Recognizing the Signs When You're Under Too Much Stress

It might seem unusual to pose the question of how to know when you're under too much stress. After all, many people instantly recognize the symptoms and frequently complain about feeling frazzled.

However, as a licensed NYC psychotherapist with over 25 years of experience, I often see clients who are completely unaware of how severe their stress levels have become.

Chronic stress often hides behind a mask of daily busyness until our bodies force us to stop and rest

Why Don't People Realize They are Experiencing Chronic Stress?

People who have endured acute stress or developmental trauma during childhood often do not recognize when their adult stress levels are too high. Because they became accustomed to a baseline of survival and chaos early in life, an elevated stress response feels entirely "normal" to them.

They don't recognize it as an unhealthy or dangerous state. However, enduring acute stress on a long-term basis can have severe negative medical and psychological consequences. Chronic stress has a way of quietly creeping up on you, gradually wearing down your nervous system without you even realizing it.

The Physical Warning Signs of High Stress Levels

One of the most effective ways to identify an unhealthy level of chronic stress is to observe your somatic responses. When you are emotionally overwhelmed, your body will often send out warning signals before your mind consciously registers the anxiety.

• Sleep and Energy Disruptions: Experiencing persistent insomnia, frequent nightmares, feeling tired most of the time, and experiencing low energy even after resting.
• Tension and Physical Pain: Chronic muscle tension, shoulder and back pain, muscle spasms, a clenched jaw, and grinding your teeth at night (bruxism).
• Gastrointestinal and Cardiovascular Distress: An upset stomach, nausea, constipation, diarrhea, or flares of Irritable Bowel Syndrome (IBS). You may also notice a rapid heartbeat, high blood pressure, difficulty breathing, or chest pain.
• Nervous Habits: Fidgeting, pacing back and forth, nail-biting, dry mouth, difficulty swallowing, or cold, sweaty hands and feet.

• Changes in Intimacy: A noticeably low libido and sudden problems with sexual performance.

The Psychological and Emotional Symptoms of Overwhelm

When stress exhausts your cognitive and emotional reserves, it fundamentally alters how you think, feel, and interact with the world around you.

• Mood Dysregulation: Feeling persistently agitated, frustrated, moody, losing your temper easily, and snapping at loved ones.
• Cognitive Fatigue: Experiencing racing thoughts, persistent worrying, being exceptionally forgetful, and having severe problems focusing on daily tasks.
• Social Isolation: Finding it difficult to relax or quiet the mind, isolating and avoiding others, and feeling less pleasure in socializing or engaging in hobbies you once loved.
• Emotional Vulnerability: Feeling easily overwhelmed, hopeless, helpless, pessimistic, or experiencing a dip into low self-esteem and depression.
• Maladaptive Coping: Relying on or abusing alcohol or drugs to artificially numb the nervous system.

Note: Many of these physical and psychological signs can also involve underlying medical conditions. When in doubt, it is essential to check with your primary care medical doctor to rule out organic causes.

Holistic Lifestyle Changes for Sustainable Stress Management

If you are recognizing these warning signs in your own life, there are proactive lifestyle modifications you can implement immediately to regulate your nervous system.

To explore specific self-care and mindfulness tools, you can read my comprehensive guides on Stress Management: Taking Time For Self Care and Managing Your Stress: Workplace Burnout. 

Dedicating time to Self Reflection and Basic Mindfulness can help you reconnect with your body's signals before they turn into chronic pain.

When you feel an acute spike in anxiety, utilizing somatic techniques like Square Breathing can instantly soothe your nervous system. 

Additionally, examining the Mind-Body Connection: Can Yoga Improve Your Mood?.  

Also, using therapeutic tools like Journal Writing to Relieve Stress and Anxiety are proven strategies to release trapped emotional tension.

When to Seek Professional Psychotherapy in NYC

A certain amount of healthy stress is a natural part of living. However, if your medical doctor has ruled out underlying physical issues and you have tried making healthy lifestyle adjustments but still feel entirely consumed by overwhelm, you could benefit deeply from professional clinical support.

A skilled mental health professional can help you uncover the root causes of your stress response. If you are ready to explore your options, you can read my advice on The Benefits of Attending Psychotherapy and How to Choose a Psychotherapist. 

Embracing specialized therapeutic support can make all the difference in restoring your peace of mind and overall quality of life.

About Josephine Ferraro, LCSW

 I am a licensed New York City psychotherapist, hypnotherapist, and specialist in EMDR, AEDP, IFS, Emotionally Focused Therapy for Couples and Somatic Experiencing. 

With over 25 years of experience, I help individual adults and couples get to the root of chronic stress, anxiety, and trauma to restore long-term well-being.

I offer a complimentary 15 phone call before setting up an appointment.

Connect With Me:

• Website: Josephine Ferraro, LCSW - NYC Psychotherapist
• Phone: 📞 9177422624 (Tap to Call)
• Email: ✉️  josephineferraro@iCloud.com
• Location: Greenwich Village, New York 10011

Healing From Moral Injury

Moral injury is the profound psychological, social and spiritual distress that occurs when someone perpetrates, witnesses or fails to prevent acts that violate their deeply held moral beliefs and values.

Healing From Moral Injury

Moral injury was originally studied in military veterans returning from war. Now, it's seen as a widespread phenomenon affecting healthcare workers, first responders and everyday individuals.

The consequences of moral injury is that it has a negative impact on a person's conscience, shatters their sense of self worth and erodes their trust in institutions or leaders. 

What Are Core Causes of Moral Injury?

A moral injury is triggered by a Potentially Morally Injurious Event (PMIE) which usually break down into the following categories:

• Acts of Commission: Doing something that actively violates your moral code (e.g., a soldier either accidentally or following orders to harm civilians in a combat zone).

• Acts of Omission: Failing to act or prevent harm when your ethical compass dictates that you should (e.g., as a bystander you fail to stop an assault).

Healing From Moral Injury

• Betrayal: Witnessing individuals in authority or institutions act against what is moral and just, especially in high stakes situations (e.g., an executive ordering employees to hide serious defects in a product that can do harm to consumers).

• Bearing Witness: Observing atrocities, extreme cruelty or systemic injustices without the power to change the outcome (e.g., care workers or visiting relatives witness bed-bound residents suffering from severe bedsores, malnutrition and prolonged isolation due to corporate understaffing and regulatory failures).

What Are the Symptoms and Manifestations of Moral Injury?

When an individual's ethical boundaries are crossed or when they are placed in a situation where they violate their own moral beliefs and values, it alters their worldview.

Common symptoms include:

• Sustained Guilt and Shame: Feeling a persistent sense of remorse or believing "I am a bad person."

• Social Isolation: Withdrawing from loved ones, peers or community activities due to feeling unworthy or that they will "contaminate" others.

Healing From Moral Injury

• Loss of Trust: An inability to trust authority figures, organizational leadership or systems.

• An Existential or Spiritual Crisis: Questioning long-held religious or spiritual beliefs, faith n a higher power or the fundamental goodness of society.

• Anger and Disillusionment: Directing profound bitterness toward a system or the people that forced an impossible choice.

What is the Difference Between Moral Injury and Posttraumatic Stress Disorder (PTSD)?

While moral injury and PTSD often co-occur, they are distinct psychological concepts:

Whereas moral injury is primarily a guilt, shame and values-based condition, PTSD is a mental health condition after experiencing of witnessing a deeply traumatic, terrifying or ife-threanting event or ongoing events. 

Primary Triggers

• Moral Injury: Ethical transgressions or a betrayal of core values

• PTSD: A life threatening, psychological event (or series of events) that overwhelms an individual emotionally and psychologically

Core Emotions

• Moral Injury: Guilt, shame and deep remorse

• PTSD: Fear, horror, helplessness or panic

Biological Impact

• Moral Injury: Identity disintegration (i.e., a shattering of a person's core sense of self, moral identity and personal narrative)

• PTSD: hypervigilance, visual replay (e.g., visual replay, present-moment distortion, flashbacks, body memories and so on) and a heightened startle response

Clinical Status

• Moral Injury: Recognized as a moral problem and clinical focus, but not a separate diagnosis

• PTSD: A formal psychiatric diagnosis

What Are Current Examples of Moral Injury in Everyday Life?

There are many current examples including but not limited to:

• Healthcare Resource Triage: A doctor or nurse is forced to triage care by rationing ventilators or critical ICU bed during a pandemic which, effectively, determines which patients will live and which will die.

• Family and Caregiver Burnout: A family member caring for a relative with severe dementia becomes completely exhausted and places the relative in an understaffed nursing home. This results in a deep sense of abandonment.

• Navigating Marital Separation and Divorce: A parent files for divorce to escape an unhappy marriage, but they experience profound guilt over the emotional distress and disruption caused to their children.

How to Heal From Moral Injury

Since moral injury is a wound of the conscience rather than a fear-based disorder (like PTSD), conventional trauma treatment focused only on anxiety reduction might not be enough.  Recovery requires specialized multi-dimensional support including:

• Meaning Making: Processing the event to contextualize actions within a chaotic or impossible situation.

• Self Forgiveness: Moving away from persistent self punishment and developing self compassion.

Healing From Moral Injury

• Communal Recognition: Speaking the truth to a supportive group of peers who understand the unique pressures of the situation.

• Moral Repair: Engaging in altruistic actions, volunteerism or advocacy work to reaffirm personal values.

• Psychotherapy: Therapy helps to heal moral injury by providing a structured, nonjudgmental place to process guilt and shame, deconstruct impossible standards or responsibility and rebuild a functional moral identity.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS, EFT (for couples), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

 

Pets Can Improve Your Mental Health

Millions of people around the world consider their pets to be part of their family.  Not only are pets a source of unconditional love, they can also improve your mental health.

How Can Pets Improve Your Mental Health?

Pets can provide the following mental health benefits:

• Providing Comfort and Social Support: The mutual love between pets and their humans is a source of comfort for most people.  Pets and humans form a bond that helps each of them to feel less alone. 

Pets Can Improve Your Mental Health

• Providing Companionship: The comfort of having a pet can reduce loneliness and social isolation. In addition, taking care of a pet can help you to feel needed and loved.

• Helping to Relieve Stress and Anxiety: Many people who struggle with anxiety experience relief with their pet. Many pets are attuned to their human's stress and anxiety and they provide emotional support.

• Helping to Relieve Depression: The companionship of a pet can help to relieve depression.

• Reducing Work Stress: Pets have a way of building bridges in groups. In most work environments employees come together more easily when there is a pet in the office. Pets also help people to be more productive and reduce stress at work.

Pets Can Reduce Work Stress

• Improving Physical Health: People who have dogs get exercise when they walk them. Daily walks can help with cardiovascular health.

• Providing Structure and Routine: Pets need daily structure to thrive and so do humans. When you have a pet, you benefit from the daily structure as well.

Pets Can Improve Your Mental Health

• Helping to Meet New People: People who have pets, especially dogs, often meet new people in dog parks or on daily walks, so pets can be help to increase your social circle.

• Providing Sensory Stress Relief: Stroking a dog or a cat can help reduce your stress and help to reduce blood pressure. 

• Providing Help With Managing Emotions: Unconditional love from a pet can help people to manage their emotions when they come home from a stressful day and they are met by their loving pet at the door. This interaction can help people to transition from a difficult day to a loving home environment.

• Providing Meaning and Joy: Having a pet can provide meaning and joy, especially as you age and lose connection with loved ones who aren't around any more. A pet can increase your pleasure, give you a sense of meaning and purpose, and increase your sense of confidence and optimism.

Pets Are a Major Commitment

Before getting a pet, make sure you understand that it's a major commitment in terms of time and money.

You also have to be around most of the time to take care of a pet. For instance, if you travel a lot and you're not around, this can be lonely for a pet who doesn't understand where you are or if you're coming back.

You also need to make sure you're not allergic to certain pets.

Before you get a pet, make sure you have the right home environment. For instance, big dogs might not get the exercise they need in a small apartment.  In that case, having a cat might be better since they can thrive in cozy spaces.

Conclusion

Under the right circumstances, pets can help improve your overall health and mental health as well as bring you joy and comfort in many ways.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Imagine: Using Positive Imagination to Cope - Part 2

In my prior article, Imagine: Using Positive Imagination to Cope - Part 1, I began a discussion about using positive imagination and how it can be helpful during the COVID-19 crisis.  In today's article, I'm providing a clinical example to illustrate the benefits of positive imagination (see my article: Using Imagery as a Powerful Tool).

Imagine: Using Positive Imagination to Cope

Using Positive Imagination, including Imaginal Interweaves, as a Internal Resource
As I mentioned in my earlier article, Attached Focused EMDR therapy, which is a trauma therapy developed by Laurel Parnell, Ph.D., uses a form of positive imagination called "imaginal interweaves" when clients are blocked in terms of processing the trauma.

Imaginal interweaves function as an internal resource or coping technique (What Are Imaginal Interweaves?)

Although the example I'm giving is about psychological trauma, imaginal interweaves can be used whenever you need a way to calm yourself and help yourself to cope.

The Therapeutic Benefits of Imaginal Interweaves: A Clinical Vignette
The following clinical vignette, which is a composite of many different cases, illustrates the use of imaginal interweaves as a form of positive imagination:

Sandy
During 2003, when Sandy was living and working in Toronto, she and other people in her neighborhood, were forced to self quarantine during an outbreak of severe acute respiratory syndrome (SARS). Sandy had no symptoms of SARS, but she was obligated to follow government regulations to quarantine.

Not only was Sandy fearful of SARS, but since she lived alone and she wasn't allowed to see other people in person, she felt very isolated and lonely during that time.  Her only contact with family and friends in New York City was by phone, so her history of depression and generalized anxiety were exacerbated by the quarantine.

After she assessed to be healthy and she was able to return to New York City, Sandy believed that she would feel better.  But, even though she was able to be with family and friends, she couldn't understand why her depression and anxiety-related symptoms continued.  So, after a few months of struggling on her own, Sandy sought help from a psychotherapist in Manhattan.

During their initial consultation, her therapist explained how Sandy's social isolation and loneliness while she was in quarantine, as well as earlier traumatic experiences as a child, exacerbated Sandy's depression and anxiety (see my article: Coping With Loneliness and Social Isolation).

Her psychotherapist recommended that they use  EMDR therapy to deal with the trauma related to the quarantine as well as the earlier unresolved trauma (see my article: EMDR Therapy When Talk Therapy Isn't Enough).

She explained to Sandy that, as part of the preparation work to do EMDR therapy, she would help Sandy to develop internal resources and coping strategies that she would use either in session or between sessions.

During the preparation phase of EMDR therapy, Sandy's therapist talked to her about imaginal interweaves and how they could be helpful if Sandy got blocked in the EMDR processing and they needed to find a way to undo the block (i.e., being "blocked" means the client's emotion or thought creates an obstacle to continuing to do the work).

She explained to Sandy how powerful the imagination can be and that using imaginal interweaves engages the mind and the body so that Sandy experiences what she is imagining as if it were actually occurring.  She explained that, of course, Sandy would know that she was still using her imagination, but she would get the beneficial effects of the interweaves (see my article: Mind-Body Oriented Psychotherapy: Healing With New Symbolic Memories).

As part of the imaginal interweaves, Sandy's therapist asked her to choose three people who are either real or imaginary ("real" means someone that Sandy knew from any time in her life and "imaginary" means someone from a TV program, book, movie, and so on) for the qualities of:

• Nurturing
• Powerful
• Wise

The therapist acknowledged that these categories are intentionally vague and explained that Sandy should interpret nurturing, powerful and wise as whatever it meant to her.  So, for nurturing, Sandy chose her current best friend. For wise, she chose her godmother, who always gave Sandy good advice.  And, for powerful, Sandy couldn't think of anyone in her real life, so she chose a superhero, Wonder Woman.

After they completed the preparation phase of EMDR therapy, which also included learning a Relaxing Place meditation, they began processing Sandy's experience of being quarantined and how it was affecting her now.

As part of the work, they also did a process which is called a "Float Back" in EMDR and which is the same as an "Affect Bridge" in clinical hypnosis where the client goes back to the earliest time when she had the same emotions as in the current memory.

The Float Back is an important part of EMDR therapy because it gets to the earliest memory when the client had the same emotional experience (even if what happened in that memory was different).  The important part is that the client has a similar emotional experience.

So, for instance, if, as an adult, the client has an experience of feeling helpless and overwhelmed, the Float Back goes to the earliest experience of feeling the same way--even if the people and circumstances in the earlier memory were different.

Getting to these earlier memories enables the client and the therapist to see what earlier memories are being triggered by the present experience so that they don't continue to be triggered in other similar circumstances in the future.

At one point in the processing of the trauma using EMDR, Sandy became blocked and couldn't go any further in the trauma work.

Even though, logically, she knew she deserved to feel better, on an emotional level, a big part of her felt that she didn't deserve to feel better.

Sandy was surprised that she could experience such a contradiction between what she experienced logically and what she felt emotionally.

She also said that if someone else had told her this, she would be much more compassionate with that person than she was with herself.

This negative emotional response was so powerful that regular EMDR processing was blocked, so her therapist asked Sandy to imagine what her nurturing person, her best friend, would have said and done if she knew that Sandy felt this way.

In response, Sandy imagined her best friend being with her, and her therapist heightened that experience by having Sandy slow down so she could have a felt sense of her best friend's nurturing quality.

Sandy was able to take in what she imagined her best friend would say and do--that she cared about Sandy and she deserved to feel better.  She was able to feel her friend's compassion on a visceral level and, as a result, she felt much more self compassion).

The felt sense of her friend being compassionate and developing her own self compassion undid the block, and Sandy and her therapist were able to continue with EMDR processing.

Gradually, over time, Sandy and her therapist processed the present, past and anticipatory anxiety about the future.

Conclusion
The fictional vignette provided above focuses on how trauma therapy, specifically EMDR therapy, using imaginal interweaves, which is a form of positive imagination.

Using your imagination is a powerful tool--whether it's used during trauma therapy, like EMDR therapy, or you use it as your own individual coping strategy.

So, even if you're not in therapy, you can use imaginal interweaves on your own to cope with current problems.

Getting Help in Therapy
If you're feeling overwhelmed, you're not alone.

Rather than suffering on your own, you can seek help from a licensed psychotherapist.

Many therapists, including me, are providing online therapy, which is also called teletherapy, telemental health and telehealth (see my article: The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person).

By being proactive now, you can work through your problems and go on to live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I am currently providing online therapy during the COVID-19 crisis.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.