Emotional-support animals & psychiatric service animals: what you need to know

Humans and dogs share about 84% of their DNA; and dogs and humans have had a symbiotic relationship for at least 7,000 years (some even argue this relationship could go as far back as 400,000 years!). Cats are not dissimilar: they were first domesticated about 10,000 years ago and share about 90% of our DNA*.  With such longstanding history of human-animal partnership, and even some genetic similarities, it’s no surprise that many of us look to animals for emotional support.

A Brief History of Emotional Support Animals

Humans have been investigating the role animals play in emotional well-being for a number of years. In 1872, Charles Darwin collaborated with multiple psychiatrists to publish The Expression of the Emotions in Man and AnimalsAlmost 100 years later, Boris Levinson, a child psychologist, published one of the first texts directly related to animal-assisted therapy: Pet-Oriented Child Psychotherapy.  The concept of utilizing the human-animal bond for emotional well-being is therefore not a new concept.

The Science Supporting Animal Assisted Interventions

In recent years, when it’s become increasingly important to demonstrate that certain types of treatment are consistently effective, scientists and social scientists have been engaging in research related to emotional support animals.  In her book Made for Each Other, Meg Daley Olmert investigates the science of the human-animal connection.  This research showed that a key player in this bond (and in our emotional well-being) is oxytocin.

Oxytocin is most-widely known for being released when women give birth, as a way of bonding mother and child.  However, research has shown that we release oxytocin in various levels based on the interactions we have in day-to-day life.  For example, we produce about 15-25% more oxytocin than normal when we have a pleasant interaction with a stranger, 25-50% more oxytocin when we engage with a friend or acquaintance, and 50% or more oxytocin when we engage with someone we love like a family member or spouse. It may be no surprise to those of us who think of our pets as family members, but guess what? We also release oxytocin when petting our dogs. (And even better, our dogs release oxytocin too!). Why does this matter? Well, according to an article published on Psych Central, “greater amounts of oxytocin hormone levels appear to be associated with greater relaxation, more willingness to trust others, and general psychological stability. It appears to help us reduce our stress response and reduce general anxiety in people when produced.”  Therefore, having an emotional-support animal, or spending time with an emotional-support animal, potentially provides you with these benefits of oxytocin release.

In addition, research studies have shown that animal-assisted therapy reduced aggression levels in children, increased self-efficacy and decreased anxiety and depression in people with psychiatric disorders, decreased loneliness in elderly residents in a long-term care facility who previously had an association with animals, and even have been shown to increase social skills in children with Autism.

Accessing an Emotional Support Animal

Before you begin seeking out an emotional support animal, or therapy animal, it is important to distinguish the difference between therapy animals and service animals.  Service animals engage in specific tasks to help a person with a disability. For example, a seeing eye dog helps a blind person decide when to cross the street, or a psychiatric service animal may warn a person with Bi-Polar disorder that they are going into a manic episode. Emotional support animals are not trained to perform specific duties for a person, but instead provide therapeutic benefit to its owner through companionship and affection.

There are a few ways you can access the potential benefits of an emotional support animal:

  1. Consider adopting a pet for your home.
  2. Seek out a mental health provider, agency, or group practice that utilizes emotional support animals.

Deciding Whether or Not an Emotional-Support Animal is Right for You

Before deciding to welcome an emotional support animal into your home, there are a number of questions you should consider:

  1. Are you emotionally prepared to care for an animal, and to do-so on a long-term basis?
  2. Are you physically capable of caring for the type of animal you would like to adopt? (Your animal should match your lifestyle. The good news, all kinds of animals have been shown to have a positive impact on mental health. In fact, one senior living facility saw an increase in client happiness when the residents were given crickets as pets!)
  3. Can you afford the immediate and long-term costs of caring for an animal? Examples include food, toys, bedding or litter, vet visits, basic healthcare, etc.
  4. Do you have adequate space for the animal? For example, I had a client living in an apartment who chose to get a guinea pig as an emotional support animal because it fit their lifestyle and living situation. Emotional support animals do not always have to be dogs (or cats).

When you are Unable to Have an Emotional Support Animal, but Still Want Access

If an emotional support or therapy animal is not a good fit for you at this time, then you may still reap the benefits of an emotional support animal by seeking out a provider or organization that provides this resource.  There are a number of ways to do this:

  • If you are seeking an individual therapist who has an emotional support animal, many of them include this information on their websites or in directory listings. You can search for therapists in your area using sites like Psychology Today, Zencare, or Good Therapy. Please note that different providers will utilize therapy animals in different ways.  In some instances, the therapy animal may simply be present in the office with you to provide comfort and support.  In other cases, your provider may integrate the animal into your therapy (for example, using dog training skills as a way for clients to practice setting boundaries and speaking with confidence).
    • For those who are specifically interested in equine-assisted therapy (also known as “hippotherapy”) you can visit the Equine Assisted Growth and Learning Association (EAGALA) or American Hippotherapy Association to find a facility in your area. Note that most equine-assisted therapy is currently focused on occupational therapy, physical therapy, or speech therapy. However, there are a small number of providers offering equine-assisted psychotherapy.
  • If you are interested in having an animal visit a group setting, you can connect with a local chapter of the following therapy animal organizations to inquire about having a volunteer visit your facility:

Obtaining a Service Animal

A service animal differs from an emotional support or therapy animal.  According to the Americans with Disabilities Act (ADA), “service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities.” In the case of mental health, service dogs may remind people to take medication, calm a person with Post-Traumatic Stress Disorder (PTSD) during an anxiety attack, disrupt repetitive behaviors in children with Autism, or alert a Bi-Polar individual of a manic episode (to name a few examples.) Service animals are highly trained, working on their skills anywhere from two to three years. The average cost of training a service dog is $17,000 – or about $1,000/year over the course of an animal’s lifetime.  Some people elect to train their own service animals with guidance from a qualified trainer, while others seek out organizations that train and provide animals.  In some instances, service animals may be donated to individuals, whereas other individuals may elect to pay the costs up-front. Regardless of how you choose to pursue obtaining a service animal, it is important that you consider the points made above in “Deciding Whether an Emotional Support Animal is Right for You,” to ensure you are prepared for the time, commitment, and cost of a service animal.

Some organizations to research if you are interested in a service animal include:

  • 4 Paws for Ability: provides service dogs for children with autism
  • K9s for Warriors: provides service dogs for veterans suffering from Post-Traumatic Stress Disorder (PTSD)
  • Canines for Hope: assists people with locating service dogs for PTSD (regardless of the type of trauma) and pairing people with psychiatric service dogs
  • Service Dogs for America: accepts applications from both military and non-military individuals for PTSD service dogs
  • Assistance Dogs International: provides a directory of organizations that provide service dogs (psychiatric and otherwise) based on your state
  • Midnight Sun Service Dogs: provides service dogs for clients with a variety of psychiatric concerns, including: agoraphobia, anxiety disorders, bi-polar disorder, major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder, PTSD, and social anxiety disorder

    Note: this post is intended as an introductory resource for people interested in emotional support animals (also known as therapy animals) and service animals. If seeking an emotional support or service animal, it is important to do your research, speak with friends, family members, or a therapist about your wishes, and to consider the pros & cons of working with a therapy or service animal. Service animals and therapy animals also should not be considered as a substitute for formal mental health treatment.

*Source: information contained in this blog post was largely obtained during a day-long workshop on Animal-Assisted Interventions offered by PESI, an organization offering continuing education to professionals working in various industries throughout the country. If you would like information about when this workshop may be offered in your area, please click here. The workshop was facilitated by Jonathan Jordan, MSW, LCSW.




The Secret to Surviving Stressful Transitions


When I went through yoga-teacher training, way back before I became a psychotherapist, I remember one of the very first things my teacher told us as a class: “There are only two things in life that are certain – death and change.”

While to some that may seem a tad morbid, holding that saying in our minds can have valuable power. It reminds us that at the end of the day, we are always going to have to deal with transitions; and we’re probably a lot better off if we can learn to live with that instead of trying to fight it.

Thankfully, there are strategies we can learn to help us ride out these periods of transition in our life without making it worse.  In fact, Distress Tolerance is one of four valuable skill sets taught in Dialectical-Behavioral Therapy (DBT) that is designed to help us do just that. DBT is a style of therapy originally designed to treat people with extreme emotional distress, but has since been tested on a number of people and populations. The main goal of DBT is to help people learn strategies to improve the quality of their lives.

Distress Tolerance: What is it and when to use it?

Distress tolerance skills are designed to help us ride out periods of crisis or emotional overwhelm.  I often tell clients that it’s time to use Distress Tolerance strategies when you feel so exhausted or burnt out that you simply don’t feel like you have the energy (or the ability) to solve whatever is stressing you out at the time. I always tell clients: If you can solve whatever problem has got you overwhelmed in the first place – DO IT! There is no need to suffer unnecessarily. But sometimes we don’t have that option, and the next best thing to do is hunker-down, ride it out, and do everything in our power to survive the transition without making it worse.  That way, when the stressor naturally passes, we will be in a better place to pick up, move on, and keep making positive change in our lives.

Goals of Distress Tolerance

So with that said, the goals of Distress Tolerance skills, according to Marsha Linehan and the most-recent DBT manual are:

  1. To survive crisis situations (or periods of transition) without making them worse
  2. To accept reality as it is in this moment, and to replace suffering (stress) and feeling stuck with an ordinary amount of discomfort and an awareness of the possibility to move forward
  3. To become free of giving into ineffective or unhealthy urges (like calling out sick from work, avoiding friends and family, or binging on that delicious chocolate cake when we know we are going to feel guilty afterwords)

How to Practice Distress Tolerance

Now that you have an understanding of what Distress Tolerance means and why we use these skills, the next natural step may be to wonder HOW to put these skills into practice. Well, to be truthful, the good news is that there are a WHOLE BUNCH of strategies you can use to help ride out stressful transitions. One of my personal favorites is self-soothing.

Self-Soothing with the Five Senses

I like using self-soothing skills to manage stress and overwhelm because when it comes down to it, they are simple to implement and remember; and I am a HUGE proponent of keeping things simple! After all, you can’t use healthy life strategies if you can’t remember them, right?

Self-soothing skills encourage us to have a variety of tools at our disposal that nurture each of our five sense, because sometimes the best thing we can do is take really, really, (really!) good care of our bodies until life eases up a bit. What nurtures you may be different from what nurtures someone else. Therefore, the most important factor is that you listen to your gut and develop a toolkit that works best for you.  To get you started, I am providing some suggestions often given in DBT:

Self-soothing with Sight
  1. Buy one beautiful flower for yourself and take a moment to study it and examine its beauty.
  2. Light a candle and watch the flame flicker.
  3. Take a walk through a pretty part of town (or at the beach).
  4. Watch the sunrise or sunset.
  5. Carry a photo of a person, pet, or place that you love. Take it out throughout the day to look at when you are feeling stressed.
Self-soothing with Sound
  1. Pay attention to nature sounds. Sit outside and listen to leaves rustling in the breeze, waves at the beach, or birds chirping in your backyard.
  2. Hum or sing your favorite song. Or learn to sing a new song that you like (or try to play it on an instrument).
  3. Make the updated version of a mixtape: load up your cellphone, Ipod, or whatever you choose with songs that make you feel empowered. Then make sure you listen to it when you need to!
  4. Buy a windchime. Hang it outside and listen for it.
Self-soothing with Smell
  1. Treat yourself to your favorite body wash, cologne, or perfume. When you use it, take a moment to consciously enjoy the aroma.
  2. Burn a scented candle or some incense in a smell that feels comforting to you.
  3. Get outside into a wooded area and mindfully breath in the fresh air and the scents around you. If the woods are not accessible to you, go out into your yard or a public park and literally “smell the roses.”
Self-soothing with Taste
  1. Eat one of your favorite foods. (Mine is spicy chocolate!). Take a moment to slow down and really enjoy it.
  2. Think of a food that brings you back to your childhood in a happy and comforting way. It could be macaroni and cheese, pigs in a blanket, or smores. Whatever it is, treat yourself to it.
  3. Drink your favorite soothing drink, such as an herbal tea, latte, or smoothie.
Self-soothing with Touch
  1. Take a long, hot bath or shower.
  2. Snuggle with your pet.
  3. Put a cold compress on your forehead.
  4. Put clean sheets on the bed.
  5. Wrap yourself up in your favorite blanket.


As you have hopefully come to realize, coming up with ideas to soothe your senses in times of stress is not that difficult.  However, these are the things that often fall by the wayside when we become stressed and overwhelmed. Identifying what soothes you and knowing this ahead of time can increase the chances that you utilize these skills when you really need them. So take some time to brainstorm for yourself using the list above or by simply coming up with your own ideas.  Think about the things that soothe each of your five senses, and come up with strategies to make sure you have access to these when you need them.  Are you already great at self-soothing? If so, leave your favorite self-soothing ideas in the comments below!




Mindfulness in Nature


There are so many ways to bring Mindfulness into our lives; During the summertime, when many people find it easier to get outdoors, practicing Mindfulness in nature can be a great way to combine active Mindfulness strategies with taking in the benefits of being in nature. How exactly can you incorporate Mindfulness skills in nature, and why would you want to combine the two in the first place? Well, read on!

For starters, an article in National Geographic recently cited research that found people’s brains respond differently while in nature: showing decreased activity in the frontal lobe (the part of our brain responsible for analytical thinking) and increased alpha waves (which indicate a “calm but alert state”). Couple this with research showing that Mindfulness can contribute to decreased activation in the amygdala (the part of our brain responsible for hyper-arousal), and combining the two seems like a winning combination.

What is Mindfulness?

If you are new to Mindfulness practices, you may be asking yourself what exactly “Mindfulness” is.  According to Dialectical-Behavioral Therapy (DBT), Mindfulness is the act of being in the present moment with awareness, without judgment, and without rejecting or clinging to the moment.

How can we be more Mindful?

There are many, many ways to bring Mindfulness into your daily life.  Most people familiar with Mindfulness are exposed to this idea in meditation practices or in yoga classes.  However, these are not the only ways to be Mindful.  In fact, DBT has developed a number of strategies to take the kinds of skills cultivated in yoga & meditation and take them out into daily life.  According to DBT, being more Mindful is actually really simple, you just need to learn how to: OBSERVE, DESCRIBE, and PARTICIPATE in life on a day-to-day basis. You can read a more in-depth description of each of these strategies on DBT Self-Help.

Ideas for practicing Mindfulness in nature.

So now that you’ve familiarized yourself with what Mindfulness is and WHAT to do to be more Mindful (Observe, Describe, and Participate), here are some ideas for taking these skills outside and into nature:

Ideas for practicing Observing

  • Go outside and sit, lie down, or stand still in an area. Observe as many sounds as you can. Try not to label what you are hearing, but simply pay attention to how many different sounds you hear.
  • Sit on a bench in a public area like at your local park, beach, or outdoor shopping center. Watch who or what go by in front of you without following them with your vision. Just notice people and objects coming and going.

Ideas for practicing Describing

  • Look for things in nature (examples: flowers, leaves, rocks, animals). For each thing that you find, practice describing it in as much detail as you can. For example, what color is the object? Does it have a texture? How would you describe its size? Shape? If you can pick up the object (don’t try this with wildlife please!), try to describe the feel of the object in your hand.
  • Lie down on the ground and watch clouds in the sky. Try to find and describe patterns in the clouds that you see. Do not include interpretations or opinions (such as, “that cloud reminds me of a cat, I hate cats.”) Just simply label and put words to what you see.

Ideas for practicing Participating

  • Go for a hike, a walk in your local park, or a walk in your neighborhood. Throw yourself COMPLETELY into this activity of hiking or walking. Become one with your experience of walking and GO WITH THE FLOW. If you catch yourself thinking or describing what is going on around you, bring your attention back to fully participating in the act of walking. Focus on walking, and only walking.
  • Participate in nature with awareness of your connection to the universe. Find a tree to sit beneath and lean your back against it. Focus all of your attention on where your body connects with the tree. Think about how this tree serves a function in your life and how you and the tree are similar in this moment: the tree is providing support for you to rest your body; you are both being held up by the ground beneath you, taking in oxygen from the air around you, and being warmed (hopefully!) by the sun above you. Take a few moments to fully participate and enjoy this connection.

Mindfully Managing Stress


Feeling stressed? What are your options to manage it mindfully?

According to the Merriam-Webster Dictionary, Mindfulness is defined as “the practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis.”

Many of us strive to practice Mindfulness by engaging in practices like yoga or meditation. Some practice Mindfulness in other ways, like while walking, or during exercise.

Most people agree that being Mindful is a challenge, even on our best days. But what happens when stress hits? That’s usually when we feel like our stress-management tools go out the window.

I’m here to share what I consider to be the very first step in mindful stress management. This comes originally from Dialectical-Behavioral Therapy (DBT). DBT was invented by Marsha Linehan originally for the treatment of people with high levels of suicidal thoughts and behaviors. Since it’s development, it has been expanded to include anyone who is looking for strategies to improve their quality of life. Mindfulness is a core-component of DBT, and DBT also shows some similarities with Eastern philosophies and spiritual practices like Buddhism.

Mindful Stress Management, what are our options?

If you re-read the definition of Mindfulness, two of the most important words that may stand out are “nonjudgmental” and “awareness.” Whenever we are faced with stress, the first step is acknowledging that we are overwhelmed, and looking at the situation from a place of nonjudgement – towards the situation, and towards the way we are handling it. While practicing this nonjudgmental awareness, we can ask ourselves the following questions:

  • What exactly is the problem I am trying to solve, in this exact moment?
  • What are my options in handling this problem?

According to DBT, we have FOUR options to choose from, whenever we are faced with any problem. They are:

  1. Do nothing. Stay Miserable, and Stay Stressed.
  2. Solve the Problem. Do something to make the external stressor go away.
  3. Feel Better About the Problem (or Regulate our Response to it). Change our perspective, or focus on where we DO have control and make our lives better, so that the problem doesn’t bother us so much.
  4. Tolerate the Problem. This doesn’t make the problem go away, and we are likely to still feel frustrated by it, but if we learn strategies to tolerate the problem, it decreases our chances of making it worse (and therefore making life even MORE stressful).

So the next time you find yourself stressed out and overwhelmed, ask yourself “What’s stressing me out right now, and how have I been handling it?” Have you been tolerating it? Doing nothing? Trying to change your perspective? Then, ask yourself if choosing one of the other problem-solving strategies might be more effective for you today. If you’ve been tolerating a problem that’s been happening over, and over, and over again, maybe you want to give solving the problem a try, or seeing if you can add in some positive life events that will develop your emotional resilience and give that problem less power.

Mindful stress management is about learning to ask these questions and make these decisions day-by-day, moment-by-moment. However, in order to do so, we must practice those core components of Mindfulness: nonjudgmental awareness, so that we can take a look at our problem-solving strategies in a balanced and effective manner.

If you live in the Rhode Island area, and would like to learn more about Mindful Stress Management, check-out my upcoming workshop at Breathing Time Yoga on Saturday, March 4th in Pawtucket, RI, titled “Riding the Wave: Mindful Stress Management and Stress Tolerance.” The drop-in fee for workshop participants is $17. You can register by creating an online account  and then reserving your space.

On Medical Marijuana & Mental Health: Understanding Costs & Benefits

smokingAs a holistic practitioner, I feel that it’s my responsibility to be open to various forms of treatment and acknowledge the many different ways in which we can cope with distress.  For some of us, this may mean going to therapy, exercising regularly, or testing out “alternative” methods like acupuncture, Reiki, or massage. Here in Rhode Island, where the state approves the use of medical marijuana, that may also mean visiting Compassion Centers to utilize this substance.

But what exactly IS medical marijuana? How is it regulated? And is it actually a valid form of treatment for mental and physical disorders? Well, these are exactly the same questions I hoped to answer for myself when I attended a training recently held by the Substance Use and Mental Health Leadership Council of Rhode Island. Because, I’ll be honest, I have clients who sometimes express interest in medical marijuana; I admit that I don’t know much about it; And I only think it’s fair as practitioners that we educate ourselves about any treatment our clients may pursue, regardless of personal opinions.

Before getting into the nitty-gritty of medical marijuana, I would like to attest that I am neither FOR or AGAINST, medical marijuana at this time, and the purpose of this post is not to take a stance on this topic. Rather, my goal here is to share with others the information I recently obtained so that clients, counselors, and the general public can use this to make a more-informed decision about their personal beliefs on this topic.

SO without further adieu, what exactly is medical  marijuana? Medical marijuana is marijuana that is prescribed to treat physical and mental health issues.  Proponents of medical marijuana argue that is a medicine just like any other, that is not addictive, can be a source of tax revenue for local governments, and will reduce the amount of people in prison for marijuana-related offenses. Proponents also argue that marijuana does not contribute to cancer or mental illness. It can be taken in multiple forms: by smoking, by vaporizing, or by ingesting it in form of edibles.

  • Does the form in which you ingest medical marijuana matter? Yes. Different forms of medical marijuana are metabolized differently by the body.  For example, smoking marijuana creates a fast-acting, short-term high (most people will feel the peak effects 5-10minutes after use), while edible marijuana takes longer to be processed by the body, but then also results in a longer duration of high.  Due to a delayed onset of effects, it is not uncommon for uninformed users of this form to over-take medical marijuana in edible form. In fact, a 19-year old in Colorado, died after consuming a marijuana edible that contained 6-servings of THC (the active ingredient in marijuana) and jumping from a building.

What can medical marijuana be used for? And does it work? This is an issue on which medical providers and medical marijuana advocates are divided.  Proponents of medical marijuana argue that it can treat a variety of concerns, while medical providers and researchers argue that more research studies are needed to determine claims made by marijuana advocates. One of the major criticisms against medical marijuana is that the quality of the research studies are not significant enough to broadly market the claims that medical marijuana can be used as effective treatment. Of the research studies conducted, there has been substantial evidence that medical marijuana may be an effective treatment for chronic pain, to fight chemo-induced nausea and vomiting, and for improving patient-reported multiple sclerosis symptoms. There is also limited evidence that it may be effective for increasing appetite in HIV patients, decreasing social anxiety, and decreasing PTSD symptoms (limited evidence means there are some indicators that these claims may be true, but that the research is not conclusive enough to make definitive claims on this subject).

  • So, even if there is limited evidence that medical marijuana may be effective, isn’t that enough to give it a try? Why are people pushing back against a potentially helpful form of treatment? This is an issue many people feel strongly about.  Some are clearly pro medical marijuana, some are firmly against, and others stand more in the middle.  For those who find themselves in the middle ground, they argue that prescribers and users of medical marijuana need to be better regulated, that more research needs to be done on the effectiveness, and that people need to be better educated on the risks & benefits of medical marijuana use so that they can make more-informed decisions.  One example provided in my training was prescribing Oxycodone to an elderly woman for chronic pain.  In this instance, the patient would be prescribed a clear dose, would be educated about the potential side-effects of the medication, would learn the warning-signs for addiction to the medication, and would be given clear instructions on when and how to take the medication and safety factors to consider (for example: how many medications have labels that read “do not take before driving,” or “do not take when operating heavy machinery.”)  Medical marijuana is not currently regulated at this same level.  Thus, it makes it harder, some people argue, to appropriately and safely prescribe it as a medication.

If there are risks, what are they? According to the training I attended, the short-term effects of marijuana include impaired short-term memory, impaired coordination and balance, and impaired attention and judgement. These effects are normally only present during the time of use, but could place people at increased risk for accidents, injury, or poor decision-making. It can also negatively impact learning skills, though people believe these will start to repair themselves over time if a person stops using the substance. In the long-term, regular marijuana use can lead to addiction, bronchitis, emphysema, and increased risk for head, neck, and lung cancer. It can also decrease immune function, which could be dangerous for people on immunosuppressant drugs, and decreases sperm count and concentration in men. For a more detailed discussion on the health effects of marijuana, you can visit the New England Journal of Medicine and read their blog post on the research article Adverse Health Effects of Marijuana Use.

  • One last question: is marijuana addictive? Proponents of medical marijuana will say “no,” but research conducted in the article mentioned above argue otherwise.  According to the study, conducted by Nora Volkow, Ruben Baler, Wilson Compton and Susan Weiss, approximately 9% of people who use marijuana become addicted.  This is not as high as for alcohol (about 30% of people who use alcohol will become addicted) or heroin (almost 25% of people), but still argues that a small percentage of people are vulnerable to addiction for this substance and thus should be educated on this risk.  Also, about 80% of medical marijuana users were previous recreational users of the drug, indicating that there may be a group of people who pursue medical marijuana not for its potential medical benefits, but for the desired side-effects associated with the high.

What now? Hopefully, I’ve highlighted that medical marijuana is a complicated issue, with people who firmly support both sides of the argument.  As mentioned previously, my goal is not to take a personal stance on this topic, but to provide useful information to providers, or people in the community, who are considering this as a potential treatment, so that they may make informed decisions. For more information on science-based marijuana education and awareness, consider visiting the website Smart Approaches to Marijuana (SAM).


Thai Yoga Massage as self-care and supplement to positive mental health

Recently, I treated myself to a Thai Yoga Massage at Santosha Yoga & Holistic Health Center in Cranston.  My reasons for exploring this modality were two-fold:

  1. As self-care, I’d heard through word-of-mouth that Thai Yoga Massage (TYM) was relaxing , increased mobility, and provided relief from chronic tension.
  2. As a holistic health practitioner, I am always looking for practices that improve mental health and well-being.  I believe that before anyone can recommend anything, however, one must try it firsthand.  This allows us as providers to share concrete and authentic feedback about experiences and expectations.

And so it was with this two-sided intention that I booked my first ever Thai Yoga Massage. First, for self-care, and second, for curiosity and as a possible recommended supplement to psychotherapy.  My massage was scheduled with Katherine Berrio, a Thai Body-worker, energy healer, and certified yoga instructor.

According to Santosha’s website, “Thai therapy is a relaxing, full-body treatment that includes both stretching of the joints and muscles and compression applied to the energy lines in the body. It’s the combination of touch and stretching that makes it so relaxing yet energizing.”  Contrary to other forms of massage, TYM is done lying down on the floor and fully clothed.

My session began lying on my belly, with the practitioner applying gentle pressure to the backs of my legs, back, and arms.  Occasionally, the practitioner used techniques that felt similar to “traditional” massage, while at other times she used what felt more like acupressure.  She also integrated meditation and active stretching – at times using her hands and feet to pull on  or massage my legs, arms, head, and neck, and even taking time to rotate my joints in their sockets.

As I lay on my mat allowing the practitioner to conduct her work, I couldn’t help but reflect on everything I have come to learn as a psychotherapist, yoga practitioner, and general lover of all things neuroscience.  Early on in my career, while studying communications, I learned that people have three different learning styles: auditory, visual, and kinesthetic.  Lying there, as the practitioner attempted to manipulate the muscles of my legs, I contemplated the value of this type of work for those of us who identify as kinesthetic learners, for whom no amount of talking will ever  help us fully connect the dots.  At one point, Katherine asked me to relax the muscles in my legs.  I tried, but they didn’t respond.  “Let the muscular tension go,” she said.  I told her, intellectually, I knew exactly what she was requesting, but for some reason my body was failing to listen.  I had been running around all day, in nervous system overdrive, trying to get WAY too much done in too little time, and (not surprisingly) my body was having difficulty slowing down.  Also not surprising: my thoughts had been racing all day and I felt more emotionally escalated than normal.  It was only when the muscles of my body were finally able to release, when I allowed Katherine to take over and do her work, that my mental and emotional state began to shift.  This, I believe, provided a direct, concrete experience for my body to slow down, to turn over control, and to ease up on my anxieties.  As a kinesthetic-based learner myself, I can assure you that no amount of talk-therapy or visual presentation would ever allow me to understand (that it was time to slow down), more than the direct, felt experience of doing it within my body.

Another interesting point came to mind when Katherine began massaging my core and paying special attention to the area of my belly.  This is something I had definitely never experienced in “traditional” massage.  Again, my mind went to everything I’ve learned as a yoga and holistic practitioner.  “This is so awesome,” I thought to myself, as research has recently uncovered that we have a whole second nervous system in our gut (known as the “enteric” nervous system), and that as much as 95% of serotonin is found in the intestines.  In yoga, we often hear about the “squeeze & soak” effect – the idea that when we restrict blood flow temporarily to an area, it is flooded with nutrients upon releasing the pose.  The same concept came to mind as Katherine massaged my belly-bits, “aaw man, I am going to get so much serotonin release from this!”

As you can see, a Thai Yoga Massage is not exactly your typical massage.  Should you choose to investigate this modality, you should acquaint yourself with what to expect.  As with any form of bodywork, you should also research your body worker and communicate with them openly and honestly about your goals for treatment and any physical, mental, or emotional issues that may come up during treatment.  For some, bodywork can be triggering.  This doesn’t mean that bodywork is off-the-table, but it would be in the best interest of both client and practitioner if both parties felt adequately prepared.

In closing, I’ll share what my research has uncovered about the benefits of massage:

  • In an article published in 2012 in the Journal of Bodywork & Movement Therapy, Field, et al., found that yoga OR massage therapy (research participants were randomly assigned to yoga, massage therapy, or treatment as usual), resulted in a decrease in depression, anxiety, and leg/back pain in prenatally depressed women.
  • The Journal of Clinical Oncology published an article titled the Effectiveness of Aromatherapy Massage in the Management of Anxiety and Depression in Patients with Cancer: A Multicenter Randomized Controlled Trial.  This was the first large-scale research study of complementary therapy in conjunction with treatment-as-usual for cancer patients with clinical anxiety and depression.  Results showed that participants receiving aromatherapy massage showed a significant improvement in self-reported anxiety and depression for two weeks post-intervention (post-massage).  This indicates that massage is a valuable tool for helping relieve anxiety and depression, but that in order to reap the benefits, one must engage in the practice consistently (basically: one massage isn’t going to cure your depression or anxiety).
  • Cooke, et al. (2006) published a research study in the Journal of Clinical Nursing indicating that weekly 15-minute aromatherapy massages with music had a direct & immediate impact on stress levels of emergency care nurses, regardless of season (summer or winter).


For more information, or to book a Thai Yoga massage, visit the following resources in Rhode Island:



Guest post: How Yoga Helped Me Escape My Eating Disorder

I am excited to feature the following guest post about how one woman utilized her yoga practice to support her recovery from her eating disorder. If you have used yoga or Mindulness to support your own recovery from mental illness, life transition, or substance abuse and would like to share your story via guest blogging, please email me at nikolai@ompowermentpsych.com

How Yoga Helped Me Escape My Eating Disorder


Confession: I began doing yoga as a way to exercise behind my friend’s and family’s backs. After having been put on an exercise restriction in 2006 when I was first hospitalized for a dangerously low heart rate due to my eating disorder, my doctors and nutritionist told me exercise could not be a part of my life until I gained weight and was “more recovered”. So, although I had been joining gyms and exercising behind everyone’s backs since then (something I do NOT recommend and ultimately pulled me deeper into my disorder), when my friend invited me to a warm vinyasa class at a local studio, I happily accepted. “Yoga” and “going to the gym” give quite different impressions, don’t they? Initially I loved how I felt after each practice. I felt tired and sweaty and accomplished. However, the entire practice I was anxiously waiting for the next challenging pose–thinking they burned more calories than the “easier” poses which focused on breathing and flexibility. At the same time I was fixated on whatever I would be eating for dinner afterwards. Every tiny morsel of food, how the meal would look, taste, smell, and how I would eat it. I was anything but a mindful yogi.
As time went on I began to notice myself getting stuck in class, both in my head and with my physical progress. It was as if I hit a wall that seemed impossible to surpass. I could do the poses, and do them well, but not to my fullest expression and definitely not with the healthiest mindset. I found myself faced with my thoughts–unable to run or numb them in any way. Standing in warrior two, with only the sound of my breath and no other distractions, I was forced to choose either to listen to the negative, eating disorder driven thoughts, or to push that aside, fall into the posture, and focus on my breath.

I don’t remember a specific moment when my thoughts began to shift and my practice became less of a competition with myself and more of an acceptance of who I was. But it happened, and continues to happen. I do, however, remember going to an arm balance workshop after a night of eating and drinking more than usual and getting myself into an inversion that I never thought I would be capable of. When I came out of the pose I felt strong, confident, and invincible–three things that I hadn’t felt in a long time–if ever. It was at this point that I began focusing on fueling my body for each class which, over time, meant fueling my body always. There’s a quote in a book titled “Meditations from the Mat” in which Rolph Gates speaks about how yoga poses never end. He states “The reality is that the posture never ends, it just shifts from one form to the next, one lesson to the next, one opportunity to the next. We remain life’s student whether we are inhaling or exhaling, in a relationship or out of one, saving the world or looking for a temp job. The posture never ends.”

For me, this meant that any challenges I faced while standing in a posture on the mat never went away, and that how I took care of my body both mentally and physically was not isolated to yoga class itself but to all areas of my life. I began to focus on my breathing in class, and out. I began to focus on how each pose felt instead of how I thought I looked, which in turn allowed me to begin focusing on this in my daily life. When I found myself in an uncomfortable pose I was unable to run from the discomfort, and instead began to relax and embrace it. I learned how to let things go–to confront my fears, experience them, understand them, and ultimately let them go.

I began choosing healthier and more nourishing foods to fuel my body day to day. They often contained more calories than my usual perfectly portioned, low calorie snacks, but they made my body feel good–something that yoga taught me was okay to feel. I began eating bigger meals that filled me up and didn’t leave me longing for more. If I was tired I allowed myself to sit and relax instead of forcing myself to be active. I began to truly listen to my body, and treat it well.

As I began to fuel my body, give it rest, and allow it to tell me what it needed I also began to see my yoga practice improve. I was gaining muscle, flexibility, and courage. If I wanted to do a pose I became determined to do so. However, if I was unable to accomplish it due to whatever reason, I allowed myself to feel frustrated and then I simply took a deep breath and let it go.

Over time, as I stepped on my mat, I was able to stay present; to forget what I thought of my body and myself beforehand and focus on the here and now. My mat became my sanctuary, a place where I was no longer attached to my expectations of myself. Rolf gates states that “eventually, caught up in the beautiful work of being present for grace, we forget about ourselves, and through self-forgetting we find ourselves”. I definitely found myself on my mat, and continue to find myself every single time choose to practice.

For the past 10 years I have found myself stuck at not only a low weight but an unhealthy state of mind. I was in and out of recovery programs, sneaking behind my loved one’s backs, and always listening to the unhealthy voice. I was controlling, rigid, and extremely hard on myself. Yet, after almost two years of practicing yoga regularly I have come to realize that I have learned how to care for myself both physically and emotionally. I am now in a healthy weight range for the first time since I was 15 and I am kind to myself when I go against the rules that my eating disorder has set up for me. I can’t say that I am recovered, or that yoga was the sole reason for my big step towards recovery, but I can say that it contributed immensely to how I viewed myself, my body, and the world around me. Each pose may look like a normal pose to others, but to me it is more than that. It is proof that with proper care and nurturing, my body is capable of doing more than I ever dreamed possible.

The Mindful Way Through Depression

The Mindful Way Through Depression

Zindel Segal developed a style of Mindfulness-Based Cognitive Therapy to help people manage recovery from major depressive episodes. As he mentions in this talk, for most people depression is a chronic lifelong illness prone to flare-ups and periods of remission. However, some people seem to go longer between depressive episodes and Segal set out to discover why.

What he learned was that the emotion of sadness was a trigger for clinical depression. Sadness is a natural emotion that occurs for all of us. However, when people are clinically depressed they are more likely to experience sadness. This led to sadness being associated with depression. Thus, for some people feeling sad in general leaves them open to the recurrence of a major depressive episode.

Mindfulness-Based Cognitive Therapy taught people how to be mindful of their thoughts without attaching to them. It also was shown to increase activation in the present-moment pathway. This is significant because people who suffer from depression are known to have increased activation in the executive control network (the part of the brain responsible for judgment). Thus, having training in Mindfulness-Based Cognitive Therapy balanced activation between these two networks and provided people the opportunity to make more balanced evaluations about their emotions.

Mindfulness-Based Cognitive Therapy was also shown to be as effective as antidepressants.