Addiction and Mental Health

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Posts Tagged ‘Mental Health

Making Changes in Recovery, Step-by-step

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Making Changes in Recovery, Step-by-Step

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego;


Have you ever wanted to make changes in your life, but felt so overwhelmed by the situation that you didn’t know where to start?  Sometimes it helps to break the change down, working through the situation step by step using pencil and paper.  (A useful worksheet can be found at  First, think about why you want to make the change and then work through the steps you will need to get there. As you do this, you may find that the change you want to make really requires more than one significant change.

For example, let’s say you want to start exercising in the morning. As you work through the steps, you find that to do this, you will have to leave earlier in the morning, which means that you need to be more organized in the morning, which requires that you go to bed earlier, which means that you need to leave work earlier, which requires that you have lunch by noon.  Too many major changes means overwhelm!

Instead of becoming frustrated, break each of these steps into a different change plan, starting with the easiest change (such as having lunch earlier!)  By doing this, you will feel less overwhelmed, be more successful, and will feel better about your ability to make changes. With thoughtful forethought, you will be amazed at the changes you can make!

– Julie Myers, PsyD, MSCP


The Diagnosis of Bipolar II Disorder

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The Diagnosis of Bipolar II Disorder

By Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego

Bipolar II Disorder  is a mood disorder, characterized by shifting states between hypomania and depression. Diagnosing Bipolar II Disorder is particularly difficult, because those with this disorder often do not recognize their hypomanic episodes as being abnormal and so do not report their presence. They may also loathe to give-up these hypomanic states. Patients usually present for help during the depressive stage (Perugi, Ghaemi, & Akiskal, 2006), and when in a depressive state, patients may have difficulty remembering their hypomanic states, feeling that they have always felt low; insight is state-dependent. “Diagnosis may only be possible retrospectively utilizing histories from patients who have distorted recollections” (Stahl, 2005, p. 14.)  Because of these distorted recollections, it is important to have collaborating information from family members or close friends.  The hypomania, which the client so often enjoys, is often more problematic to those close to the patient than to the patient themselves and may lead to dysfunctional family interactions and stress.

It may be the patient’s unwillingness to disclose these hypomanic states and the stressful events that trigger them that often leads to misdiagnosis. As a case example, Mr. Smith symptoms of depression had become so severe that he was no longer able to function. From the age of 30, he was treated intermittently for depression, acquiring a long medication history from many different psychiatrists, even one of the leading authority in psychopharmacology in the world, but he continued to cycle in and out of depression. It was not until he was persuaded, at the age of 57, to bring a close friend in with him to treatment that he was finally given a diagnosis of Bipolar Disorder II and received adequate treatment. It was Mr. Smiths’ unwillingness to share his hypomanic states, which were generally triggered by stressful events, which kept him from receiving a diagnosis of Bipolar II Disorder.

When assessing anyone with repeated periods of depression, it is extremely important to carefully consider the possibility of Bipolar II Disorder.  By creating an open and safe environment for the client to recount his/her history, periods of mood instability and hypomania are more likely to be revealed to the therapist. Mood-charts, which detail lifetime events and mood events, are particularly beneficial for use with those who either do not recognize their own hypomanic states or who may be unwilling to address them. Once properly diagnosed, someone with Bipolar II Disorder can be helped to manage their hypomanic and depressive states with various therapeutic methods.

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbac  


Perugi, G., Ghaemi, N., & Akiskal, H. (2006). Diagnosis and clinical management approaches to bipolar depression, bipolar II and their comorbidities. In S. Hagop, & A. Tohen, Bipolar Psychopharmacotherapy: Caring for the Patient. John Wiley & Sons, Ltd.

Stahl, S. (2005). Diagnosis and treatment of bipolar spectrum disorders. NEI Psychopharmacology Academy 2-Day Series (pp. 37-54). United States: Neuroscience Education Institute.

Stress Relievers for Urge Control

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Stress Relievers for Urge Control

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego, California


Have you ever thought about how much stress triggers your using?   Stress (and the resulting anxiety or anger) drives people to seek relief.   For many people, such stress means searching out relief with drugs and/or alcohol.   But there are other ways to relieve stress!  Here are just a few:

  • Exercise.  Try a walk or even something with more exertion!
  • Slow, regular breathing
  • Call a friend and talk it out
  • Make a plan for how you’ll deal with stressful events
  • Develop coping statements to redirect yourself.
  • Soothing music

Try some of your own brainstorming, make a list, and keep it handy.    When a stressful event occurs, you’ll be glad to have a list of alternatives to using!

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbac