Tips from a Highly Sensitive Person
There is SO much energy whirling around us right now, and a lot of it is negative. That doesn’t mean the positive isn’t out there, but given the state of things right now, it may be harder to find. You may find yourself feeling drained or exhausted from all of the bad news or upset energy. This may be new for you or if you are highly sensitive, it may be more intense than usual but perhaps feels like business as usual.
As a highly sensitive person living in a world that is not, I have picked up some skills over the years to protect my energy and be selective around what I let in. I am noticing so many more people struggling with this than usual, so here are things to try that help me.
You know that gut-punching, heart-sinking “unh” sensation you have been feeling? It may be
Ambiguous Loss. Pauline Boss coined the term for this loss without the promise of anything that looks like resolution, loss without certainty. After listening to a podcast interview of Dr. Boss by Krista Tippett, I knew that was the “unh” I had been feeling.
Military Sexual Trauma or “MST” is all together too common. About one in four women seen at the VA report some form of military sexual trauma. While this does not include all women who have experienced MST, women are more likely to report this type of trauma. On the other hand, many men do not report MST; only 1 in 100 men disclose that they have experienced MST. Men tend to report less often as they are more likely to see MST as “hazing”, bullying, or physical abuse (https://www.sexualassault.army.mil/whatweknow_militarymen.aspx). Additionally, It is common for men feel too much shame to report sexual trauma feeling that it somehow makes them less of a man. That said, while women are at higher risk for MST, 40% of MST reports are made by men. So what exactly is Military Sexual Trauma?
Having lived the life of a military significant other for ten years, I know it can be challenging even in the best of times. Often times, by choosing to be with our veteran partner we are uprooted from our communities, our families, and our friends. Frequently, our careers are interrupted in some way whether due to not being able to stay with a company or agency long enough to gain seniority and related benefits, having a lower income due to living in areas that don’t pay well, or perhaps not being able to get a job in our field. If we have children, they are raised away from family and go through many transitions in their little lifetimes. And for those active duty spouses, we may be moved often and have to reintegrate into a new community, a new way of life in some ways, every few years. That’s not to say there aren’t benefits to being with our military partner. It’s just to honor that there are unique challenges that we face in doing so.
In the past 21 years since I entered the field, a lot has changed in how we identify, understand, and help people heal trauma. Thankfully, research over the past thirty plus years has helped us shift our knowledge base and thus inspired newer body-based (somatic) therapies to fully address the way that trauma shows up in the body.
Whether or not you have read more recent books on trauma such as Bessel van der Kolk’s “The Body Keeps the Score”, Judith Herman’s “Trauma and Recovery”, Peter Levine’s “Waking the Tiger”, or Pat Oden’s “Trauma and the Body”, just considering the titles gives us the idea that perhaps the body is involved in trauma and how trauma impacts us. That idea is not only correct, but also what has shifted us to understand the need for trauma therapies that involve the body. Knowing this, we have come to understand that to heal trauma, the body must be involved. What follows is a peek into some of these treatment options. It is not meant to be an exhaustive list or prescriptive in any way, but just a way to share what may be available to you. I have also shared some adjunctive treatments to trauma therapy as they can greatly assist in the healing process.
What does it mean to have “trauma”?
Before we get into some of the integrative treatment options for healing trauma, let’s clarify what we mean by trauma. In the 5th Edition of the Diagnostic and Statistical Manual (DSM5), what is used by many clinicians for diagnosis of psychological disorders, traumatic events are those we have experienced or witnessed in which we were exposed to actual or threatened death, serious injury, and/or sexual violence. Under certain circumstances, this can include learning about a traumatic event happening to a close family member or close fired or “experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., can happen with therapists, first responders, police officers, and others).
The tough part is, for some who grew up in unstable family situations a disappointing look filled with shame from a parent could be experienced as trauma; a child experiencing this could fear abandonment or being harmed in some way, or something else potentially life threatening. So in some ways, trauma is in the eye of the beholder. This doesn’t mean that everything that upsets us or that we don’t like is trauma. It is just important to understand that trauma doesn’t have to be being raped, beaten, blown up or shot at, or other experiences like those. In trauma therapy, we refer to those trauma experiences as “big T” traumas - essentially traumatic events that almost everyone and anyone would see as traumatic. “Little t” traumas are still traumatic. They just tend to be more individualized based on the circumstances, as in the case with the aforementioned disappointing and shaming look.
Note that while we may have a history of trauma, we may or may not meet criteria for Post-Traumatic Stress Disorder (PTSD). That doesn’t mean your trauma doesn’t impact you and that you don’t need treatment. It just means that at the time of being assessed, your symptoms do not align with what we now consider to be PTSD.
Now that we have an idea of what trauma is, let’s take a look at some integrative therapies.
Eye Movement Desensitization and Reprocessing Therapy (EMDR Therapy)
EMDR Therapy is a well researched and effective treatment for trauma that can also be used for some other presenting issues such as anxiety, stress, anger, shame, and many others. It assists your brain's natural ability to process information and heal from trauma, particularly when your natural healing process has been interrupted or turned off. Developed in 1987 by Francine Shapiro, EMDR Therapy has been well researched since that time. It has been accepted as a treatment for PTSD by the American Psychological Association and the American Psychiatric Association as well as the Department of Defense and the Department of Veteran's Affairs. It is important to note that EMDR Therapy is a client driven therapy. That is, if we decide EMDR Therapy is appropriate for you we will work together to honor your pace and therapeutic needs.
We begin EMDR Therapy by working on stabilization skills and resourcing to prepare for the trauma reprocessing phase of treatment, a phase of treatment that can be quite intense. Once you and your EMDR therapist agree that your system has stabilized enough to tolerate the trauma reprocessing phase, you will work methodically through your trauma memories as related to your current symptom picture.
For more information about EMDR Therapy click here or go to https://www.emdria.org.
Internal Family Systems (IFS)
Internal Family Systems (IFS), sometimes referred to as "parts work", honors the fullness of who we are recognizing that at our core, our Self-energy helps us navigate the world with compassion, curiosity, clarity, confidence, courage, creativity, connection, and from a place of calm. However, sometimes extreme events such as trauma can interfere with our ability to connect with our inner wholeness. IFS helps us heal so we can reconnect with our ability to live and lead from a grounded, connected place.
For more information on IFS click here or go to https://ifs-institute.com.
Sensorimotor Psychotherapy ®
Sensorimotor Psychotherapy is a method developed by Pat Ogden for processing traumatic memory from a body-based orientation. It integrates sensorimotor processing with cognitive and emotional processing to holistically address all parts of the system impacted by trauma. It joins somatic therapy and psychotherapy into a comprehensive method for healing the disconnection between body and mind that often occurs with trauma. Ogden identifies as particularly helpful with dissociation, emotional reactivity or flat affect (i.e., numbed out), frozen states or hyperarousal and other PTSD symptoms.
For more information about Sensorimotor Processing Therapy click here or go to https://www.sensorimotorpsychotherapy.org.
Somatic Experiencing® (SE)
Somatic Experiencing (SE) is a body-oriented approach to healing trauma and other stress related disorders. SE was developed by Peter LeVine over the course of his career studying stress physiology, psychology, ethology, biology, neuroscience, indigenous healing practices, and medical biophysics. He reports 45 years of successful clinical application with this approach. SE’s approach is one of freeing the nervous system from being stuck in the fight, flight, or freeze responses through movement.
For more information about Somatic Experiencing click here or go to https://traumahealing.org/about-us/.
ADJUNCTIVE TREATMENTS TO TRAUMA THERAPY
Trauma Center Trauma Sensitive Yoga (TCTSY)
Trauma Center Trauma Sensitive Yoga (TCTSY) is a SAMHSA Approved, evidence-based protocol for treating PTSD and complex trauma developed by leading researchers in the field of trauma and psychology. TCTSY is based on clinical trials performed at the Trauma Center at JRI in Brookline, Massachusetts by psychiatrist and leading trauma researcher Dr. Bessel van der Kolk and yoga teacher David Emerson.
TCTSY is a somatic (body-based) modality that has been proven as an effective adjunctive treatment for psychological trauma. The intent of it is to engage the neural networks in the brain impacted by trauma. TCTSY is an opportunity for you to be in complete control of your body in the present moment. You are welcome to make choices and notice feelings in your body in a way that feels useful to you. Through the process of interoception, feeling and moving the body, we can reconnect the damaged neural networks. Interoception is a learn-able skill we can practice together!
Additional potential benefits include:
The Safe and Sound Protocol (SSP)
The Safe and Sound Protocol is a five-day auditory intervention that has been shown to address anxiety and trauma related stressors as well as inattention, stressors impacting social engagement, social emotional difficulties, and auditory sensitivities.
The Safe and Sound Protocol (SSP) was developed by Stephen Porges as a way to calm one's physiological and emotional states. In doing so we can reduce stress and enhance social engagement and resilience through increasing vagal tone. In turn, this can improve communication and lead to more successful therapy.
The SSP is best used as an adjunctive to psychotherapy, as it helps enhance the process of psychotherapy and related treatments. It can be useful to engage in this protocol prior to trauma work to help enhance trauma therapies.
For more information about the SSP, click here.
If you are experiencing challenges in your life from trauma, I encourage you to connect with a trauma therapist who offers one or more of the above treatments. You don't have to suffer in pain; there is help.
We’ve likely all experienced it at one time or another. Something happens, and our mind goes to the worst possible thing. Our partner is crabby and we wonder what we did wrong. A friend doesn’t return a text. Our boss says s/he wants to see us in her/his office. How do we deal with this catastrophic thinking?
There is no one right way. Today I am sharing one thing I have found that works for me and has worked for the clients with whom I work.
(2) Identify the Belief
Here you are just identifying the underlying belief about yourself or the world that you stepped into after the incident, event, or trigger happened. It sounds like this: “When my boss asks me to see her/him in her/his office, I believe I am in trouble and have done something wrong.”
(3) Is it true?
Ask yourself, is it true that every time you go to your boss’s office you are in trouble? If no, skip to step (5). If yes, go to step (4).
(4) Is it absolutely true, 100% of the time?
Ask yourself, is it true 100% of the time, that every single time in the history of your working life that when you have gone into a boss’s office you are in trouble. (I’m guessing the honest answer to this is “no”.)
(5) How do you feel when you believe it?
Ask yourself, how do you feel when you believe the above belief. My guess is some variation of “crappy”.
(6) List Evidence
Look for the evidence that your above belief isn’t true. So in the above example, think of/list off times when you have gone to your boss’s office for something other than being in trouble. Perhaps think of alternative explanations as well (e.g., times when you have gone into your boss’s office for positive things, something positive or neutral that could be behind the reason for the request). Sometimes we need help with this step, so feel free to ask safe-enough loved ones for their ideas; select someone who can help you find evidence contrary to your belief rather than fueling it and preferably someone who won’t invalidate your concerns and feelings.
Know that the above strategy is a practice; it may take trying it out a few times (maybe LOTS of times) to get the hang of it and to notice a shift in your thoughts. That’s okay. Just keep practicing.
A note on complex trauma: If you have a history of complex trauma and are bumping into long held beliefs related to past traumatic experiences, know that this can be a start or something to try. However, you may also benefit from work with a psychotherapist who specializes in complex trauma to help you resolve past trauma and release past limiting beliefs.
Having a daily routine is a great way to start the day; it helps us get grounded moving into our day in a more regulated way both so we can navigate the world with a greater sense of calm and enjoyment and be able to be more productive. During challenging times and times of uncertainty, a daily routine becomes essential to help us feel a sense of predictability and normalcy while also helping us feeling calmer.
Over the years, I have created a morning routine - not by doing all of these things at once, but through hearing the benefits of different things and trying them out one by one, identifying what worked for me and letting go of what didn’t. The morning routine I am about to share is the culmination of those efforts and basically everything that stuck.
In 2006 I read a study on the benefits of cultivating gratitude through keeping a gratitude journal, that is, writing down three things for which you are grateful every day. I read that it would help improve my overall mood and increase happiness, with the study citing it could happen in as little as 12 weeks! Being prior to my time as a yoga student and teacher, this sounded like complete BS to me. I decided to try it and find out if it would work for me.
Despite my lack of faith in this approach, sure enough, keeping a gratitude journal had a significantly positive impact on my life and how I looked at and navigated the world. At the time of this post, it is 14 years later and I haven’t missed a day! Since then, I have read a number of studies as well as Alex Korb’s neuroscientific research on gratitude journals, all of which show how (and more recently why) this works so well for improving mood. My observation is that part of why it works is that when we start, we write down the more obvious things for which we are grateful (for me, my loved ones including pets, my health, my education, and my yoga practice). But after a few days of writing the same things we start to observe more closely and notice the beauty around us. So why my gratitude journal still includes those more easy to notice pieces of my life, I also find myself grateful for small flowers I notice or today, the tiny buds on a tree near my house. If you haven’t done this or even if you have, this is a quick and relatively simple way to start your day.
Dump Your Mind Through Writing
In December 2019 I set an intention to work my way through “The Artist’s Way”. What stuck from that work was writing “Morning Pages” as a way to clear out the mind. Julia Cameron recommends we do this first thing in the morning and that we write three pages. I have found being relaxed about the number of pages makes it easier to get started. Starting with the intention of writing whatever comes up (also known as stream-of-consciousness) and just writing anything at all also releases any pressure that might prevent one from doing it. Some days I start with “I don't feel like f@*$ing writing today” and find I continue to write, while other days I’m okay with that being good enough.
Through my morning writing, I find I start the day calmer and with greater clarity as there is less stuff clouding my mind. At times it also slows the flow of thoughts in my morning meditation. Further, as Julia Cameron promises, it has helped increase my creativity both in more artistic pursuits but also in terms of day to day problem solving. One note, it is recommended you do not go back and read these pages or allow anyone else to; this isn’t the time to write your memoir, start your blog, or create your next book. Just allow yourself to write unfiltered and be sure to keep it in a safe spot.
Read Spiritual or Growth Inspiring Text
This is an idea I picked up from Greg McKeown’s book “Essentialism: The Disciplined Pursuit of Less” and have seen it mentioned other places. It is often recommended as a way to help us remember we are part of something bigger than ourselves, helping us connect with spirit or some form of inspiration each day. As a yoga practitioner and teacher, I take this time to read different yogic texts but you could read whatever resonates with you. On a good day I find this helps to remember connection to Spirit, honoring the beauty of the world; on tough days it gives me perspective allowing me to step back, reflect, and move through the challenges.
Candle Lighting with Prayers/Intentions
As I prepare for meditation, I light four candles on my meditation alter. Perhaps this little ritual is a remnant from my Catholic upbringing or just a way to mark the beginning of my seated practice. Either way, I find it as a lovely small piece of my day.
If you choose this practice, you are welcome to find what works for you. My approach came up organically and looks like this: As I light the first candle I say a short prayer for protection for myself; the second candle I light while saying the loving kindness prayer for myself (May I be happy, May I be healthy, May I be at peace, May I live with ease). As I light the third candle, I say the same protection prayer for everyone in the universe with the fourth being the loving kindness prayer for all Beings.
Common to relatively newer meditation practitioners, when I first started meditating I was upset and stressed about my busy thoughts and anxiety when I sat to meditate. In my request for something that would help calm my anxiety and thoughts even just a little when meditating, one of my earlier meditation teachers offered a breathing practice called nadi shodana or alternate nostril breathing. While I have learned to allow my thoughts, feelings, and body sensations to just be part of my meditation and something I notice, I still find benefit from practicing nadi shodana. Another option is to pause, noticing your breath and just being present with it. Further, there are many, many different breathing practices to try which in yoga we call pranayama, each with a different intention.
During a time of high anxiety in my life, a yoga therapist recommended I gather some rocks on a hike and meditate with them in a circle around me. I have found this practice incredibly grounding and helpful in my meditation practice.
The thing with meditation is it can be simple, but isn’t always easy. What often gets in the way is the expectations we place on ourselves about what meditation should look like whether it is a calm mind, having a certain metaphysical experience, feeling calm afterward, and/or how we think meditation should impact our life. If instead, we just decide to sit, perhaps simply noticing our breath, maybe listening to a guided meditation, or perhaps reciting a mantra, the practice happens. And it is just that - a practice. So perhaps just take a seat and breathe, noticing what unfolds.
One note on meditation and trauma, particularly complex trauma. Sometimes mindfulness and other meditations that invite you to notice your body sensations and experience can be too overwhelming or triggering. Details about this are out of the scope of this post; it is recommended that you honor your experience and if something is upsetting in a way that doesn’t feel like it is supporting growth, perhaps try something else or perhaps connect with a psychotherapist well-versed in trauma and meditation to help you.
Move Your Body
If we look at the anatomy of our bodies with our moveable joints and muscles, it is clear we are meant to move and that most of the time, we feel better when we move versus when we are sedentary. However, many people get caught up on what this movement needs to look like. In doing so, we place unrealistic expectations on ourselves or choose things that we think we “should” do but don’t enjoy.
What if instead, we shifted our focus to movement… to moving our bodies in ways that we enjoy. For some this could be walking or hiking or maybe dancing around the house as we do our chores. For others this could be biking to work or practicing yoga asana. For others it could be heading to the gym. So I invite you find a way you enjoy to move and try it, maybe just adding a little bit each day if you aren’t already in the habit of moving your body.
NOTE: Be sure to ask your doctor, particularly if you have health conditions, about adding movement to your life to make sure you are medically cleared for the movement you are choosing.
There is no right way to start out the day. What is clear, is that having some kind of morning routine can help us feel calmer, more grounded, and perhaps be more productive throughout our day. What is also clear is that if we try to start too many new things at once, it is too hard to give up the lifestyle we were used to having. So perhaps try going to bed fifteen minutes earlier tonight and getting up fifteen minutes earlier tomorrow, starting with one new thing for you way to start the day.
All of this is so surreal. As I was hiking today, I found myself curious about our current reality and how this could be happening. In so many ways, these are scary times and it can feel quite overwhelming, because the reality is, this is happening. Our fears, worries, loneliness, and grief are just as real as COVID-19 and they need our attention.
There is a lot of helpful information out there on how to approach this unprecedented global experience. As it comes across my newsfeed and email, I am finding myself struggling to track it all. Thus, my intention is not to add to the clutter, but creating a living document (see my COVID19 Resources Page) to be updated with this information in one place, for you, for me, for all.
There is no one “right” way to navigate these scary and challenging times with our mental health and wellness in tact (or at least not wildly out of control) and these are just some ideas, not an exhaustive list. My hope is you will sift through this post, take what seems to resonate and reflect on it further to tailor it to work for you, discarding what doesn’t fit.
Our nervous systems are rightfully dysregulated right now. With all that is happening, from the scary news stories to hoarding of resources giving the impression of scarcity, to people not taking this seriously, to physically isolating, this is a lot to take; it is hard for us to regulate into our Social Engagement System where we feel safe enough to connect or even just to be. (For a deeper look into regulating the nervous system, see my previous blog post on how our nervous system helps us and other post on regulating the nervous system). In addition to whatever was going on for us before, we are now faced with a new and quite significant stressor.
Why is regulating our nervous system important? First, if we can regulate our nervous system our bodies are better able to access the resource of our immune system to help keep us healthy which is crucial right now. Further, I find it helps if we can identify and understand our autonomic state, that is if we are in the “rest and digest” response of the Social Engagement system, our fight or flight response, or in shutdown/freeze; with that knowledge we can make efforts to shift back into a state of regulation, back into the ventral vagal response of our parasympathetic nervous system (more simply named the Social Engagement System), back to where we can rest, digest, learn, and connect and where our immune system is at its strongest.
Key to being able to regulate our nervous systems is the breath and often, the breath with slow, fluid movement. This could be a walk, yoga, Tai Chi, or some other movement in which you engage the breath. One of my favorite ways to help calm the nervous system that is easy to do almost anywhere is volcano breathing from Yoga Calm. To do this, place your palms together in front of your chest. As you inhale, extend your arms slowly up over your head with palms still together using the entire inhale to lift your arms. As you exhale, reach our arms out to the sides to make a big circle and having your hands meet back in front of your chest using the entire exhale to get there. Repeat several times.
Another essential piece of regulating our nervous systems is to limit our exposure to news and information about COVID-19. Yes, it is important to have enough information to protect yourself and your family. However, having the news on all day or checking news sources throughout the day can be overwhelming to even the calmest person. Thus, I highly recommend selecting just one or two reputable sources to stay informed enough to stay as safe and healthy as possible while also following local guidelines for physical distancing and staying at home. My suggestion is checking out either the CDC website or the World Health Organization (WHO) website and then checking your local government website (in Colorado, they have a specific page set up for COVID-19.
If you are choosing to watch news or information about COVID-19, or even if you aren’t, consider balancing this out with noticing some of the beautiful ways people are helping each other or finding some of the humor in life right now (the toilet paper thing is pretty funny - assuming you have some!). Have you seen how at hospital shift change in Atlanta, people stand out on their balconies and porches and cheer loudly? So lovely.
Sufficient sleep is essential both for coping effectively and reducing our anxiety and depression as well as for helping bolster our immune system. See my blog post on Tips for Better Sleep to help improve your sleep.
For most of us, our regular routines have been disrupted. Given that COVID-19 may be with us for a while, it is important to find a new daily routine or schedule to create some sense of normalcy. This can help us feel more centered or grounded at a time when there is so much uncertainty in the world; our routine is something we can often control to some degree.
Some grounding ideas for starting your day include journaling (I find this super helpful to just dump the mind by stream-of-consciousness writing every morning), cultivating gratitude through a gratitude journal or jar, reading something spiritual or inspiring daily (even could be a quote), working with the breath, or meditating (Insight Timer is a free app and has thousands of free guided meditations). Throughout the day to ground, feel your feet on the floor, practice 5-4-3-2-1 (notice 5 things you see, 4 things you feel to the touch, 3 things you hear, 2 things you smell, and 1 thing you taste), or notice things in your surroundings in other ways.
Stay Engaged, Stay Connected
Staying connected can be tough right now due to physical distancing and stay-at-home orders. Thankfully, many of us have access to the internet. Perhaps instead of texting, now is the time for phone calls and video chats or even video messages to our loved ones. Instead of dinner out with a friend, perhaps we video chat with a friend as we eat dinner separately but simultaneously.
At times, social media can be a nice way to connect and I am noticing using it too much can increase anxiety both through scrolling (even during non-crisis times I notice an increase in anxiety in my body when I scroll through my newsfeed) and by being exposed to COVID-19 related posts almost constantly. Thus, you may seek out additional ways to stay connected. Many faith communities have moved their offerings online as have yoga studios and other communities. We are likely going to be physically distancing from each other for quite some time. I highly recommend not also distancing socially but rather finding ways to stay connected from afar.
It is also helpful to stay engaged in some way. Maybe this means taking an online course you have wanted to take for a while, starting a new at-home hobby, learning a new language (I like the Duolingo app), doing some art, or perhaps trying yoga for the first time. There are so many opportunities for these types of activities and more. I will try to list different resources for this on my new COVID-19 Resource Page as I find them.
Move Your Body
Our bodies are made to move and staying at home can make this challenging. However, moving is not only essential for our physical health and well-being but also for our mental health as well. So whether you find workout videos on YouTube, subscribe to a service, dance in your kitchen, or do your own workout routine, find a way to move your body at least thirty minutes a day.
Take Care of Your Body
Crises like a global pandemic can often through our bodies off kilter. It is important to find ways to fuel our bodies with plenty of water and nutritious foods. One way to think about this is asking the question “how can I nourish my body today?”. This isn’t about restricting certain foods or following a special diet, but rather about connecting with how your body feels and helping nourish it.
Most of us are suddenly faced with a drastic increase in the amount of time we spend with the people in our homes. Whether this is roommates, partners, family, or someone else, we are likely not used to so much time together. Thus, it is essential that we still have some time apart. Whether we create certain times in the day that are quiet, alone times (as much as you can if you have kids), get out for a walk on our own (while physically distancing of course), or something else, we need to be able to have some personal space.
During times of struggle, finding ways big or small to help others can help both them and ourselves. Support local businesses. Check in on neighbors. Make cloth masks and donate them. Thank your grocery store workers. Check on elderly or immunocompromised neighbors. There are so many ways we can show up now and doing so will help us feel less alone and part of a community fighting this together.
There is so much we cannot control in all of this which can be scary. My hope is you have found some of these ideas helpful, perhaps as a way to shift your focus to things you can control. In times of challenge, I have found what gets me through it is often stepping back (as much as I can) and reflecting on what I am learning from this and how I can grow. It doesn’t make the pain less, but certain reduces the suffering and shifts my focus to my own locus of control. Remember this is temporary - it may be a longer term temporary than we are used to, but we will find our way through this. May you be healthy and well!
This blog is for information only. Reading this blog or interacting with it is not medical advice and does not constitute a therapeutic relationship. This blog is not a substitute for mental health care. Please be sure to seek out mental health care as needed.