Ep 38 Understanding Anxiety, Overcoming Stigma: A Dialogue with Shobha George, LCSW
Dec 12, 2023
Martamaria Hamilton
Imagine what it would be like if accessing mental health care was as easy as making a phone call. Imagine too, the relief of finding effective help for anxiety that fits seamlessly into your daily life. This dream is the reality for clients of Shobha George, owner of Manas therapy, our guest for today, who brings 25 years of experience in the mental health field and a wealth of knowledge on how telehealth is breaking down barriers and combating stigma in mental health.
As the curtain lifts on mental health, we explore the shadowed contours of anxiety disorders, their symptoms, and prevalence. From the youngest child to the oldest adult, anxiety spares no one. Yet, stigma continues to discourage many from seeking help. Together with Shobha, we dissect this stigma, especially in private practice settings, and reveal strategies to combat it, such as creating a non-judgmental environment and supplementing therapy with exercise and mental health apps.
Shifting gears towards treatment, we delve into Cognitive Behavioral Therapy, often used in conjunction with medication, for handling anxiety disorders. We shed light on exposure therapy, a specific approach for phobias, panic disorders, and social anxiety, driving home the point that help is available and accessible. Finally, we navigate the tricky terrain of decision-making processes and how specialized clinicians can guide us. All throughout our wellness journey, our goal remains constant and clear – to break the stigma of mental health and raise awareness about available treatments. Join us, as we journey towards understanding, acceptance, and healing.
Hey there, future parents living in CALIFORNIA! Are you on the journey to conceive and looking for support and guidance along the way? Conceivable Psychotherapy is your trusted partner from conception through parenthood. Veronica Cardona, Licensed Clinical Social Worker, at Conceivable Psychotherapy, specializes in infertility, perinatal-postpartum struggles, and grief & loss. They offer online therapy throughout California. You don’t have to do this alone; Conceivable Psychotherapy is here to help you. Connect with Veronica through her TeleWellness Hub Profile: https://telewellnesshub.com/listing/veronica-cardona-lcsw/
Imagine what it would be like if accessing mental health care was as easy as making a phone call. Imagine too, the relief of finding effective help for anxiety that fits seamlessly into your daily life. This dream is the reality for clients of Shobha George, owner of Manas therapy, our guest for today, who brings 25 years of experience in the mental health field and a wealth of knowledge on how telehealth is breaking down barriers and combating stigma in mental health.
As the curtain lifts on mental health, we explore the shadowed contours of anxiety disorders, their symptoms, and prevalence. From the youngest child to the oldest adult, anxiety spares no one. Yet, stigma continues to discourage many from seeking help. Together with Shobha, we dissect this stigma, especially in private practice settings, and reveal strategies to combat it, such as creating a non-judgmental environment and supplementing therapy with exercise and mental health apps.
Shifting gears towards treatment, we delve into Cognitive Behavioral Therapy, often used in conjunction with medication, for handling anxiety disorders. We shed light on exposure therapy, a specific approach for phobias, panic disorders, and social anxiety, driving home the point that help is available and accessible. Finally, we navigate the tricky terrain of decision-making processes and how specialized clinicians can guide us. All throughout our wellness journey, our goal remains constant and clear – to break the stigma of mental health and raise awareness about available treatments. Join us, as we journey towards understanding, acceptance, and healing.
Hey there, future parents living in CALIFORNIA! Are you on the journey to conceive and looking for support and guidance along the way? Conceivable Psychotherapy is your trusted partner from conception through parenthood. Veronica Cardona, Licensed Clinical Social Worker, at Conceivable Psychotherapy, specializes in infertility, perinatal-postpartum struggles, and grief & loss. They offer online therapy throughout California. You don’t have to do this alone; Conceivable Psychotherapy is here to help you. Connect with Veronica through her TeleWellness Hub Profile: https://telewellnesshub.com/listing/veronica-cardona-lcsw/
Welcome back incredible listeners to another episode of the Telowana's Hub podcast. I'm Marta Hamilton, your host, and today we have a repeat guest, shobha George. Welcome to the episode.
Speaker 2:
Thank you, Marta. I'm so glad to be back here and I really enjoy speaking with you and then having this opportunity to share my experience with the listeners. I hope you're enjoying and finding this youth.
Speaker 1:
Yes, I think it will be Our last if you haven't checked it out. If you missed our previous conversation, I recommend you check that out from season one, if you're listening, because it's been a really popularly downloaded episode and we talked about. Well. First of all, I should mention that you're the owner of a practice called Lana's Therapy, correct, that is correct.
Speaker 2:
Yes, yes, you did Making sure you're pronouncing it Correct?
Speaker 1:
Yes, and we talked about OCD and teen mental health and consistently, before I hit record, I was sharing with her that that episode consistently has so many downloads every week, and I think I was so grateful to have a follow-up conversation because I think there's a lot of value in what you're able to share with our listeners. Today we're going to dive in into talking about the stigma of mental health in general. I think this is an important topic in trying to destigmatize mental health so that we can gain access to help. I think most people know someone or have experienced some type of mental health challenge, so I'm really grateful for the opportunity to have this conversation so we can break it down and just share some great insights. So thank you for coming back on. I want to just go ahead and dive in. For those who are maybe listening for the first time, can you share a little bit about your background and what you typically see as a clinician in your private practice?
Speaker 2:
My background largely is in mental health. I have over 25 years of experience. I did most of my schooling back home in India, in the southern part of India. So I bring a bit of a culture and experience. I would say that kind of built my cultural competency training part already. But to kind of set that into our culture here is very mixed and that comes through a lot.
Speaker 2:
And my clinical practice and as to who I am as a person, I kind of blend that into my practice. I think my clients do appreciate that and that's another way that I'm able to connect that connect with them also. So I'm very grateful for that. And I moved into private practice in the last three and a half years after having a kind of a career switch, I would say working with adults with chronic mental illnesses and in very large state hospitals. So the population that I serve now is kind of different from what I have been serving previously for about 19 and a half years. But I should say I enjoy both sets of populations. There's no difference in the way that I look at things and how I enjoy and how passionate about this area of health.
Speaker 1:
Wow, 25 years. I don't think I realize that. I'm sure you've seen an evolution then too, in terms of our approach to mental health. What have you noticed? I don't know if there's anything that we can think of that, just something that really stands out over the past 25 years, any kind of in terms of the evolution of the discussion of mental health or mental health treatment. Is there anything that you've seen or noticed?
Speaker 2:
What I have seen is actually, although we call this stigma around mental illness, there's a lot of stigma that perhaps have evolved and changed in a positive direction, especially in the last three years because of COVID, although we did not enjoy COVID as much, but that's one of the positive effects of COVID, I should say, and I've also seen some policy changes, which has added, kind of boosted the not just the services that has been amped up, but there was a lot of political backup for it and in that manner patients are able to access services much easier and they have more available hours, I would say, and I'm seeing a lot of insurance. They are able to provide the patients with no cap for services or no cap for number of sessions, even the public insurance that we provide. I am seeing a lot of changes there in a very good direction. So that's not so much of a barrier in the last three years that I have seen. So thank you to our president.
Speaker 1:
Yes, now, such a good point because I think we as clinicians and practice know that there can be barriers, are on our end too right in the past, being able to having to justify additional sessions with some insurances. And you're right. Thanks to telehealth, now we have more opportunity to reach more people. I saw a statistic the average and there are many areas throughout the United States where for every 150 people, there's only one mental health provider. So gaining access to providers maybe outside your city, you're said, go to who provide telehealth, such as yourself, right, because you're in all of what states do you practice in, you can take clients in all of what states.
Speaker 2:
I have two licenses my primary licenses in California. I also have a Massachusetts license. So you're absolutely right. It has taken a lot of barriers in that manner cross the lines and being able to open your services up to larger populations. Also, they don't have to come to an office location. It makes life much easier. You don't have to drive in time for it, or sometimes the time difference also helps both the provider and the patient.
Speaker 1:
You're so right. Yeah, just the time to take, sometimes take off of work and just find parking and driving. I'm sure you also have had sessions for anyone who's considering telehealth sessions, but not sure how you could factor it in. People have sessions in the privacy of their home while baby is napping in their car in their driveway not while they're driving, of course, but in their car in a closet, wherever they can at their workplace, in the private room. I think that creates a lot of opportunity there and I think, since we're touching on this topic of the stigma of mental health, I'm assuming that too creates ease in being able to have the conversations with other people. I've seen people saying you know, I'm going to meet with my therapist, so I need to block this hour, but I want to dive into for anyone who's listening and maybe it maybe feels that they have been maybe struggling with something like anxiety. Can you provide an overview of what anxiety is and how it can affect individuals' lives, both mentally and physically?
Speaker 2:
So, if I can define anxiety in the most simplest fashion, it's basically an emotion, just like a ton of other emotions that we all experience as human beings. Or I can describe it as a feeling tone. You know the state that you are in, what you're feeling at that moment in time or over an extended period of time. That is perhaps not helping you as much because it is a negative feeling tone in itself. And I also look at anxiety often as patients describe it or clients put in a name to it, as to how they have it in their, in their head, or based on how they experience.
Speaker 2:
Common terms that are used are I'm feeling on edge, or I feel tense, or I worry a lot, and we kind of worry goes around as a circle and or jitters butterflies in the stomach so these are very common terms or I worry too much before something even happens, maybe something that should happen in two days, I'm bringing that worry now and that is constant. So these are kind of common terminology that's used. I think that's the best I can describe anxiety.
Speaker 1:
No, that's wonderful. I think it sounds like you really meet your clients where they're at and I think that's so important that we can really recognize the language. I think anyone out there who's looking for a therapist I would say find yourself someone like Shoma, because you sometimes there. You can't exactly describe the clinical terms, but you know what your day to day life, what you feel like the jitters or wondering what's going to happen next, or worry, I think anxiety we know it's one of the most common mental health issues. What do you think are some of the most prevalent types of anxiety disorders? Because I think we as clinicians we know there are different, I guess, subsets of types of anxiety. Or you know, we know that there are things like phobias or OCD, but what are some of the most prevalent types of anxiety disorders and what are some of their key symptoms? Just for our listeners to have an awareness, knowledge, yeah, I should go with that Absolutely.
Speaker 2:
So I would kind of like to categorize I do that in the sessions also with my clients because it's very important for them to know it's just one, not one mood that I'm experiencing. There's a set of other symptoms that go along with it. So it's very easy for them to kind of categorize them as a set of mood symptoms, a set of thought symptoms and a set of bodily symptoms or slash some behaviors. So just like the mood that I describe, it's most of the time excess of worry or fear about things and I would put that under the mood category. But under thought symptoms there's a bunch of them also and one is anticipatory anxiety and anticipating. That's kind of in my thought that something's going to go totally wrong, when in in actuality or in the real world there's nothing going wrong. So it's a negative thought process. And again, just like I said, really what fear about? Something very specific, an object or a situation, and that's very specific to phobias. Maybe it's related to hides, animals or seeing blood. So very specific to that particular situation on an object. Also, fear or anxiety related to any type of danger. Danger that's posed me, it's real or it's out of proportion. Also, again, another thought symptom.
Speaker 2:
Another thought symptom that's very common in social anxiety or social phobia is possible scrutiny by others. You know I'm being judged by negatively by people when in when they are in a social circle, it's not really happening, but that's the negative perception about self, or I'm being negatively evaluated. I may be rejected by people around me or I may put myself in a situation that's embarrassing for me, or I may stumble upon words Again not really happening, but a negative thought symptom. Other symptoms relating to thought of fear of losing control I may go crazy Of, even to the extent that thoughts may go to the level that I may have, I may, they may have a fear of dying. So it's pretty, it's pretty serious.
Speaker 2:
And when I look at bodily symptoms, I think most clients will be able to associate this very much with panic attacks, because those are very common in panic attacks. How everyone goes through these physiological responses, but some may, and the common ones are palpitations, sweating, trembling, fear of choking, chest pain, chills or heat sensations, some feelings of derealization, again losing out of control, or depersonalization. I know that's a lot. So I think that helps people to kind of look at are these real or is this just me, or are the people are going through this or what? Let me. Let me check with someone who who has been in this area or seek professional help where, where is that fine line that makes someone decide? Maybe I'm not able to take care of it myself, so I hope that answers some part of your question. I'll go into some of the most common disorders. How landing?
Speaker 1:
Yes, no, that's very helpful because I think I feel like you're doing an amazing job bringing down the layers. Anxiety, so complex and it's so common. You mentioned just the, the language we might use on a day to day, but really kind of like peeling back those layers, we see that there are different, really specific, and it's to specific symptoms or specific thoughts, specific fears, specific experiences that we might feel physiologically, and it varies person to person. I'm wondering what are the age ranges that you see? Some of these come up because, I'm right, I know that everyone is different, but in your practice and your experience you have decades of experience what have you seen in terms of different age ranges and anxiety?
Speaker 2:
That's a bit of a challenging question to answer because some of the diagnosis are more common in certain age ranges. But just to give a context here, separation anxiety is not as common in adults because it comes through or a parent may be able to identify this when the kid is starting school. So I can say very early on, maybe the first few days of school, because the kids being separated for the first time from home and not every kid is responding the same way. So meaning we also do not want to pathologize everything that's happening. Maybe a parent has skills to kind of manage it. Then it doesn't hit a clinical level that needs attention. So it's hard to pinpoint an age range.
Speaker 2:
What I would say is, from my experience I have tweens and adolescents and adults and also some older adults. So that's not an age bar that I'm looking at. I would say all age ranges is what I would call it. But I also wanted to plug in some numbers here, especially for the US population 19.1% of adults this is US population numbers every year experience some form of anxiety disorders and 7% of children. So ages, I would say children, maybe 7 and up, but during the lifetime someone who's diagnosed with anxiety disorders is a bit higher. That's 33.7%. I would say that's the world population.
Speaker 1:
Yes, that's like 1 out of 3 and in the US then 1 out of 5 individuals. Yes, so it could be you or a loved one. When you see these people come into your clients, come into session or just in general, based on the research, when they start the therapy session, I know that for a lot of people there's stigma that presents them from even setting up that first appointment or seeking help for anxiety or mental health concerns. How can we work to reduce any stigma that may play a role in preventing people from seeking help? Because that's a big number, it's common. So what can we do? How can we reduce that stigma?
Speaker 2:
I think I would like to start from a little bit of what stigma looks like when it comes to a private practice setting and what I experienced from my side of the table. And in a lot of instances it's related to how society or culture or media are painting the picture and how this particular person is taking that in and kind of creating a self stigma. And sometimes it's related to some labels also that they kind of stuck with or they are having difficulty accepting a name of a diagnosis because it really does not sync well with me or does not gel well with me because this is a picture I have in mind or this is a picture my family has created or the society has painted for me. So I have seen that as a big barrier when, especially when the first couple sessions that I can see, it's hard for first of all, sometimes for them to come to the first intake session and open up or they're getting stuck with much or not much of a progress. There's a bit of stagnation there and a lot of times when someone's going through a period like that, they might Afterwards, when they, you know they warmed up with the sessions and and are able to open up and talk a bit more. They would say these are signs of more weakness or these show that I have less self control. That's, that's how I'm in a perceiving the things very differently. What, once I get to talk about it? You know they setting a better stage for to proceed with therapy. So I think that's that's a good starting point then.
Speaker 2:
So other ways that that in practice, that I have seen what has helped, you know, patients who are going through issues with stigma, or is created very safe, non-judgmental environment, you know, allowing them to speak up. You know what's in your mind, what's really bothering you and in a lot of instances, generalizing that others like you are in therapy and sometimes to the extent saying, yeah, this, this age range is a very common range range that I'm seeing in my private practice also. Or there are students like you who are attending, you know, therapy and it's not a bad thing and sometimes linking that up with how well they are doing after they started therapy and for them to also do a self evaluation, kind of connecting those thoughts help a lot. And I've also been very direct with some patients, letting them know if you need treatment. You do need treatment period and, yeah, sometimes that kind of breaks the ice and because they're not very sure, or they're, they're going back and forth whether to make a decision and I, you know I also have to say education about symptoms go a long way. Sometimes they are there in the dark, they're not sure.
Speaker 2:
Is this really what's going on with me and what's out there, and can I read out? So in multiple instances than not all the you know. Maybe some clinicians may disagree with me, but one of the homework that I assigned in the first few sessions Is why don't you Google and look up the common symptoms of anxiety or the common symptoms of depression in DSM five? And that's a same criteria that I am using to diagnose in my practice and because it's very transparent. There's no secret, secrets, secrets here. You can look up and see what symptoms do you associate with and is that something that you can start to open up and see I need to move forward with where I'm at now.
Speaker 1:
No, absolutely, I think. Being able to recognize, I think that sounds really empowering to be able to say, okay, do you, what do you, what do you see that relates to you, because then from there you can really identify. Okay, there's an option for help because therapy has been shown Numerous times to research to help. I wonder to what people come in and see you In your experience in practice, what have they tried before? Have you seen them Ever have? I'm assuming because the stigma sometimes maybe they try talking to a friend or powering through it. I've seen that in my experience when it comes to anxiety, people just trying to suppress it, ignore it, avoid it, which can make it so in many times, depending on what the anxiety is right, kind of reinforce fears if we're avoiding it. Have you ever seen any kind of? Just Everyone's path is different, but things when you see people finally kind of come in, is when they tried other things first.
Speaker 2:
Yeah, they do. I actually check in with them when I do my first assessment. What have you tried already? And, because we don't want to reinvent the wheel, you're doing something. Is that working? We could incorporate that in what you're going to build together as a treatment plan. And what I have to also say is I want to give a lot of food to this particular generation that is becoming much more aware than we we we think is the, the high school age range, the college age range of Students or you know what, coming in as clients, they have a much larger vision, they have a much larger understanding what we think about mental illness and they're supportive of each other and they're comfortable talking to their friends or even sharing. How did your therapy go today? So? So that's a you know that has been very helpful for them and has been helpful, helpful for me as well.
Speaker 1:
Yes, that's huge. That's a huge thing to be able to see that conversation about. How did your therapy appointment go in the lunch cafeteria of high schools? I think you're right. I've seen that in that generation. I I'm hopeful for what, how it can affect other generations to come and ones that came before as well. I definitely I second that. Kudos for sure. Yeah.
Speaker 2:
A couple of things I would add here. Martha is very, you know, it's very simple things, like people know, I need to go and exercise or I need to get some fresh air or get some vitamin D and go out in the sun a bit or even do some deep breathing very simple things, it doesn't cost you a penny. And also, something that I've seen moving in a very good direction is and this also comes with insurance coverage there are patients who are able to access apps that are free and comes with their insurance coverage and they go in and see what's in the app that I can use to calm myself down, and so people, you know, try those out and find benefits, and sometimes I keep them going to and, you know, as part of the treatment, because those are some things that they have already learned and kind of connected to say, yeah, if I'm trying this, I can bring my anxiety down to this level.
Speaker 1:
That's incredible that there's tools like that. I wasn't aware that insurance could cover some. Do you happen to know some of the apps that can sometimes be covered for people to kind of look into that?
Speaker 2:
Some is a very common app C-A-L-M, and also Applefulness has some. You know, if you don't want to buy a subscription, you know. You just need a basic, you know, basic way to keep track of your mood or your thoughts, or how did I respond? What triggered my mood? Some of the basic things are in the, you know, in a watch or on your phone.
Speaker 1:
That's wonderful. That's a great tip for people that everyone has access to. It seems like to some form of technology, so being able to utilize that for good and help with your mental health, that's a great suggestion. When it comes to another tool, I wonder too you know, as a mental health approach, as a mental health professional, what approaches or strategies do you find most effective in helping individuals cope with anxiety? Because I mean, it sounds like you have an amazing. You have an amazing rapport with your clients. You set up a really safe environment. You talk about what's helped them, what have they tried, what has helped or hasn't really helped educate them, have them also have an awareness of what's going on with them and in their own words and being able to confirm it through the DSM, and what do you find is most helpful when it comes to helping them with anxiety and how do you create a safe and non-judgmental environment for your clients?
Speaker 2:
So a couple of things that are very general, not just with anxiety, is creating a supportive environment for the particular individual. When I say that, that starts from the beginning of the session until the termination session, and sometimes it can get challenging to keep their motivation levels going, especially if they're not seeing anxiety levels coming down sooner than later. And that could depend on various factors. Maybe the anxiety has been a chronic condition that would have been given much attention to, or there's multiple symptoms, or the symptoms are of very high severity. So those two I would say I would plug in with every anxiety disorder. So can we apply it in all situations, all patients? And what I have also seen nowadays I don't think this is a surprise for most of the clinicians is some patients are choosing you because they are. They're looking at your profile to see anxiety disorders or depression, responds well with CBT. They already know what CBT is, the, which stands for cognitive behavioral therapy. So some more than I, when I, when I'm describing a treatment plan, the client is bringing with bringing a treatment plan to the table also, which is very helpful because they've sometimes looked it up or they have had some experience, maybe with the previous provider, what CBT is. So cognitive behavioral therapy, I would say, is the crux of the treatment that I use in anxiety disorders. It's a big umbrella and depending on what symptoms sets or disorders is being looked at. But CBT is is a main form of treatment and, combined with medications again depends on the symptom presentation, the chronicity and how intense the symptoms are and how the symptoms are affecting the daily lives. And the combination of a therapy and medication in those instances are are the best than one particular treatment mentality alone.
Speaker 2:
I also would like to mention there's very specific treatment I would be looking at, especially for phobias, panic disorders and social anxiety, and that relates to greater exposure. Yeah, this is exposing yourself to the, the fears that are challenging the first place, but doing that in a very systematic fashion, the. The intent, finally, is to positively reinforce your tolerance level for anxiety with repeated practice takes takes a bit, it needs a lot of patience from both the therapist and the providers and and to reach a level that your anxiety is finally extinguished. You know you kind of kill the anxiety there and it takes time, practice and courage. So that's one, an area that's kind of a you know very I can say it's very specific to those sets of diagnosis, and so I think that that's the best I can describe a treatment plan.
Speaker 1:
You know, I know it's not an easy task.
Speaker 2:
I don't know.
Speaker 1:
You did an amazing job. I don't think I could do that in you know, a short, short minute, because I know it's very individualized, right. Each person has different. But I think you know what you mentioned is so true that, because we have are having greater conversations and you can Google, you know what kind of really effective you know, you, can you know, you, can you know, you, can you know you methods based on research, right, what the evidence shows is helpful in helping you feel less anxiety and less intense, less often anxiety. Cet is definitely kind of the gold standard. I know it's an umbrella term, but it does show to be really effective.
Speaker 1:
So, if you're listening and you're one of the five or one of the three who has experienced anxiety or is experiencing some symptoms of anxiety that maybe you didn't even necessarily know was anxiety, you're on edge and, kind of as Shobha shared with us, you can feel better. There are proven treatment methods that professionals can guide you in. So I'm going to encourage anyone who's ever been on the fence of should I even seek help, or is this something I should follow up with? There are professionals who, like Shobha, has dedicated decades of their life in training and extensive follow up education In our field. We have to continue with education for the best practices for our clients and I'm going to encourage you to seek help. I think even this conversation we both have the intention to help break down the stigma. Even this podcast, right, is one of the intentions in creating this episode is just bring more awareness. So I encourage anybody who's an experienced you know mental health challenge to seek help or even contact Shobha. So I don't know what's the best way to get in contact with you.
Speaker 2:
They can email me at shobha G, as in George Alice, in Lama C, as in Kat SS and Sam W at gmailcom, and I also would like to offer a 15 minute free consult if they would like to decide him. I'm not, I'm not decided, but you know what helps me kind of go through this process and make a decision. So you know, please reach out.
Speaker 1:
Yes, if you're in California or Massachusetts and you would love to work with this season clinician who specializes in this, I definitely encourage you to reach out and thank you so much for joining us on our wellness journey and being a part of that today. Thank you, martha.
Speaker 2:
It was my pleasure and I'm hoping the listeners are getting some benefit out of this.