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The Therapist’s Corner

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I’m often asked how someone can get rid of anxiety. The answer is simple: we can’t and nor should we try. Anxiety is normal. It helps to protect us, and can optimize our performance in a multitude of situations. Any driver has had this experience: you’re driving on the freeway and suddenly you notice the car next to you coming into your lane. Your heart beats faster; your breathing becomes more rapid. You react quickly, swerve out of the way, and hopefully drive off safely. Without some anxiety propelling you into action, the outcome of such a situation may be very different. There are many other, far less dramatic examples of how anxiety helps us, such as in taking a test, in a job interview, and in playing sports.

There is, of course, a tremendous difference between normal, healthy anxiety and that which warrants being defined as a disorder. While forty million adults are believed to suffer from anxiety disorders, children are by no means immune to it. In fact, the Anxiety Disorders Association of America notes on its website that anxiety disorders affect 1 in 8 children. Left untreated, anxiety disorders in children may contribute to substance abuse, social difficulties, and academic problems.

Kids may not always be able to put words to their feelings, and so as parents it is especially important to be mindful of signs which could indicate the presence of an anxiety related problem. These include: physical symptoms such as persistent headaches, stomach aches and fatigue, as well as concentration problems, avoiding school, shyness, social isolation, sleep disturbance, nightmares, crying spells, and bedwetting. In addition, behaviors such as tapping, nail biting, skin picking, pulling out of one’s own hair, counting and excessive hand-washing all can be signs that anxiety is causing problems.

For most kids these symptoms will be transient and often will go away on their own without any intervention. Just as for adults, however, there is reason for concern when the symptoms persist and begin interfering with normal functioning. In addition, it is important to know that anxiety disorders come in many different forms. These include: separation anxiety, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobias (i.e., social anxiety, fear of heights), and posttraumatic stress disorder. Identifying which may be present is often a complicated process and is best explored with a professional, such as the child’s pediatrician, or a mental health clinician.

As with many psychiatric problems, people with anxiety often experience considerable shame and may suffer in silence without sharing their fears with anyone. This is no different with children. Knowing the warning signs is an important step in identifying a problem before it becomes a more significant issue. Fortunately, anxiety disorders are generally quite treatable, whether through counseling, medication or a combination of the two.

— Scott M. Granet

Scott Granet, LCSW is a long-time resident of Redwood Shores, and is director of the OCD-BDD Clinic of Northern California in Redwood City. He would like to hear your suggestions for future columns, and can be reached at 650-599-3325 or .

The Therapist’s Corner

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On a wall in my office is a poster of John Lennon with the quote, “Life is what happens to you while you’re busy making other plans.” We all live with a relatively healthy sense of denial which keeps us from being overwhelmed by the tragic events which we know could occur at any moment. If we lived our lives consumed with fears of earthquakes, floods, hurricanes and terrorist attacks we would be too afraid to leave our homes. Yet, we also can’t ignore the possibility that disaster can strike at anytime and as such we should be as prepared for them as is reasonably possible. Since we live in earthquake country, most of us have come to appreciate the importance of having a family disaster plan, and a disaster preparedness kit.

Emotional responses to disasters will vary a great deal, though for most people their reactions will be well within what would be considered normal. Feeling a sense of shock or emotional numbing, some sadness and depression and even guilt are all normal. Anger, anxiety, panic, and irritability may also be present as may problems with concentration and physical symptoms such as headaches and stomach pains. Also, given that disasters often occur with little or no warning, it is very common to feel out of control with tremendous uncertainty about the future. Yes, a disaster preparedness kit is vital, but let’s not overlook the importance of preparing for the emotional challenges we will inevitably face as well.

While our reactions to disasters may differ, there are some very useful coping strategies which are beneficial for everyone. Perhaps most important is to accept that returning to normal life may take a while. When possible, however, it is still best to keep up with normal daily routines, and to make sure that you are eating properly, and keeping up with good sleep hygiene. Regular exercise and other activities such as meditation and yoga can also be very beneficial during a time of crisis. Resisting alcohol and drug use is also important as they can worsen an already difficult situation. Additionally, watching images of the disaster on TV and on the internet needs to be limited as well, especially for children. During the 9-11 terror attacks many people repeatedly watched the images of planes flying into the World Trade Center buildings. Some children believed that these were many different attacks while not understanding that they were actually repeated showings of the same event.

Perhaps our greatest resource during a disaster is the support we can give to each other. Keeping ourselves surrounded by family members and friends, and being a part of organizations such as religious and neighborhood groups is invaluable. Of course, professional counseling may also be important, especially if the above symptoms linger long after the crisis situation has ended.

— Scott M. Granet

Scott Granet, LCSW is a long-time resident of Redwood Shores, and is director of the OCD-BDD Clinic of Northern California in Redwood City. He would like to hear your suggestions for future columns, and can be reached at 650-599-3325 or .

The Therapist’s Corner

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We all know the feeling: you wake up, feel sluggish and have trouble getting ready to tackle the day. You’d rather just stay in bed, don’t really want to interact much with others and don’t have the energy you usually have. Basically, you feel kind of “blah.” Even so, you pull yourself together, go to work and have a decent enough day. The next day you’re back to your old self, and those other feelings are just a memory. While it’s an uncomfortable way to feel, in clinical terms it really isn’t depression. It’s normal to feel that way on occasion.

Given that the holiday season is upon us, it seemed like the right time to write an article on the subject of depression. This is a time of year many people look forward to with both excitement and trepidation. It’s also a time when some may experience heightened states of feeling depressed. There are several forms of depression to consider, such as that which occurs in the context of bipolar disorder (formerly called manic-depression), and dysthymia, which is a less severe, though fairly chronic condition that generally waxes and wanes for years. Additionally, post-partum depression is one that occurs in some women following childbirth, and seasonal affective disorder (SAD) has its onset during the winter months when there is less natural sunlight.

Major depression, however, is probably the form most people think of when the term depression is used. The diagnosis is not made unless someone experiences five or more of the following symptoms for at least a two week period: depressed mood, sleep and appetite disturbance, poor concentration, inability to derive pleasure, low energy, agitation, feelings of worthlessness and thoughts of death/suicide. Typically, major depression will also have an impact on important areas of functioning, such as with work and relationships. This is by no means a rare condition. The National Institute of Mental Health estimates that major depressive disorder affects approximately 14.8 million American adults and is the leading cause of disability for people ages 15-44.

So what can you do if you or a loved one suffers from depression? The combination of anti-depressant medication and psychotherapy is generally the best approach. There are, however, many forms of each, and so a good place to start may be to consult with your primary physician as they generally have a lot of experience with depression.

One final note about thoughts of suicide: always take them seriously. When someone is feeling such hopelessness and despair it’s not unusual for suicidal thoughts to surface. It is at those times that loved ones have to intervene. Taking the person to their physician or to an emergency room may be necessary and even calling the police is an option if you believe there is imminent risk and the individual is not cooperating in seeking help. While it’s often an uncomfortable topic to discuss openly, the consequences of not doing so can be much, much worse.

— Scott M. Granet

Scott  Granet, LCSW is a long-time resident of Redwood Shores, and is director of the OCD-BDD Clinic of Northern California in Redwood City. He would like to hear your suggestions for future columns, and can be reached at 650-599-3325 or .

The Therapist’s Corner

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The middle and high school years produce challenges unlike any other time of life. How many times have your daughter or your son come to you with questions such as “do you think I’m fat?” or “is this pimple on my face noticeable?” How we answer those questions is not a simple matter. They’re growing. Their bodies are changing. And it’s all very normal. Adolescence is a unique period of our lives when many issues begin to surface. As their bodies experience significant changes, it is likely that most kids will develop at least some concerns about body image. While we can’t protect our children from this, we can have some influence over how they deal with it. A good place to start is by being careful not to make negative appearance related comments about others and ourselves. Such comments even made in jest may impact our kids much more than is realized at the time.

There’s no question that we live in a society which is obsessed with physical appearance.

It’s impossible to go to a magazine stand, watch TV or go to the movies without being inundated with images of people looking “perfect.” Make-over type reality shows have further complicated this, and can contribute to feelings of inadequacy and the desire to radically change appearance. While many adults certainly struggle with this too, most of us will eventually come to recognize that people come in all shapes and sizes, and that appearance is only one part of what defines us. Some children and teens, however, may have a very different perspective and believe that part of being happy includes pursuing the perfect body. We need to be able to convey that we all have other, more important qualities. Being kind to others, a good student and a reliable friend are just a few traits which ultimately will provide more long term satisfaction in their lives.

It’s important to note that I’m referring to the normal worries that kids will have during a time of life which is often tumultuous. Of course, closer attention to the issue is vital if the child develops obvious medical issues (i.e., obesity and severe acne), psychological problems such as anorexia and bulimia, or if social and academic problems begin to surface as a result of too much worry over body image. Body dysmorphic disorder is another, though lesser known body image related problem which results in people obsessing over a part of their body they believe to be flawed in some way even though they typically look very normal to others. These all can develop into very serious problems and generally will require intervention by a medical and/or mental health professional.

As the old saying goes: kids will be kids. Worrying about their body is normal as they get older. Keep the lines of communication open. Encouraging healthy discussion about it when their young can help tremendously in avoiding more serious problems later in their lives.

— Scott M. Granet, LCSW

— Scott is a long-time resident of Redwood Shores, and is director of the OCD-BDD Clinic of Northern California in Redwood City. He would like to hear your comments and suggestions for future columns and can be reached at

The Therapist’s Corner

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The middle and high school years produce challenges unlike any other time of life. How many times have your daughter or your son come to you with questions such as “do you think I’m fat?” or “is this pimple on my face noticeable?” How we answer those questions is not a simple matter. They’re growing. Their bodies are changing. And it’s all very normal. Adolescence is a unique period of our lives when many issues begin to surface. As their bodies experience significant changes, it is likely that most kids will develop at least some concerns about body image. While we can’t protect our children from this, we can have some influence over how they deal with it. A good place to start is by being careful not to make negative appearance related comments about others and ourselves. Such comments even made in jest may impact our kids much more than is realized at the time.

There’s no question that we live in a society which is obsessed with physical appearance.

It’s impossible to go to a magazine stand, watch TV or go to the movies without being inundated with images of people looking “perfect.” Make-over type reality shows have further complicated this, and can contribute to feelings of inadequacy and the desire to radically change appearance. While many adults certainly struggle with this too, most of us will eventually come to recognize that people come in all shapes and sizes, and that appearance is only one part of what defines us. Some children and teens, however, may have a very different perspective and believe that part of being happy includes pursuing the perfect body. We need to be able to convey that we all have other, more important qualities. Being kind to others, a good student and a reliable friend are just a few traits which ultimately will provide more long term satisfaction in their lives.

It’s important to note that I’m referring to the normal worries that kids will have during a time of life which is often tumultuous. Of course, closer attention to the issue is vital if the child develops obvious medical issues (i.e., obesity and severe acne), psychological problems such as anorexia and bulimia, or if social and academic problems begin to surface as a result of too much worry over body image. Body dysmorphic disorder is another, though lesser known body image related problem which results in people obsessing over a part of their body they believe to be flawed in some way even though they typically look very normal to others. These all can develop into very serious problems and generally will require intervention by a medical and/or mental health professional.

As the old saying goes: kids will be kids. Worrying about their body is normal as they get older. Keep the lines of communication open. Encouraging healthy discussion about it when their young can help tremendously in avoiding more serious problems later in their lives.

— Scott M. Granet, LCSW

Scott is a long-time resident of Redwood Shores, and is director of the OCD-BDD Clinic of Northern California in Redwood City. He would like to hear your comments and suggestions for future columns and can be reached at

The Therapist’s Corner

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“Snakes. Why did it have to be snakes?” I’m sure many people remember this famous quote from the Raiders of the Lost Ark scene where Indiana Jones is faced with a pit full of snakes. Yes, even our brave hero Indy has a phobia. He’s not alone: according to the National Institute for Mental Health approximately 19.2 million Americans age 18 or over have one. Additionally, 15 million people suffer from social phobia, which is essentially a fear of social situations. It’s important to not overlook children as they too can develop a wide variety of phobias.

A fear of snakes is just one of many phobias which exist. Some of the best known are claustrophobia (enclosed places), arachnophobia (spiders) and acrophobia (heights). There are also many which most people haven’t heard of, such as coulrophobia (clowns) and emetophobia (vomiting). There is even a phobia called ephebiphobia, meaning a fear of teenagers! So what is a phobia and how do they develop? A phobia is generally defined as an excessive and irrational fear of a situation, object or activity. While the cause is unknown, it is believed that life experiences and genetics both probably play a major role in their development. For example, someone with a spider phobia may have been frightened by one crawling on him or her as a child. A family history of anxiety may also help explain why not everyone in those types of situations becomes phobic.

Fortunately, we usually don’t need to know much about the cause for phobias to be successfully treated. While cognitive therapy is very helpful in changing irrational beliefs, it isn’t likely to be enough if used alone. Since the single-most common coping strategy in dealing with phobias is avoidance, exposure therapy is a necessary part of the treatment. The essence of exposure therapy is for someone to gradually put themselves in increasingly more difficult circumstances, and stay in the situation long enough until the anxiety begins to dissipate. If someone with a fear of elevators uses the stairs all the time they’ll never get to the point of recognizing that there truly is little to fear. While using the elevator initially will often cause considerable anxiety, that anxiety is very likely to lesson thru repeated exposure exercises. Yes it can be frightening, though often not as hard as someone may anticipate.

It is important to add that not all phobias are worth working on. If you have a fear of snakes but never come in contact with them there isn’t much of a reason to seek therapy for it. Treatment, however, may be very important if you have a fear of flying and need to travel for business. Or, if you are Indiana Jones and need to confront your fear of snakes as you avert various crises around the globe.

— Scott M. Granet

Scott  Granet, LCSW is a long-time resident of Redwood Shores, and is director of the OCD-BDD Clinic of Northern California in Redwood City. He would like to hear your suggestions for future columns, and can be reached at 650-599-3325 or .

The Therapist’s Corner

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Bullying comes in many forms, from verbal threatening and teasing to name calling and spreading rumors to physical brutality. It’s also important to not overlook “cyber-bullying,” or bullying which is done electronically thru email, texting, instant messenger or on social networking sites such as Facebook and MySpace. One obstacle to providing help can be that some children may choose to keep it to themselves, whether it be because of the tremendous shame they may feel, or because of other factors such as fear of retaliation.

So, as parents how can we help? First, kids need to know this is not their fault. Secondly, we need to be aware of the signs which could indicate that a child is being victimized by bullies: depression, anxiety, aggressive behavior (i.e., fighting, talking back), academic problems, injuries, avoidance of certain activities ( i.e., recess/playgrounds/sports), decreased interest in going to school/certain classes, and frequent physical complaints such as headaches and stomach problems. There have also been reports of suicide attempts precipitated by bullying. Of course, these symptoms could be due to various other problems so one important initial intervention is simply to express your concern about what you’re observing.

If you discover that bullying is going on, then what?  One response to avoid is to encourage physical or verbal fighting back. This will likely only result in further problems, and encourage behavior which won’t serve our kids well as they grow into adults. One strategy to consider is to ignore the bully, and just not respond at all. Typically, a bully is looking for a reaction, and to have one just gives them what they want. Also, assertively telling the bully to stop his/her actions can help, though this may be hard. Many children don’t possess the skills to do this effectively, and may need coaching from their parents on the most effective ways to do so.

Encouraging your child to tell an adult (teacher, school counselor, principal, coach) can be a very important strategy, though many may find this in itself frightening. It may be useful to convey to kids that it takes courage to talk to adults about bullying, and that you are proud of them for doing so. Kids also need to know that there is a difference between tattling and reporting threatening behavior. Tattling is essentially trying to get someone in trouble for the sake of getting them in trouble, while reporting bullying is an attempt to stop hurtful behavior which should be unacceptable. While we all want our kids to learn to “stick up for themselves,” there are also times when parents will need to intervene directly with the appropriate authority figures themselves.

Bullying has been around forever, and so to say it can be stopped entirely would be foolish. But, as parents we can do our part by being proactive in preventing it from causing serious problems later in our children’s lives.

— Scott M. Granet, LCSW

— Mr. Granet is a long-time resident of Redwood Shores, and is director of the OCD-BDD Clinic of Northern California in Redwood City. He would like to hear your suggestions for future columns, and can be reached at 650-599-3325 or .