you, whether they ping you with a frustrating work email or a happy Facebook notification. Try to stop using all electronics 1 full hour before bed. That includes your television, computers, phones, e-readers, and tablets. If you absolutely can’t tear yourself away from any of these items, at least turn on the red light filter.

Limit Screen Time Before Going to Bed

Improve Your Sleep Habits

Sleep Hygiene

Achoo! Food allergies range from a variety of severities.

Food allergies can cause all sorts of health problems that might seem non-obvious. Food allergies cause inflammation. Inflammation is the source of all ailments. Inflammation in your gut as a result of food allergies can cause many symptoms, including skin rashes, hives, brain fog, weight gain, weight loss, reduction of white blood cell count, stomach ulcers, and more.

Food Allergies 101

Learn about some common food allergies and their symptoms.

Wheat is one of the top eight food allergens in the United States. A wheat allergy is an immune response to any of the proteins present in wheat, including but not limited to gluten. It’s most common in children. Around 65 percent of children with a wheat allergy outgrow it by the age of 12. Symptoms of wheat allergy include:

- nausea and vomiting
- diarrhea
- irritation of your mouth and throat
- hives and rash
- nasal congestion
- eye irritation
- difficulty breathing.

Symptoms related to a wheat allergy will usually begin within minutes of consuming the wheat. However, they can begin up to two hours after. The symptoms of a wheat allergy can range from mild to life-threatening. Severe difficulty breathing, known as anaphylaxis, can sometimes occur. Your doctor will likely prescribe an epinephrine auto-injector (such as an EpiPen) if you’re diagnosed with a wheat allergy. You can use this to prevent anaphylaxis if you accidentally eat wheat. Someone who is allergic to wheat may or may not be allergic to other grains such as barley or rye.

Symptoms of Wheat Allergy

Celiac disease is an autoimmune disorder in which your immune system responds abnormally to gluten. Gluten is present in wheat, barley, and rye. If you have celiac disease, eating gluten will cause your immune system to destroy your villi. These are the finger-like parts of your small intestine that are responsible for absorbing nutrients. Without healthy villi, you won’t be able to get the nutrition that you need. This can lead to malnutrition. Celiac disease can have serious health consequences, including permanent intestinal damage. Adults and children often experience different symptoms due to celiac disease. Children will most commonly have digestive symptoms. These can include:

- abdominal bloating and gas
- chronic diarrhea
- constipation
- pale, foul-smelling stool
- stomach pain
- nausea and vomiting

The failure to absorb nutrients during critical years of growth and development can lead to other health problems. These can include:

- failure to thrive in infants
- delayed puberty in adolescents
- short stature
- irritability in mood
- weight loss
- dental enamel defects

Adults may also have digestive symptoms if they have celiac disease. However, adults are more likely to experience symptoms such as:

- fatigue
- anemia
- depression and anxiety
- osteoporosis
- joint pain
- headaches
- canker sores inside the mouth
- infertility or frequent miscarriages
- missed menstrual periods
- tingling in the hands and feet

Recognizing celiac disease in adults can be difficult because its symptoms are often broad. They overlap with many other chronic conditions.

Symptoms of Celiac Disease

There is increasing evidence for a gluten-related condition that causes symptoms in people who don’t have celiac disease and are not allergic to wheat. Researchers are still trying to discover the exact biological cause of this condition, known as NCGS. There’s no test that can diagnose you with NCGS. It’s diagnosed in people who experience symptoms after eating gluten but test negative for wheat allergy and celiac disease. As more and more people go to their doctor reporting unpleasant symptoms after eating gluten, researchers are trying to characterize these conditions so that NCGS can be better understood. The most common symptoms of NCGS are:

- mental fatigue, also known as “brain fog”
- fatigue
- gas, bloating, and abdominal pain
- headache.

Because no laboratory test exists for NCGS, your doctor will want to establish a clear connection between your symptoms and your consumption of gluten to diagnose you with NCGS. They may ask you to keep a food and symptom journal to determine that gluten is the cause of your problems. After this cause is established and your tests come back normal for wheat allergy and celiac disease, your doctor may advise you to begin a gluten-free diet. There is a correlation between autoimmune disorders and gluten sensitivity.

Symptoms of Non-Celiac Gluten Sensitivity

Food Allergies Symptoms

Food Allergies

Discover how you can help someone you know who may be struggling.

Discover the warning signs for someone who may be struggling.

There is no typical suicide victim. It happens to young and old, sick and well, rich and poor. But, fortunately, there are some common warning signs which, when acted upon, can save lives. Here are some signs to look for:

- Talk about committing suicide
- Have trouble eating or sleeping
- Experience drastic changes in behavior
- Withdraw from friends and/or social activities
- Lost interest in hobbies
- Prepare for death by making out a will and making final arrangements
- Give away prized possessions
- Have attempted suicide before
- Have a recent severe loss
- Be preoccupied with death and dying
- Lose interest in his or her personal appearance
- Increase usage of alcohol or drugs

Warning Signs

What should you do if you think someone you know might be suicidal?

Contact:

A community mental health agency,
- A private therapist
- A school counselor or psychologist
- A family physician
- A suicide and crisis center

Contact

DO:
- Be aware
- Learn the warning signs
- Get involved
- Become available
- Show interest and support
- Ask if he or she is thinking about suicide
- Be direct
- Talk openly and freely about suicide
- Be willing to listen
- Allow expression of feelings
- Accept the feelings
- Be non-judgemental
- Offer empathy, not sympathy
- Offer hope that alternatives are available, but do not offer glib reassurance. It only proves you don't understand
- Take action
- Remove means
- Get help from persons or agencies specializing in crisis intervention and suicide prevention

DON'T
- Don't debate whether suicide is right or wrong, or if feelings are good or bad
- Don't lecture on the value of life
- Don't dare him or her to do it
- Don't give advice by making decisions for someone else or tell him or her to behave differently
- Don't ask "why". This encourages defensiveness
- Don't act shocked. This will put distance between you
- Don't be sworn to secrecy. Seek support

Ways to be Helpful

What To Do?

Helping Suicidal Friends

Volunteering is a win-win situation - it improves your mood and helps other people out!


Learn about volunteering benefits and opportunities.

Dummy Title: Part 1 - video

Part of being a great volunteer is loving what you're doing. Find something that you're passionate about or something that inspires you, and then find a need in your community. There are dozens of reasons why you should volunteer - you just need to find the one that feels right.

20 GREAT REASONS TO VOLUNTEER:
- Help others
- Make a difference
- Find purpose
- Enjoy a meaningful conversation
- Connect with your community
- Feel involved
- Contribute to a cause that you care about
- Use your skills in a productive way
- Develop new skills
- Meet new people
- Explore new areas of interest
- Meet good people
- Impress your mom
- Impress yourself
- Expand your horizons
- Get out of the house
- Make new friends
- Strengthen your resume
- Feel better about yourself

Why Volunteer?

VolunteerMatch
Idealist.org
Network for Good
Points of Light Volunteer Opportunities
Points of Light’s HandsOn Network
Peace Corps
AmeriCorps
Senior Corps

Places to Find Volunteering Opportunities

Volunteering 101

Volunteering

Learn about digital fasting and how digital fasting can improve your well-being.

See what a digital fast is, who likes to digital fast, and how to do a digital fast.

Also known by various other terms like “digital detox,” “digital Sabbath,” and “unplugging”, the idea behind a digital fast is to voluntarily and deliberately stop using all connected devices – smartphones, computers, tablets, and so on – that plug you to the internet for a pre-specified amount of time. The abstention could be for as little as a few hours (say, from 7 pm until the next morning). However, most digital fasts are at least a day-long event, and many span an entire weekend or even longer. 

Like food fasts, longer digital fasts are thought to be more effective (up to a point) in weaning oneself away from digital connectivity, and in regaining self-control. Some versions of the digital fast recommend off-line activities you should perform instead (with all the spare time freed up from not texting and Facebooking): going on a walk or a hike, or organizing a pot-luck meal with friends who are also digitally fasting. 

In theory, the idea of a digital fast has generated a lot of interest, with organizations such as Adbusters and the Huffington Post each promoting their respective versions of digital fasts. It is especially popular among Silicon Valley employees of tech companies like Facebook and Google. But in practice, digital fasting really hasn’t moved beyond the fringes of our culture. One reason is that there is a raging debate about whether a digital fast is desirable. Advocates take the digital stance that digital technology has addictive properties that cause harm in various ways, and we need to regain control over its use. Its opponents counter with the argument that digital technology satisfies our fundamental needs today and is irreplaceable. So, they say, there is no need for anyone to fast or unplug.

What is a digital fast?

Discover the different perspectives of how technology affects us.

They point to the fact that when using smartphones, or playing online games, or using social media, many people exhibit features that are very similar to those displayed by drug addicts. These features include the following: excessive use of the digital technology without discretion, experiencing symptoms of withdrawal including feelings of anger, tension, or depression without negative repercussions from using technology such as lowered ability to focus and insomnia. 

One study from 2014 led by psychologist Julia Hormes concluded: “The use of online social networking sites is potentially addictive…Disordered online social networking use seems to arise as part of a cluster of symptoms of poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction."

Under this perspective, unchecked use of digital technology is a potential problem that could have serious consequences. One avenue to gain control over the problem is to disconnect from the source of the addiction in a deliberate and systematic way by means of a digital fast.

The Addiction Perspective

Technology enthusiasts take an entirely different view. They see nothing problematic or dangerous with our incessant digital connectivity. They believe that there is no need for anyone to unplug at all, even momentarily. Rather, they argue that digital technologies now satisfy many of our most basic needs and we no longer have other, old-fashioned ways of meeting these needs.

For instance, (at least in the United States) people no longer stroll to the town square every evening or call each other to talk for hours on a landline phone. Our online and offline lives have now blended together so completely that one is not possible without the other. Thus, fasting digitally will lead to nothing more than depriving ourselves of basic need fulfillment and constitutes a case of unnecessary technological asceticism.

This view is expressed nicely by business consultant Alexandra Samuel: “When we’re online — not just online, but participating in social media — we’re meeting some of our most basic human needs. Needs like creative expression. The need to connect with other people. The need to be part of a community. Most of all, the need to be seen: not in a surface, aren’t-you-cute way, but in a deep, so-that’s-what’s-going-on-inside-your-head way.”

Under this perspective of technology and digital connectivity, it is clear that a digital fast is an anathema. Instead, it would see each of us as electric appliances. Unless it is plugged into a power source, it is useless. In the same way, we are only functioning when we are digitally connected.

The Tech Enthusiast Perspective

It is worth thinking deeply about which perspective of technology relationship – addiction or empowerment – resonates with you. When I thought about this question, it was clear even though using digital technology and being connected is empowering, I am also addicted to its use. Some experts suggest that people like me should approach digital connectivity like a diet instead of a fast. In other words, use technology in a restrained way rather than not at all. Nevertheless, I choose to unplug from all digital devices from time to time, usually for a few hours, or sometimes for a weekend. If nothing else, digital fasting is a way to prove to myself that I have the strength to act willfully in my relationship with technology.


Which Perspective Makes Sense?

Perspectives

Digital Fasting

Anxiety disorders are much more than just nervousness and worrying. They can cause terrifying fear about things that other people wouldn't give a second thought to.

Learn about anxiety and depression, symptoms, and how anxiety can often lead to depression.

People with anxiety disorders — social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder — or phobias spend most of their lives in an agitated state. After a while, that can take a huge emotional toll, and depression often sets in. There’s no conclusive explanation as to why anxiety and depression so often co-exist, according to the Anxiety and Depression Association of America, but you can find relief from both with the right treatment.

Anxiety disorders are much more than just nervousness and worrying. They can cause terrifying fear about things that other people wouldn't give a second thought to. Many people with anxiety disorders understand that their thoughts are irrational, but they still can't stop them.

"It's a cycle," says Sally R. Connolly, LCSW, a therapist at Couples Counseling of Louisville in Kentucky. "When you get anxious, you tend to have this pervasive thinking about some worry or some problem and you feel bad about it. Then you feel like you've failed, and you move to depression."

The two conditions have a complicated relationship. The incidence of developing depression in addition to an anxiety disorder is high — almost half of all people with major depression also suffer from severe and persistent anxiety, Connolly notes.

"People who are depressed often feel anxious and worried, so one can trigger the other," she says. "Anxiety often comes before depression." There may be a biological predisposition to both depression and other anxiety disorders. People who have post-traumatic stress disorder (PTSD), an anxiety disorder, are particularly likely to also develop depression, according to the National Institute of Mental Health (NIMH). "Especially with anxiety, more so than depression, there often is some family history, and so therefore we think that there may be some genetic predisposition to this," Connolly explains. "Some people are just worriers and pass it down."

Why Anxiety Leads to Depression

These are signs that a person may suffer from both anxiety disorder and depression:

- Constant, irrational fear and worry
- Physical symptoms like rapid heartbeat, fatigue, headaches, hot flashes, sweating, abdominal pain, and difficulty breathing
- Insomnia
- Changes in eating, either too much or too little
- Difficulty with memory, decision making, and concentration
- Constant feelings of sadness or worthlessness
- Loss of interest in hobbies and activities
- Feeling tired and cranky
- Inability to relax
- Panic attacks

Symptoms of Anxiety and Depression

Anxiety 101

Learn about treating anxiety and depression, and how you can help a loved one.

Cognitive-behavioral therapy (CBT), which is often used to treat anxiety disorder with depression. CBT can teach people to manage their fears, anxieties, and depressive symptoms by figuring out what's really causing them; people also learn how to take control of their emotions.

Antidepressant medications, which may be prescribed to help treat both conditions. These drugs are often used in conjunction with CBT. Selective serotonin reuptake inhibitors (SSRIs) are newer, commonly used antidepressants that offer fewer side effects than older antidepressants, according to the NIMH.

Exercise, which can also help both depression and anxiety disorders. Exercise releases chemicals in the body that make you feel good, and it can help you relax. Taking just a 10-minute walk may alleviate symptoms for several hours, the Anxiety and Depression Association of America states.

Relaxation techniques, which include practicing meditation and mindfulness. Both can ease symptoms of both anxiety and depression and improve your quality of life, according to a large research review published in the March 2014 issue of JAMA Internal Medicine.

Organizations offering mental health services, which can include a hospital or support group in your community. Check out the National Institute of Mental Health or the Anxiety and Depression Association of America for more resources.

Treatment Strategies

Loved ones of those struggling with anxiety and depression should be on the lookout for these warning signs of a mental health crisis:

- Poor daily self-care, such as refusing to perform personal hygiene habits, get out of bed or eat
- Sudden and extreme changes in mood
- Becoming violent, threatening, or aggressive
- Abusing substances
- Appearing confused or having hallucinations
- Talking about suicide or about not having a reason to live

Treatment for anxiety disorders and depression needs to be administered and managed by a psychiatrist, Connolly says. "It's really crucial for people with both [anxiety and depression] to have a good assessment to rule out bipolar disorder," she says. Bipolar disorder, a condition in which emotions can swing from very low to very high levels of mania and depression, is treated much differently than anxiety disorder with depression. No one has to suffer from an anxiety disorder or depression, and certainly not both. People with anxiety disorder should speak with a psychiatrist, therapist, or other healthcare professional about their symptoms, and start treatment before depression has a chance to set in.

Warning Signs You Shouldn't Ignore

The Road to Recovery

Anxiety and Depression

Everyone experiences stress. Sometimes it can help you focus and get the task at hand done. Learn how to productively manage stress.

Learn about how stress affects you, about when you are most vulnerable to stress, and about ways to reduce stress.

Everyone experiences stress. Sometimes it can help you focus and get the task at hand done. But when stress is frequent and intense, it can strain your body and make it impossible to function.  Finding effective ways to deal with stress is crucial to living well.

Stress 101

Stress affects your entire body, mentally as well as physically. Some common signs include:

- Headaches
- Trouble sleeping
- Jaw pain
- Changes in appetite
- Frequent mood swings
- Difficulty concentrating
- Feeling overwhelmed

When experiencing long-term stress, your brain is exposed to increased levels of a hormone called cortisol. This exposure weakens your immune system, making it easier for you to get sick. Stress can contribute to worsening symptoms of your mental illness. For example, schizophrenia can encourage hallucinations and delusions, while bipolar disorder can trigger episodes of both mania and depression. Knowing what situations cause it is the first step in coping with this very common experience.

How Stress Affects You

People are most susceptible to stress when:

- They are not getting enough sleep
- Don't have a network of support
- They are experiencing a major life change such as moving, the death of a loved one, starting a new job, having a child, or getting married
- They are experiencing poor physical health and not eating well

Everyone has their own threshold. Certain things that may upset you out might not even make one of your friends raise an eyebrow. Some people are affected when they experience large crowds and noisy environments, while others react to silence and free time.

When You Are Most Vulnerable To Stress

Developing a personalized approach to reducing stress can help you manage your mental health condition and improve your quality of life. Once you've learned what your triggers are, experiment with coping strategies. Some common ones include:

Accept your needs.
Recognize what your triggers are. What situations make you feel physically and mentally agitated? Once you know your triggers, you can avoid them when it is reasonable to avoid them, and cope when you can't avoid them.

Manage your time. 
Prioritizing your activities can help you use your time well. Making a day-to-day schedule helps ensure you don't feel overwhelmed by everyday tasks and deadlines.

Practice relaxation. 
Deep breathing, meditation, and progressive muscle relaxation are good ways to calm yourself. Taking a break to refocus can have benefits beyond the immediate moment.

Exercise daily. 
Schedule time to walk outside, bike, or join a dance class. Whatever you do, make sure it's fun. Daily exercise naturally produces stress-relieving hormones in your body and improves your overall physical health.

Set aside time for yourself. 
Schedule something that makes you feel good. It might be reading a book, go to the movies, get a massage or take your dog for a walk.

Eat well. 
Eating unprocessed foods, like whole grains, vegetables, and fresh fruit is the foundation for a healthy body and mind. Eating well can also help stabilize your mood.

Get enough sleep.
Symptoms of some mental health conditions, like mania in bipolar disorder, can be triggered by getting too little sleep.

Avoid alcohol and drugs. 
They don't actually reduce stress: in fact, they often worsen it. If you're struggling with substance abuse, educate yourself and get help.

Talk to someone.
Whether to friends, family, a counselor, or a support group, airing out and talking can help.

How to Reduce Stress

Reducing Stress

Managing Stress Productively

Being in a community organization has positive impacts on your mental health. Learn about the benefits of a community.

It is a well-known fact that physical activity and a nutritious diet can improve health and well-being. Most of us know that we are supposed to eat more vegetables and consume fewer fats, that we need at least 30 minutes of exercise per day, and that we need to engage in strength training and recreational activities to maintain our physical health. While these things are undeniably good for us and do contribute to being healthier and reducing chronic disease, it’s important to note that these recommendations don’t cover every aspect of health and wellness. In addition to being physically healthy, we also need to consider the mental components of health and wellness.

According to the National Institute of Mental Health (NIMH), mental illness affects approximately 13 million American adults each year. Mental health plays a major role in people’s ability to maintain good physical health and participate in health-promoting behaviors. People who are mentally healthy are happier, have lower levels of depression and anxiety, maintain healthier relationships with others, and feel that they are making a contribution to society. Several studies support the idea that more green space (e.g., community parks) results in greater mental health for communities. A recent study from England’s University of Exeter titled Longitudinal Effects on Mental Health of Moving to Greener and Less Green Urban Areas illustrates just how important parks are for long-term mental health and well-being. The study determined that people who moved to urban areas with more green space reported higher mental health scores — meaning they were happier and had lower levels of depression and anxiety. Interestingly, the study also showed that the mental health scores continued to improve each year for the duration of the study. In the United States, another study titled “Exposure to Neighborhood Green Space and Mental Health: Evidence from the Survey of the Health of Wisconsin” found similar results. This study examined the relationship between environmental green space and mental health in both urban and rural areas and found that “higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety, and stress.” Both of these studies provided significant evidence that parks have a positive impact on the mental health of their communities.

Recreation and Mental Health

Parks can help to improve mental health in a variety of ways, from simply providing the actual green space for people to engage in their natural surroundings to facilitating programs like tai chi, yoga and qigong classes that engage the mind and body, to sponsoring and developing neighborhood gardens that reduce stress and anxiety. Many park and recreation agencies already foster programs that help support mental health. The San Diego Park and Recreation Department provides “open-space parks” within their community. These parks provide community members with opportunities to engage in nature through hiking, walking, biking and other activities. In addition to the open-space parks, San Diego offers popular tai chi and yoga classes in their parks and community centers. Tai chi, an ancient Chinese practice, uses a combination of physical movements, deep breathing, focus, and energy flow to reduce stress and anxiety. With these open-space parks and through its classes, San Diego’s community is experiencing both physical and mental health benefits.

Engagement Activities

Gardening is another tool that parks can use to help stimulate mental health. Researchers have found that gardening can help to lower blood pressure, reduce stress, increase brain activity and produce endorphins. The Portland, Oregon, Parks and Recreation Department’s community gardens program has offered gardening opportunities since 1975. The program provides the chance for community members to garden, volunteer, engage socially with neighbors, learn from other cultures and give back to the community. Heading into its 40th year, the program features 50 community gardens located throughout the city with more than 2,180 individual garden plots. The program is facilitated by four staff members and more than 2,300 annual volunteers. Another large part of their garden program, Produce for People, provides produce for food pantries in an effort to help combat Portland’s high poverty rate. In 2014, Produce for People donated 36,545 pounds of produce to food pantries across the city. Both San Diego’s and Portland’s efforts to provide environments and programming that encourage mental health are prime examples of how park and recreation agencies across the country can make a difference.

Community Gardening

Get Involved in Your Community

Community Recreation

Negative thought patterns are repetitive, unhelpful thoughts. They directly cause what we could describe as ‘negative’ (unwanted or unpleasant) emotions like anxiety, depression, stress, fear, unworthiness, or shame.


People often try many different ways to get rid of their negative thoughts, including distractions, diversions, or ‘drowning their sorrows’ only to later mentally beat themselves up for being still stuck in their negativity. It can feel like a real internal battle. These are common strategies that attempt to stop the thoughts and numb the pain in the short term but they only make things worse in the long term. It doesn’t fix the problem at its core. The research shows that struggling with, arguing with, trying to drown out, or push away unhelpful thoughts only amplifies them and makes things worse. If you are struggling with negative thinking, it is possible to turn things around, cultivate inner peace, and live a rich, meaningful, and fulfilling life. Read on to find out how.

Ineffective Ways People Try to Stop Negative Thinking

Negative thought patterns are repetitive, unhelpful thoughts. They directly cause what we could describe as ‘negative’ (unwanted or unpleasant) emotions like anxiety, depression, stress, fear, unworthiness, shame, etc. Once we learn to recognize and identify negative thought patterns as they occur, we can start to step back from them. This process of stepping back from thoughts is called ‘cognitive defusion.’ In cognitive defusion, we learn to see the thoughts in our head as simply that—just thoughts. Not reality. You see, when we are fused with our thoughts (cognitive fusion) we tend to take our thoughts very, very seriously. We believe them. We buy into them and we obey them. We play them out. When we are not fused with our thoughts—when we can step back into cognitive defusion, then we do not take our thoughts too seriously. We hold them lightly. We only listen to them if we find them valuable or helpful.  We certainly don’t take our thoughts to be ‘the truth’ and we don’t automatically obey them or play them out. We see our thoughts as simply bits of language that pass through the mind. Mental events if you will, that move through the mind all the time just like the weather passes through the sky. We have a choice in how we choose to respond to them. An example to illustrate the difference between cognitive fusion and cognitive defusion is this...imagine waking up one day and looking out the window and seeing rain. It’s possible that a thought might come into your head that says “what a dreadful day”. Now is it true that the day is dreadful? No, of course not, it is simply raining. However, if you believe the thought “what a dreadful day”, in other words, if you are stuck in cognitive fusion (literally fused with the thought) then guess what you will probably have? That’s right, you will probably have a dreadful day! In other words, if you believe a thought like that, it can generate what we might call negativity. It’s completely normal to have negative thoughts! It’s part of our evolutionary history. There is nothing wrong with you. We all have minds that have evolved to be constantly on the lookout for problems and dangers, so most of us have minds prone to have many negative thoughts. The problem is not that we have negative thoughts. The problem comes when we believe our thoughts are true. When you are no longer entangled in thoughts they lose their grip on you and lose their power to generate unpleasant emotions. Imagine you’re laying in bed in the morning, you look out the window and you see that it’s raining and once again the thought arises “what a dreadful day”. If you are not fused with the thought (you don’t buy into it) then your experience would be like this. You’re watching the rain falling, then you also watch the thought (as simply a mental event) “what a dreadful day” arise and fall away just like the rain is falling and since you don’t take it seriously or believe it, it generates no negativity, passes by easily and you’re free to lay there relaxed and at ease, enjoying the pitter-patter of the rain on the roof. As you can see, the ability to recognize unhelpful thinking and step back from it is incredibly liberating! It can change the quality of your whole day and indeed your whole life.

Recognize and Take a Step Back

“My life has been full of terrible misfortunes, most of which never happened”. ~ Michel de Montaigne

Worry is when the mind projects into an imagined future and conjures up scenes and thoughts about what could go wrong. Here it often creates ‘what if’ scenarios. Sometimes it takes the form of imagining or expecting that bad things will happen or that nothing good will ever happen for you. You might fret about your health deteriorating, your relationship going downhill, your car breaking down or your career being ruined—even though nothing has actually happened yet. You might focus on the lack in your life and believe that nothing will ever get better for you. Stress-related to your financial future, the welfare of your children or your partner leaving you fit into this category.

Anxious Thoughts and Worry

Do you have a harsh inner critic? Are you always trying to whip yourself into shape, mentally beating yourself up for not being good enough yet? Are you on a mission for perfection?
Another pattern of negative thought is to constantly criticize and self-improve because you’re not good enough yet. You may be very harsh on yourself, focusing on all of your weaknesses and perceived flaws. Likewise, you may extend this habit of criticism to others in your life. This can be the cause of tremendous strain on relationships. Negative self-talk and self-criticism often result in low self-esteem and a lack of confidence. One way some people cope with low self-esteem is to compensate for these feelings by attaining status, achievements, and recognition. Others may feel completely debilitated by feelings of unworthiness, becoming depressed, or even suicidal. There is nothing wrong with having goals and aiming to get fitter or healthier and the like—we can simply choose to do those because they are good for us or we want to stretch and grow. It’s a very different headspace to be doing those things because we don’t feel like we’re enough yet. When the mind continuously hones in on what is wrong with yourself (and your life) and disassociates from what is going well and is good, we can become stuck in negativity.

Criticism and Self-Beating

Ruminating on mistakes made in the past often creates feelings of shame, guilt, and negativity. Feelings of worthlessness may arise when you play over and over in your mind, ‘bad’ choices or ‘wrong’ actions you feel you have made. There is nothing ‘negative’ about simply reflecting on past experiences. This is how we can learn, grow and mature as people. Negativity arises when you dwell on a situation repeatedly with no real intention to learn and grow–but instead, you are self-beating or wishing things were different instead of being accepting of things as they are.

Regret and Guilt

The Patterns

Learn how to break free from negative thought patterns.

People trapped in negative thinking often say they feel hopeless because they often wrestle or argue with the thoughts or push them away, but the research shows that trying to struggle with thoughts in these ways just amplifies them as you may have noticed in your own life. What you resist persists. So how do you move through life in a way that is practical, peaceful, and authentic without getting stuck in negative thought patterns? Here is the first step. It’s a very powerful, simple, tried, and tested technique for untangling from thoughts without struggling with them. It’s called the ‘name it to tame it’ technique. "Name it to tame it" is a phrase coined by author and psychiatrist Dr. Daniel Siegel. Here are the basics of how ‘name it to tame it’ works: 

When an unhelpful thought pattern (and the associated emotion) arises you simply mentally ‘label’ the story. You’ve probably noticed many of our thoughts are repetitive and involve the same storylines. A story you could be telling yourself is, “Who am I to be putting myself out there teaching mindfulness. Aren’t you supposed to be perfect first!? Have it all totally together?!” This story is unhelpful so when thoughts come up along that storyline, you should simply take the mental note, “Ahhhh the ‘who do you think you are’ story is here again” and then let it go. By ‘let it go’ we simply mean, stop giving it all your attention and stop taking it so seriously. Realize it’s just a thought, not reality, then open your awareness to the world around you again—the birds in the trees, the sounds, the breeze. Get out of your head and into your life. As soon as you name the mental story or pattern, you have now stepped back from being caught up in it. In other words, you have initiated cognitive defusion. 

From a neuroscience perspective, when you name the thoughts you stop being hijacked by them from the negativity they create because you bring the smartest part of your brain online (the frontal cortex). The frontal cortex is reflective and helps you step back and get a greater perspective. You can do the same thing with emotions, naming them to tame them like “ahhh anxiety is here” or “oh shame has arrived”. When naming or labeling your thoughts or emotions, one important tip. Make sure when you mentally label, to do it in a soothing, kind tone of voice. This is important as it helps you to settle and invite compassion and soothing into that moment instead of aggression or struggle. We’re not going to battle with the mind here. We are gently training it into new neural pathways of peace and ease. At a biological level, when you ‘name it to tame it’ in a soothing voice you even get a squirt of soothing neurotransmitters in the brain! This brings feelings of calm and ease and comfort.

Getting Unstuck: The "Name It To Tame It" Technique

“Let us not look back in anger or forward in fear, but around in awareness.” ~ James Thurber

Notice that many negative thoughts mostly flow from two directions. The first is dwelling on the past—maybe you ruminate over mistakes, problems, guilt, and anything in your life that’s did not go the way you believe it should have gone. The second is worrying about the future—fear of what may or may not happen for yourself, others, or the planet.
This may take the form of stress over whether or not you will achieve certain goals or anxiety about the security of your finances or relationships. Or perhaps you may worry about getting old. Whatever your particular negative thoughts are, notice that in order to engage in negative thought patterns the mind needs to cast its focus mostly on the past or future. Either that or we judge and mentally label things in the present moment to be ‘bad’. When lost in negative thinking we tend to be so engrossed in thoughts that we completely lose touch with what is actually happening in the present moments of our lives. We miss the little pleasures of living each day. The sunlight on your skin, the taste of the food we’re eating, a real connection with someone we love while they are talking. When we’re lost on our heads we lose touch with the world around us... and we lose touch with ourselves. To become more present, and able to step out of negative thinking, one powerful method is to ‘come to your senses. To do this simply redirect your attention out of the thoughts in your head and bring your focus to your sense perceptions. Whether you’re in your home, at the office, in the park, or on a subway, notice everything around you. Use your senses to their fullest. Don’t get into a mental dialogue about the things you see, just be aware of what you’re experiencing at this moment. Be aware of the sounds, the scents, the sensation of the air on your skin, or the contact points with the seat beneath you. Be there fully in the moment. This is a form of mindfulness practice.

Research from Prof. Mark Williams from Oxford University showed that when difficulties arise in life many of us tend to get caught up in excessive unhelpful thinking.
Sometimes people try to stop constant unhelpful thinking but we don’t have to try to stop our thoughts. A more effective way to ease all that internal noise, Prof. Williams teaches, is to pay attention to our direct sensory experience. In this way, there’s simply little to no room left in our attention for all that excessive thinking. Coming to our senses calms the mind and grounds us in the present moment. Now, it’s not that we’re aiming to live completely immersed in our senses all the time. It’s appropriate to think when it’s useful of course. But we can use this awareness of our senses to the ground and center us in a greater awareness when we find ourselves caught up in negative thinking. It is actually almost impossible to be both deeply present in the moment in our senses and keep the negativity going! Try it out as an experiment and find out for yourself to see whether this is true.

Coming To Your Senses

Breaking Free

Breaking Negative Thought Patterns

We've all been in a situation where we know we need to work out, but one of a number of excuses has got the better of us and we've skipped the gym. Learn about the benefits of having a training partner!

Perhaps the best aspect of training with someone is that your partner provides instant accountability. We’ve all been in a situation where we know we need to work out, but one of a number of excuses has got the better of us and we've skipped the gym. Making plans with a training partner makes it much harder to cancel a workout as you know you’ll be messing up their plans too.

Accountability

It’s not uncommon to be overly critical when looking at workout progression. You may just be your own worst critic. A good training partner will always be able to look at your concerns through fresh eyes and give a healthy second opinion.

Outside Perspective

We humans (especially men, it seems) tend to work harder and perform better in competitive situations. Training with a partner can unlock your competitive drive no matter how chilled out you usually are. There’s nothing like a training partner looking great or making serious progress in the gym to fire up your desire to do better. One word of caution though: if your partner is considerably stronger or fitter than you, don’t be sucked into trying to perform the same workouts. Your partner won't progress, and you'll likely get injured. Instead, try to compete on degrees of improvement relative to your own current ability.

Healthy Competition

Those incorporating weightlifting into their training regime will benefit greatly from having a training partner who can act as a spotter on those big lifts. Depending on the type of training program you are using, reaching or approaching concentric failure on a set may be necessary to make progress. Having someone there to help control the weight means that you can push further than you could alone and have a safer workout. It’s common to hear people ask for a spot on the bench press, but it shouldn’t stop there: you can get more out of almost all free weight exercises with the help of a spotter.

You'll Be Able to Spot Each Other

One of the greatest parts of having a good training partner is the ability to share each other's successes. Setting training goals and edging closer and closer to their attainment alongside someone else is very motivating. It’s also a great idea to plan rewards together. A previous training partner and I used to book a weekend trip away to let our hair down each time we finished a 6-8 week training phase. It helps to balance all the hard work with a worthy reward.

Celebrate Successes Together

Benefits

OK, you want a training partner. How do you find one?

Finding the right training partner isn’t easy. If you don’t already have a training partner or have someone in mind to ask, here are some ways you could go about finding one:

Public goals / social media: 
Why not set a public goal on one of your social media profiles, post some of your workouts, and just add the odd "anyone fancy joining me?" tag to some of your posts. You never know, one or more of your acquaintances might be in exactly the same position as you. Make it easy for people to select themselves.

Meet-up groups: 
You could use meetup.com or other online meeting websites to directly seek out like-minded individuals in your area that are also actively seeking out a training partner. This one works really well as you already have a motivated audience.

The gym: 
You may need not look further than your own gym. Get to know the other members and keep a lookout for other users doing similar training to yourself. Be on hand and ready to lend a spot and just be an all-around positive character on the gym floor. You may be surprised how quickly people begin to present themselves as potential training partners.

Finding a Training Partner

How to Find a Training Partner

Benefits of Training With a Partner

In the twelve-step program, the human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems the groups deal with are understood to manifest themselves in each dimension

Since 1935, generations of problem drinkers have been aided by Alcoholics Anonymous, the fellowship group comprised of alcoholics helping other alcoholics. In 1953, the group Narcotics Anonymous was founded, based upon the same principles as AA. Since that time, over 200 other fellowship groups have been formed to address a plethora of addictions – Sexaholics Anonymous, Cocaine Anonymous, Gamblers Anonymous, Overeaters Anonymous, and the like.

These programs have helped hundreds of thousands of people overcome their Substance User Disorders. They’ve helped repair families and friendships. They’ve also helped people become the best possible versions of themselves. All of these programs follow a version of “The 12 Steps of AA” – the guiding principles outlining how to recover from compulsive, out-of-control behaviors and restore manageability to one’s life. After all, that’s what an addiction is, compulsive, out-of-control behavior. And the goal of recovery is to restore manageability to one’s life. Here are the 12 Steps of Alcoholics Anonymous, with an explanation of the significance of each step. Use this information to help yourself or someone you love to get clean. No one needs to remain addicted to alcohol. The 12 Steps are one of the best ways to achieve the goal of sobriety.

Introduction to the 12 Step Program

1. We admitted we were powerless over alcohol – that our lives had become unmanageable.

Substance use disorder (SUD) experts are quick to say that a person has to admit there is a problem before recovery can truly begin. But the First Step of the 12 Steps of AA means more than this – it means finally rejecting the denial and self-deception that so often accompanies SUD and once the suffering addict/alcoholic realizes THAT, they can be more receptive to the idea that they will need help to recover. There are two crucial words in the First Step:

Powerless – This means that the person has lost control over their consumption of drugs and/or alcohol. They no longer can regulate when or how much they consume. The addiction is in charge.

Unmanageable – This means that the drinking/drug use is having a negative impact on the rest of the person’s life

The First Step

2. Came to believe that a Power greater than ourselves could restore us to sanity.

There are two considerations for the Second Step of the 12 Steps of AA. First and foremost, the Second Step is about HOPE. Rather than being resigned to a hellish downward spiral of addiction, a person comes to understand that recovery IS possible. In other words, although the struggling addict/alcoholic has no control over THEIR compulsion, that doesn’t mean that there is not a solution. So the second consideration of this Step is that it is possible to gain strength, inspiration, and guidance from something outside of and greater than one’s self – IF stubborn ego can be laid aside. In other words, when you can temporarily make yourself subordinate to someone or something that is helping you, it is possible to be guided in the right direction.
That’s because alcoholism is, by its nature, a selfish behavior. It’s not selfish in the moral sense. But it does focus on only meeting the needs of the self. When the self is no longer the highest priority, it’s easier to stop drinking.

Some people are put off by the idea of a higher power. But AA isn’t a religious organization. The higher power doesn’t have to be God or any specific interpretation of God. In fact, there’s an entire AA group that’s focused on secular help. It’s called Secular AA. It could be fate, karma, or anything else. The point is that you need to find a source of inspiration to help you stay sober. There’s also a list of secular AA meetings. The group realizes that there may not be a secular AA meeting near you. That’s why they also offer online secular AA meetings. This shows that you do not need to be religious to follow the 12-step program.

The Second Step

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

The first two Steps were about reflection – but the Third Step of the 12 Steps of AA is about action. At its simplest, the Third Step means deciding to get out of your own way. For some non-religious people, the Third Step can be problematic, which is why “God as we understood Him” is important. Your Higher Power does not have to be a deity. It can also be the recovery process itself, the innate strength of human nature, your support system, or the fellowship you receive from other addicts/alcoholics. The exact nature of your Higher Power is personal – it only has to be something outside of and greater than yourself in which people can place their faith. This helps people look outside themselves. As a result, they are less likely to give in to their demons.

The Third Step

4. Made a searching and fearless moral inventory of ourselves

In this step, you continue to eliminate opportunities for denial by taking an honest – and sometimes uncomfortable – at yourself, your behavior when drinking/using, and the effect it has, both on yourself and upon others. Why is this so important? Before you can ever attempt to change your behaviors and attitudes, you have to know what needs changing. This inventory is not just about finding out your weaknesses – those things that need changing. It is also about uncovering your strengths – those positive traits that you can expand upon. Your personal inventory must be:

Fearless – as you face the truth about yourself that you may not like. But only by acknowledging your faults can you take steps to correct them.

Searching – as you sincerely take time to examine your thoughts, words, and deeds. To this end, it is a good idea to write your inventory down.

Moral – as you weigh those thoughts, words, and deeds against an objective standard of what is right against your own selfish desires.

The Fourth Step

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

This step is absolutely necessary after a moral inventory. A person who has taken an unflinching look at the harm that their addicted behaviors have done can sometimes be tormented by that knowledge. Without productive relief, that torment can lead to old, destructive ways of coping – drinking and using. Talking to someone else can help alleviate negative feelings of shame and guilt. When you unburden yourself of the weight of your past, you free yourself up to move forward unimpeded. Often, people will find that they are not so unique in their imperfection.

The Fifth Step

6. Were entirely ready to have God remove all of these defects of character

This is one of the more difficult Steps of the 12 Steps of AA because it is the culmination of everything that has come before. This is where you let go of those behaviors and attitudes that are holding you back. The reason that this step is so difficult is that often, those behaviors and attitudes that are being let go have been the only ways to cope that you have ever known. Sometimes, it means relearning a whole new way to interact with the world. After all, alcohol shapes the world for many alcoholics. The nature of the addiction means they’re always thinking about alcohol. That means that changing requires hard work. People need to admit to themselves that they’re ready for that hard work. This Step is not about perfection – it is about getting better. Throughout the course of recovery, you will find yourself repeating the Sixth Step several times. That’s because no one is perfect. But that doesn’t mean that people shouldn’t try to improve. Any addict can overcome their addiction.

The Sixth Step

7. Humbly asked Him to remove our shortcomings.

This Step is very much like the Third Step, but it is more specific. Now that a moral inventory has been completed, we see ourselves as we truly are, both the good and the bad. The truth is many of our shortcomings are intertwined with our addictions. And, because we are powerless over the addiction, we are often just as powerless to overcome our shortcomings on our own. This is where the key concept of Step Seven of the 12 Steps of AA – humility – comes in. When we are humble, we admit when our way of doing things isn’t working and when we need help to overcome specific problems in our lives. There are three reasons why humility is so important in this Step:

- It allows us to recognize the severity of our defects. Without that humility, it is possible that we will underestimate or minimize the impact of our actions.
- It allows us to recognize our own limits. We have to be humble enough to understand that alone, our intellect, our reasoning, and our willpower are not enough to overcome our addiction.
- It allows us to comprehend the enormity of our Higher Power’s ability to transform our lives.

Humility allows us to come to the realization that there is something greater than both ourselves AND our addiction. And, because it IS greater, that Higher Power can restore us to sanity.

The Seventh Step

8. Made a list of all persons we had harmed and became willing to make amends to them all

The Fourth Step was about personal house cleaning, but the Eighth Step of the 12 Steps of AA is about social house cleaning. It is about recognizing the wreckage that you have left in your wake while you were actively addicted. In order to continue moving forward, you have to acknowledge the role you may have played in hurting others. When you become willing to repair the damage you have done, you again reduce the destructive pain, anger, hurt, and resentment that addiction causes. This step also helps people work on the guilt they feel. Remember, guilt can cause people to turn back to drinking. Confronting that guilt makes it easier to stay sober. It also helps remind people of the harmful effects of their drinking.

Making a list of the wrongs someone’s committed helps them to understand the importance of changing. It’s easy to overlook one or two events. But when a person sees a list of the times that their drinking has hurt someone, it gives them more motivation to change. In this way, the Steps work together again. Understanding the effects that a person’s drinking has on those around them helps them make decisions based on overall good. That’s instead of making decisions based only on themselves. This helps stop the cycle of addiction. It is the willingness to make amends that is important because as you will see in the Ninth Step, it is not always possible to make reparation.


The Eighth Step

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

Like so many other interlocking Steps, the Eighth Step of the 12 Steps of AA was chiefly about contemplation, while this Step is about action. Now that we know what we have done and who we have done it too, we have to take action to right our wrongs. This is a difficult, but necessary Step. Difficult, because “direct” means face-to-face and in person. This may seem strange in a world dominated by text messages and email. People need the courage to ask for forgiveness. Asking forgiveness in person requires even more courage. We have to face those we have wronged, take responsibility for the harm we have caused, and try to make up for that harm in some tangible way.

Making amends is more than just apologizing. It also means trying to undo the damage. That means repaying old debts, whether they’re monetary or otherwise. It is necessary because it starts to clean up the messes we have left behind. Since recovery is all about moving forward, making amends for the wrongs we have done lets us “balance our books”, so we owe nothing from our addicted past. It allows us to have a fresh start. A word about “wherever possible” – Sometimes, reconnecting personally with someone we have harmed in the past can reopen old wounds or cause difficulties in someone else’s current life. For example:

- Seeing an ex in person can cause them embarrassment or problems in their current relationship.
- A person you may have physically harmed might be traumatized by your presence.
- Confessing to some criminal act you may have committed does not mean implicating others.
- In such instances, it may be better to write a letter acknowledging the past harm, expressing the willingness to make amends the other person may deem necessary, and asking for forgiveness.

This step requires that we (1) apologize, (2) try to repair our wrongs, and (3) ask for forgiveness. It does NOT require that the other person grant that forgiveness. In fact, some people may not be willing to forgive. A recovering alcoholic needs to accept that. This is one of the ways that the steps work together. When someone is comfortable with another person’s right to refuse forgiveness they demonstrate that they’re able to cope with the world. When we are sincere, but direct amends for forgiveness are not possible, we should simply “let go” of the burden we have been carrying around and resolve to do better in the future in our interactions with others.

The Ninth Step

10. Continued to take personal inventory and when we were wrong, promptly admitted it.

The tenth step of the 12 Steps of AA is about continued growth and vigilance. In essence, is about laying the foundation for our future. When we are continually honest with ourselves, it is much easier to recognize triggers, behaviors, and attitudes that could result in a relapse. This step helps to re-enforce the lessons and practices of the other steps. People constantly try to improve themselves instead of giving up. It also helps prevent people from making justifications to drink again.

Everyone’s familiar with these justifications. “I’ve been sober for 3 weeks, so I can have a drink.” This mindset isn’t possible with a constant moral inventory. Instead, the self-assessment helps people see when they’re wrong before they act, rather than afterward. These justifications can lead to a slippery slope. “I can have one drink because I’ve been sober for three weeks” becomes “Two drinks isn’t that bad.” This can easily lead to “Well, I’ll just party tonight and stop again tomorrow.” This situation is especially true for alcohol. Booze hurts decision-making. Once someone has some alcohol in them, they’re more likely to make decisions that serve only themselves. That can lead to relapse.

Admitting when we are wrong allows us to continue moving forward in humility, without the denial and self-deception that addiction brings about. This type of honesty is essential to recovery. After all, if a person has a problem, then ignoring that problem won’t make it go away. Just like ignoring a leaky roof won’t keep water out of the house. It also prevents us from accumulating more emotional baggage that can slow down our recovery. It encourages people to always try to be their best selves. They may not always succeed. But just trying makes their lives better and makes the world around them better. Perhaps the best thing that an ongoing personal inventory does is keep us “on track”. It keeps us from straying too far from our path of recovery. It gives people a way to focus on improving themselves. This approach means they’re less likely to fall back into alcohol abuse. That’s because they focus on getting better instead of trying to numb their pain.

The Tenth Step

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

This is a spiritual Step, but people who have reached this point have usually come to terms with the “God” language the 12 Steps of AA contains. In other words, they have already formed their own personal concept of a Higher Power. For some, GOD is an acronym that stands for “Good Orderly Direction” – the path that they want their life to take. For others, it can even stand for a “Group Of Drunks/Druggies” – the fellowship they receive from others in their AA/NA meetings. “Prayer and meditation” means making a conscious effort to improve our understanding of the path that our Higher Power has for us. To be more specific, prayer means TALKING to our Higher Power – sharing our burdens, admitting our wrongs, asking for help, and expressing our gratitude. Meditation, on the other hand, means LISTENING to that same Higher Power – putting aside our own egos and desires in order to understand what we should be doing.

The Eleventh Step

12. Having had a spiritual awakening as a result of these Steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

This Step of the 12 Steps of AA is at once self-serving and selfless. For yourself, there are few things that you can do that can better serve your own sobriety than by working with others who are still struggling. Being of service to others has several benefits:

- It reminds you of where you once were and where you no longer want to be.
- It helps hold you accountable.
- It gives you a sense of purpose.
- It keeps you from becoming complacent in your recovery.
- It enhances your fellowship with others.
- It allows you to be of benefit to other struggling alcoholics/addicts. 

Sometimes, a still-suffering person will trust you above others, because you understand what they are going through. You have insights that may allow you to help when no one else can.
When you share your story, others may be inspired by your successful ongoing recovery – to the point that they are finally able to regain their own sobriety.

It is important to understand that addiction is incurable and lifelong. Recovery requires vigilance and work, one day at a time, for the rest of your life. You’ll find yourself repeating the 12 Steps of AA over and over again as a means of safeguarding your sobriety. No, the 12 Steps of AA are not a cure for your addiction – they are guiding principles is that allow you to restore sobriety, sanity, and serenity to your life.

The Twelfth Step

The 12 Step Program

Learn about what happens after the 12 Step Program.

This is a really good question. After you’ve gone through the 12 Steps of AA, you want to know, what happens next? You should know that this is not the end of the road for you. You should actually take one of two directions. Once you’ve gone through the 12 Steps of AA, you may need to go through them again. It’s possible that there were some issues that you needed to work out in your life, but you didn’t. Perhaps you couldn’t because of some rough relationships from your past.

Don’t feel you’re ready to quit AA just because you’ve gone through the 12 Steps of AA one time. You may need more time to think about the different steps you’ve just learned. You may need additional time to put them into practice in your own life. This relates to the Steps themselves. The Tenth Step is all about taking a continued moral inventory. That means a person must be honest with themselves. If that person isn’t ready to move on, then they need to start working the steps again. 

The other direction you may want to consider is to become a sponsor yourself. Think back to the time when you first started Alcoholics Anonymous. It’s possible that the 12 Steps of AA seemed entirely foreign to you. You’re thankful for your sponsor, who helped to see you through each step and support you. Someone else may need you to do that for them.

No matter which path a person chooses, they’re never done with the program. Instead, they use it as a way to help control their lives. Remember, recovery is about making your life manageable again. The 12 Step program gives people a framework to do that.

What Next?

After the 12 Step Program

The 12 Steps of Recovery

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery. Learn about many of the substance use disorders that MAT is designed to address. MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug. Medications used in MAT are approved by the Food and Drug Administration (FDA), and MAT programs are clinically driven and tailored to meet each patient’s needs. Combining medications used in MAT with anxiety treatment medications can be fatal. Types of anxiety treatment medications include derivatives of Benzodiazepine, such as Xanax or valium.

Learn about some programs and therapy used for MAT.

Opioid treatment programs (OTPs) provide MAT for individuals diagnosed with an opioid use disorder. OTPs also provide a range of services to reduce, eliminate, or prevent the use of illicit drugs, potential criminal activity, and/or the spread of infectious disease. OTPs focus on improving the quality of life of those receiving treatment. OTPs must be accredited by a SAMHSA-approved accrediting body and certified by SAMHSA. The Division of Pharmacologic Therapies (DPT), part of the SAMHSA Center for Substance Abuse Treatment (CSAT), oversees accreditation standards and certification processes for OTPs. Learn more about the certification of OTPs and SAMHSA’s oversight of OTP Accreditation Bodies. Federal law requires patients who receive treatment in an OTP to receive medical, counseling, vocational, educational, and other assessment and treatment services, in addition to prescribed medication. The law allows MAT professionals to provide treatment and services in a range of settings, including hospitals, correctional facilities, offices, and remote clinics. Learn more about the legislation, regulations, and guidelines that govern OTPs. As of 2015, OTPs were located in every U.S. state except North Dakota and Wyoming. The District of Columbia and the territories of Puerto Rico and the Virgin Islands also had OTPs in operation.

Opioid Treatment Programs

Under federal law, MAT patients must receive counseling, which could include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services. Learn more about these treatments for substance use disorders.

Counseling and Behavioral Therapies

In 2013, an estimated 1.8 million people had an opioid use disorder related to prescription pain relievers, and about 517,000 had an opioid use disorder related to heroin use. MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy. MAT also includes support services that address the needs of most patients. The ultimate goal of MAT is full recovery, including the ability to live a self-directed life. This treatment approach has been shown to:

- Improve patient survival,
- Increase retention in treatment,
- Decrease illicit opiate use and other criminal activity among people with substance use disorders,
- Increase patients’ ability to gain and maintain employment,
- Improve birth outcomes among women who have substance use disorders and are pregnant. 

Research also shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for relapse. Learn more about substance misuse and how it relates to HIV, AIDS, and Viral Hepatitis. Learn more about common comorbidities that occur with substance use disorders.

MAT Effectiveness

SAMHSA’s Partners for Recovery Initiative produced a brochure designed to assist MAT patients and to educate and inform others. This Medication-Assisted Treatment Know Your Rights Brochure – 2009 presents and explains the federal laws that prohibit discrimination against individuals with disabilities and how they protect people receiving MAT for opioid addiction. Under the Confidentiality Regulation, 42 Code of Federal Regulations (CFR) 2, personally identifiable health information relating to substance use and alcohol treatment must be handled with a higher degree of confidentiality than other medical information.

MAT and Patient Rights

FDA has approved several different medications to treat opioid addiction and alcohol dependence. A common misconception associated with MAT is that it substitutes one drug for another. Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability. Medications used in MAT for opioid treatment can only be dispensed through a SAMHSA-certified OTP. Some of the medications used in MAT are controlled substances due to their potential for misuse. Drugs, substances, and certain chemicals used to make drugs are classified by the Drug Enforcement Administration (DEA) into five distinct categories, or schedules, depending upon a drug’s acceptable medical use and potential for misuse.

Medications Used in MAT

Programs and Therapy

Learn about the different medications used during Medication Assisted Treatment.

Methadone tricks the brain into thinking it’s still getting the abused drug. In fact, the person is not getting high from it and feels normal, so withdrawal doesn’t occur. Learn more about methadone. Pregnant or breastfeeding women must inform their treatment provider before taking methadone. It is the only drug used in MAT approved for women who are pregnant or breastfeeding. 

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