Dear GoodTherapy,

I had been seeing my therapist for 28 years. Around March, she was unwell. This was a rare occurrence in our time together. But her viral infection persisted until about six weeks ago, when she texted me to say she would not be returning to her practice. I was and am devastated.

I asked if it would it be okay to email her. She said yes, but when I did, she said she was still ill. Initially, I drew on our relationship, which I had come to internalize. However, as the weeks have passed, I have felt angry at the way it ended. And as a recovering alcoholic (dry for 10 years), I am fearful of the future. I would value your views. —Hung Out to Dry

Dear Hung Out to Dry,

Thank you for asking this question, and I imagine other readers thank you as well. Few things can be more painful than the sudden end of a relationship, particularly one in which we felt a strong connection and entrusted with our vulnerabilities. I can hear the loss and confusion you feel and what I presume is a sense of abandonment. These are huge, potentially overwhelming emotions. Congratulations for reaching out for help.

When therapy ends prematurely, especially when it is characterized by a deeply established relationship, it can feel like your world is being turned upside down. It is not uncommon to feel the way you feel. I imagine it is hard to understand what led your therapist to terminate her practice so abruptly and taper off communication. It is understandable to take this as a personal loss. In an ideal scenario, when a therapist plans to retire or end their practice, they communicate this plan with clients well in advance and they discuss and process the transition in session, perhaps even over time.

No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist.

Unfortunately, sometimes illness and/or other circumstances beyond a therapist’s control may necessitate a less-than-ideal end to the therapeutic relationship. In this case, it is up to clients to pick up the pieces and move forward, perhaps with the help of another therapist. (It is worth noting, though clearly not what is happening in your case, that when a client leaves therapy prematurely or without closure, this presents another challenge for recovery.)

You mentioned that you recognize how you have internalized this relationship. No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist. YOU have maintained your sobriety for the past decade. Your therapist was likely not with you during every one of your darkest moments, but YOU were. While you may have internalized the voice of your therapist when experiencing these dark moments, ultimately YOU have managed these circumstances. You made the decisions yourself.

It is understandable to fear what lies ahead for you. Hopefully, you are able to consider your future from a place of empowerment based on your past successes. Another important step is rebuilding your support network. This has been instrumental to you in the past and will likely continue to be instrumental in the future.

If you haven’t done so, you will want to explore options for therapy for yourself going forward. I see it as a positive indicator of success for your future that you formed such a strong alliance with your former therapist. You can do it again. The new relationship will not be the same because the therapist will not be the same. The new therapist will not always respond in the same ways, nor offer the same insights. This is okay, and arguably a real positive.

Change, though scary, can sometimes push us further into growth. You can explore options and consult with more than one therapist before starting anew. As you know, finding the right fit can make a world of difference.

I hope this feedback was useful, and I wish you luck as you move forward.

Marni Amsellem, PhD

Dear GoodTherapy.org,

I have bad OCD. Fear of germs, obsessive and anxious thoughts, needing things to always be perfect and orderly—you name the symptom, I’m pretty sure I have it.

Before you suggest it, I’m going to contact a therapist. But my question is whether, even with therapy, OCD gets worse before it gets better. Most things I see people dealing with, especially mental health issues, don’t tend to improve as they get older. If anything, their problematic thoughts tend to harden into fully formed habits and they become more difficult to shake. Is that the case with OCD? How quickly can I expect therapy to help? (For that matter, will it help at all? Will it cure me or just give me ways to cope?)

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From what I’ve read, obsessive-compulsive disorder isn’t the kind of thing you just “get over.” I want to know what kind of journey I need to buckle in for here, and whether the ride is likely to get bumpier before it smoothens out. Please be brutally honest, if need be. Thank you for your time. —Obsessing Over OCD

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Dear Obsessing,

It sounds like you’re doing the most important thing you can do if you think you have obsessive-compulsive disorder (OCD). You’re investigating what you need to know and looking into seeking help to manage and, ideally, overcome your symptoms. Your instinct to contact a therapist is a good one. If you haven’t already done so, I strongly encourage you to not delay and schedule an appointment.

While I generally caution against self-diagnosing, you may be on to something. If I were to work with you, some things I’d want to know about your symptoms include when you recognized that they are a problem; what, exactly, you mean by “bad OCD”; and what you are already doing to help yourself feel better. I’d also want to know how much your symptoms are interfering in your relationships, job/school, or other daily activities.

I hear your concern about whether symptoms will get better before they get worse; rest assured this fear is unwarranted. It is more likely that symptoms could get worse by not doing anything about them. As you noted, these symptoms are unlikely to resolve on their own without you doing something different.

When you are having symptoms (whether it be for an OCD diagnosis or for something else), the most important thing is that when you recognize you are suffering, you reach out for help. The sooner you seek help, the sooner you will have answers to your questions as they relate to you, and the sooner you’ll learn how to treat your symptoms. Seeking help now also enables you to change your thinking patterns while you are younger, which will have positive implications for your future (countering your anecdotal observation that mental health issues get worse with age, especially when left untreated).

I hear your concern about whether symptoms will get better before they get worse; rest assured this fear is unwarranted. It is more likely that symptoms could get worse by not doing anything about them. As you noted, these symptoms are unlikely to resolve on their own without you doing something different.

Generally, obsessive thoughts and related symptoms are likely to improve when you commit to a course of therapy and not terminate prematurely. This might include cognitive behavioral therapy (CBT), another psychotherapeutic approach, medication, or a combination of the above. One important aspect of treatment effectiveness is learning to recognize what may be triggering your symptoms and how to avoid or prepare for these triggers in the future.

There are no guaranteed “cures” (meaning a promise of no relapses) for anything when it comes to OCD. Treatment will likely take time, and symptoms likely will not subside after just one session. If you start with an approach and it doesn’t seem like a comfortable fit, try to not get discouraged. There are multiple treatment options, and another approach may resonate better with you. Be patient with yourself and your progress.

With many mental health conditions, including OCD and anxiety, some of the most important things we can do are to learn how to build coping skills, increase self-awareness, promote self-compassion, and prevent relapses. In other words, it’s critical to be an active part of your treatment and self-monitor your symptoms.

Sincerely,

Marni Amsellem, PhD

Dear GoodTherapy.org,

My husband and I used to have a great relationship, but ever since we had a baby and he started a stressful new job, he won’t sleep with me anymore. I don’t mean just have sex, although that’s a problem too. I mean he literally doesn’t sleep with me. He stays up half the night and falls asleep on the couch more often than not. When I get up in the morning, I often end up waking him up and telling him to go to bed. It’s like we are ships passing in the night.

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This has strained our relationship so much! I miss my husband. I want to be intimate with him, but even more than that, I want to feel him next to me. I miss snuggling. I miss his warmth and his gentle presence. I sleep better when he’s with me. I cry myself to sleep a lot now, and any sleep I do get is fitful. Having to always be the one to wake up and attend to our baby (since my husband is downstairs, out of earshot) doesn’t help.

He refuses to change or even compromise. He says the stress of his job—he’s a police officer and works evenings—makes him need to “decompress” after his shifts by “vegging out” in front of the TV. He says he can’t go to bed right after work or he just lays there and tosses and turns. But that’s basically what I do if he’s not next to me.

What am I supposed to do if my husband won’t make an effort to sleep with me? I keep thinking the lack of sex will bring him back eventually, but it’s not happening so far. He’s a pretty sexual guy, so I am starting to wonder if he’s getting sex somewhere else. Ugh. As if I needed another reason to not be able to sleep! —Restless

Submit Your Own Question to a Therapist

Dear Restless,

No doubt you’re not sleeping so well these days. In addition to having a little one wreak havoc on your sleep, you have an absentee bed partner. You describe your situation as causing a great deal of distress. It’s on your mind day and night. I’m glad you reached out for help, and I hope this reply offers some points to consider.

You describe your relationship as like “ships passing in the night,” but previously you felt like you had a strong and connected marriage. It sounds like the biggest source of distress is a lack of connection and intimacy, on multiple levels. From your account, you have expressed your desires and concerns to your husband, yet they have neither been validated nor led to change in where your husband spends his time at night. It’s no surprise you are having trouble sleeping.

Talking about sensitive topics with a partner can be tricky for many reasons—among them the baggage that people bring to the communication. It is possible your husband isn’t hearing you because of things that are affecting him, which then reinforces your feeling that he isn’t present. The explanation he has given is that he feels stressed and needs to unwind. This may be accurate, but as you insinuated, you don’t know whether this is the full story. Might there be other challenges he is not comfortable discussing or isn’t able to identify? Might there indeed be an affair of some sort? It sounds like whatever his struggles are, they are affecting him on many levels, including domestic life and his emotional and physical connection to his wife.

Even though communication is hard, it will be part of the long-term solution if you want to bring about change and break this pattern. Individual therapy can assist you with meeting these goals, as can couples therapy, if your husband is open to this.

Even though communication is hard, it will be part of the long-term solution if you want to bring about change and break this pattern. Individual therapy can assist you with meeting these goals, as can couples therapy, if your husband is open to this. Both approaches can facilitate communication and identify issues that may be contributing to the state of your relationship. Regardless of which approach(es) you try, it is important to try something.

Other considerations are important to acknowledge. For one, transition periods in life are inherently stressful. Transitioning into parenthood and starting a new job can feel overwhelming, certainly. We may not know how to deal with the stress. We may resort to coping styles that are familiar to us because it may feel comfortable or easy to react in a certain way.

How has your husband typically coped with stress in the past? Some people tend to react to stress by withdrawing or disengaging. This can, of course, be hard for others who feel like they are shut out. Ultimately, how we deal with things now, whether it be big changes, new demands, or even disagreement about the importance of sharing a marital bed, affects things in the future.

Another consideration worthy of acknowledging is how you are coping. Your sleep has deteriorated, which presumably leaves you feeling less rested during the day. Many nights of poor sleep, of course, can take their toll physically and emotionally. It can affect your energy and internal resources as a caregiver to your baby.

You are caring for someone else, but what are you doing to care for yourself? When we regularly care for ourselves, we are better prepared to deal with the stresses we face, including the ones that don’t seem to make sense or seem like they are easy to resolve. It is easy to forget to take care of yourself when you are so concerned about the well-being of others. May this be a reminder about the importance of checking in with yourself and engaging in something restorative, energizing, or otherwise positive for yourself.

Kind regards,

Marni Amsellem, PhD

How many of us struggle with weight loss, frustrated when we achieve less than our desired results? Assuming you have ruled out possible medical causes contributing to difficulty with weight loss, some of the most powerful forces that can inhibit weight loss are the barriers that exist in our heads.

That being said, many of the emotional barriers to weight loss are not initially obvious, so it is important to identify common emotional barriers and be honest with yourself about how they might be affecting you. Once you better understand any psychological factors that may be holding you back, you may be better able to tackle them.

Several common emotional barriers are described below.

How We Think About Weight Loss

If we think we’re going to fail, we are more likely to fail. Less-than-successful weight loss attempts in the past can contribute to self-defeating thoughts and/or the belief that we lack willpower. This may create the (false) belief that our destiny is to be stuck where we are now.

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If you don’t believe you can lose the weight you want to lose, it will be extremely hard to do so. Skepticism and self-doubt can easily stand in the way of making lasting, positive lifestyle change.

All-or-nothing thinking

Many people attempting to lose weight focus solely on results, look for immediate progress, and tend to view any setbacks as failures (disproportionate to how others may view the setback in question). Sometimes setbacks experienced may lead people to abandon the healthy changes they are trying to implement. The pattern of thinking often becomes, “If I can’t do this exactly the way I want to do it, what’s the point of doing it at all?”

Not prioritizing the changes we want to make

Many of us are busy and have many things demanding our attention and time. We may be regularly spread in multiple directions. But people who want to lose weight may, as a result of lacking the time or resources to plan nutritious meals, exercise, get enough sleep, and so on end up making choices that do not further this goal.

By sending ourselves the message, however unconscious it may be, that we don’t have time to address weight loss and other health goals, we are making it more challenging to find or set aside time to achieve these things. If we move this item up on our to-do list, we are more likely to remain aware of our desires and goals and less likely to make choices that will sabotage them.

How We Think About Ourselves

Negative body image

Adopting a positive body image is a challenge for many people. Though some may recognize they harbor a negative body image, they may not recognize how this is holding back their weight-loss attempts. Some may attempt to shame themselves into losing weight by repeating negative messages about how they look, but these internalized messages are generally more likely to frustrate a person and disrupt weight-loss attempts even more. Consequently, people then struggle to overcome these negative messages while also attempting to lose weight.

Ourselves vs. others.

You are you. Your body is yours. Someone else’s body or weight-loss journey is their own. It may seem motivating to compare ourselves with others, but all too often this can lead to feelings of failure when we fall short in comparison. What works for one person might not work for another. Recognize that your weight-loss journey is yours alone. Your plan of action is yours alone.

It can also help to keep in mind that bodies come in all shapes and sizes, and some desired sizes and shapes may simply be unattainable for certain body types.

Stress and Emotional Health

Life (or daily) stress

It may come as no surprise that, when we are going through a challenging time, the associated stress can affect both our appetite and how we typically respond to stress. Through past experiences, we have learned eating can often  bring comfort. While “emotional eating” and “comfort foods” often do make us feel good, eating in response to emotional cues or even simply out of habit can have the effect of reinforcing the patterns we are trying to overcome. Breaking these patterns can be much harder than we realize.

The goals that are most conducive to success are those that are realistic, specific, and attainable. If we want to see results, it is far better to adapt our ideal goals to fit these parameters than to wish for something that is abstract or unrealistic. By doing so, we are more likely to succeed. 

Mental health status

Similarly, many mental health conditions, depression among them, can affect both appetite and subsequent eating behavior. Depression is also often associated with decreased motivation, decreased self-efficacy, and lack of interest, all of which can negatively impact the ability to achieve goals. While depression (or stress, for that matter) may be associated with weight loss in some individuals, these changes may not be sustained, since they have not been achieved mindfully.

Overcoming Barriers to Weight Loss

Learn how to set goals that work for you.

The goals that are most conducive to success are those that are realistic, specific, and attainable. If we want to see results, it is far better to adapt our ideal goals to fit these parameters than to wish for something that is abstract or unrealistic. By doing so, we are more likely to succeed.

Make yourself accountable.

After you make a commitment to yourself, share your plan with someone else. Articulating a plan to others can reinforce the level of commitment to the plan while also introducing social motivators. Setting reminders with digital technology or hanging up a motivating sign at home or in the office can also help us keep our goals in mind.

Modify your thinking.

Pay attention to the messages you’re telling yourself, honing in on any negative or unproductive thoughts. Then consciously challenge these thoughts, replacing them with messages that reflect greater self-compassion. This is important to do in so any realm of personal thought, but particularly around weight management and body image. Our behaviors play a large role in weight loss, and our thinking really does help drive our behavior.

Learn to regularly manage stress.

Ideally, stress management techniques will be a part of your daily routine. Developing healthy coping responses to stress can be helpful for many reasons, reducing emotional eating among them. Prioritizing regular self-care can be one way to help manage stress.

Educate yourself about weight loss.

Many of us want to lose weight. When we struggle, when our attempts fail, or when we gain back weight we have lost, we may wonder what we are doing wrong. But knowledge is power, and making a plan based on misleading information is likely to inhibit progress.

Weight loss does not have to cost a lot of money, nor does it require a gym membership. There is a lot of data that supports the type of approaches that can be effective—and those that are often less effective. Trending diets, expensive meal plans, and other fads may seem to yield results for others, and they may indeed yield results for anyone at first, but they are less likely to lead to lasting behavioral change.

Seek outside support.

There is help out there. An entire industry, in fact. A variety of professionals can help you meet your weight-loss goals, not just for the immediate future, but for the long term. Many of these professionals also have a solid understanding of the role that emotions can play in weight management and/ or obesity. Finding a professional you enjoy working with, and/or a program or group you enjoy participating in, can make all the difference to your goals.

Talk it out.

If you struggle to lose weight, consider speaking to a therapist about any emotional causes that may be contributing to these challenges. Many therapists or other trained professionals can help provide support and education to help identify and explore barriers that may be holding you back.

Dear GoodTherapy.org,

My husband and I have been married for 27 years. About 10 years ago, his snoring became intolerable, and they ran some tests and diagnosed him with sleep apnea. They told him he could stop breathing and die if he didn’t get a CPAP machine. He refuses to get one, though, because he doesn’t like the way they feel at night.

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Because of his selfishness, I’ve started sleeping in the den because I can’t sleep through the night if we’re in the same room. It’s so disturbing. He literally stops breathing for a minute or two at a time and then suddenly explodes with noise as all the air comes rushing back into his body. Our neighbors have told us they can hear it in the summer months, when their windows are open. Still, he won’t budge. He said if he dies, he dies.

I miss sleeping with my husband, but even more than that, I miss feeling like he cares. I am so frustrated by his unwillingness to do what he needs to do. I don’t know what I can do if he’s going to be stubborn like this. What do you think? —Wide Awake

Dear Wide Awake,

No doubt when your husband continues to not do what you and/ or the doctor have asked him to do, this can be extremely frustrating. I couldn’t help but notice you use the words “unwilling,” “stubborn,” and “selfish” to describe your husband. I also hear how distressed you feel because it seems like he doesn’t care. I imagine there are probably multiple things going on. From your description, he won’t deal with this health issue because it is more uncomfortable for him to wear the CPAP mask than to do something that could potentially save his life and improve the quality of your sleep (and, presumably, your relationship satisfaction).

In order to address your concerns, I want to disentangle these pieces a little. There are multiple things going on, and consequently different ways to approach solving this issue. First is the untreated sleep apnea and possible health-related consequences. This, unfortunately, is not an uncommon issue. Many who are prescribed a CPAP mask find it unpleasant and soon become noncompliant with wearing one, even despite stern warnings from their treating physician.

Consult with the Medical Team

Does the treating physician know about your husband’s noncompliance? What has the physician’s response been? Perhaps the health care team can help increase his openness to giving this another try, as they likely see this issue regularly and may be able to directly intervene.

I imagine your husband, at this point, knows very well that his snoring disturbs you (and the neighbors), but perhaps he does not fully realize you really miss sleeping in the same bed as him and feeling like he cares. Perhaps hearing this expressed explicitly may open up a new path for your conversations to take.

Education can be a strong component—for example, explaining exactly what his test results revealed (e.g., oxygen levels, prognosis if his sleep apnea is left untreated), or simply communicating to your husband that for many people with sleep apnea, it is normal to take time to adjust to the CPAP before it feels comfortable enough to not feel burdensome.

That said, educational approaches may not be enough to change his mind. Additionally, if you feel the medical team is not empathetic to your struggles, you may want to speak with a different provider. Finally, have you explored other options for sleep apnea management? There may be other devices or procedures that may be able to help.

The second issue to address is how his refusal is affecting you. It clearly impacts the quality of your sleep, both in terms of not being able to sleep through the night because of his loud snoring and because of the frustration you feel. It is also clear that physically relocating to get a restful night of sleep is not your ideal. And when he nonchalantly states, “If I die, I die,” this seems to evoke a host of negative emotions in you, including hurt, sadness, and perhaps rejection and resentment.

Tell Him How You Feel

I imagine you have told your husband many times how you feel about his snoring. I imagine you have told him many times he should be using his CPAP. You’ve surely reminded him what his doctor has to say on this topic. How have you communicated to him about your own experience with this issue? Have you told him about the emotional impact his words and actions (or lack thereof) have on you? If so, how have you communicated this?

The way we talk to others about the impact they have on us plays a large role in the success of this communication effort. For example, consider how each of these statements might sound: Stating to your spouse, “Because of your selfishness, I can’t sleep in my own bed,” compared with something like, “I feel frustrated because I feel like you haven’t heard my concerns” or “I feel hurt because it feels like my concerns are dismissed.” While all of these statements may be accurate, not all of them are likely to be heard the same way. I imagine your husband, at this point, knows very well that his snoring disturbs you (and the neighbors), but perhaps he does not fully realize you really miss sleeping in the same bed as him and feeling like he cares. Perhaps hearing this expressed explicitly may open up a new path for your conversations to take. Sometimes, taking a closer look at how we communicate key messages may uncover new approaches that ultimately yield a desired effect.

Lastly, you may find that additional support via therapy—with or without your husband present—may be useful to you to help manage frustration and continue to identify solutions. Good luck!

Marni Amsellem, PhD

Dear GoodTherapy.org,

I’m a 27-year-old dental student with no serious medical issues other than sports injuries. Over the past few years, I have developed these thoughts about getting/being sick. I am constantly paying attention to my body. Any little thing I notice, I freak out. I am frequently going to the doctor for one thing after another and can’t seem to control my brain immediately thinking the worst. And every time I go, I am perfectly healthy.

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I also think that because I am believing in these fake ailments, it’s causing my brain to create symptoms! It’s frustrating because I don’t know how to stop feeling like this even though I know it’s mostly in my head. At this point, my girlfriend and family are getting sick of me asking things like “This isn’t cancer, right?” or “I’m going to be okay, right? It’s not going to kill me or anything?”

My main question is why am I always thinking of the worst-case scenario with my health? Why can’t I just have a sore throat and think “I must have a cold” instead of “I must have a rare infection that’s going to eventually kill me”? Any help would be awesome because as of now I feel myself worrying about being sick more than actually enjoying my life. Thank you. —Worried Sick

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Dear Worried Sick,

You’ve asked a great question, and you are not alone in asking it: Why do you seem to always think of the worst-case scenario when it comes to your health, and what can you do differently so you are not immediately thinking the worst? The answer to this question is very much tied to understanding what may be behind this in the first place.

How you describe your concerns is consistent with what is conceptualized in the DSM-5 (the most recent version of the Diagnostic and Statistical Manual) as illness anxiety, as well as what prior to this would have been considered hypochondriasis (debilitating worry about having a serious illness). Regardless, please know there are things you can do to keep the worry from getting the better of you.

It’s worth stating this about anxiety more generally: some people are more prone to either anxiety or hypervigilance (heightened awareness about small sensations or possible threats, in this case health-related symptoms) than others. This can happen for any number of reasons, and it’s okay if you tend to be that way. What you are doing, essentially, is making sense of your experiences and protecting yourself from perceived threats of danger. While this can be adaptive—as doing so can tune you in to something that is wrong—it may become a problem when your interpretations are in overdrive. Furthermore, when you worry excessively, there is a negative filter operating on your thoughts which further intensifies and reinforces the worry.

You can learn how to modify your thoughts through psychotherapy. By seeking help for this, you can learn and practice skills to help you reduce hypervigilance and significantly reduce the tendency to immediately think the worst.

The bottom line is thoughts are powerful. When we experience a symptom such as pain, fatigue, or bloating, many people try to better understand and make sense of the experience, and depending on our thoughts, this may work for us or it may signal our thoughts are in overdrive. Additionally, constantly paying attention to bodily symptoms—and perhaps even creating symptoms, as you indicated—is a pattern worth changing. When we think the worst, this sends us down a dark path leading to debilitating anxiety. Furthermore, the way we think significantly affects the way we feel. So it makes sense that if we are thinking the worst about our health, we will feel bad. We are focusing on even the slightest discomfort or sensation and then feeling distressed over the worry around what it could mean. Clearly, you have realized that health-related anxiety or worry can become extremely uncomfortable.

By modifying the thoughts you have around bodily sensations, you can change your level of comfort. You will, in fact, be able to do just as you want—to be able to enjoy your life. Imagine how powerful a small shift in a thought can be. Instead of “This means I have a rare infection that will kill me,” try something else. Perhaps, “It is possible this is something that warrants medical attention, but it is also possible this will go away on its own.” You can learn how to modify your thoughts through psychotherapy. By seeking help for this, you can learn and practice skills to help you reduce hypervigilance and significantly reduce the tendency to immediately think the worst.

Here are some other tips that are important to consider:

• Beware of conducting your own health-related research. Many individuals who experience illness anxiety find they spend a lot of time online researching suspected conditions or symptoms. I suspect you know this already, being a dental student, but sometimes reading about things that “could” happen serves as an unnecessary trigger for anxiety. Be mindful of the amount of time you spend conducting such research, as well as how you feel while reading information (especially compared to times when you are not reading about symptoms). I suspect such information may spike anxiety in you. If so, consider whether this is useful for you to do.
• Consider new ways of coping and reframing. You mentioned you gather that the people close to you are already getting annoyed by you regularly seeking reassurance. This is one mechanism you have developed as a pattern to manage anxiety. Another is to frequently make medical appointments for these symptoms, which is essentially doing the same thing. You want reassurance that everything is okay. Because neither of these practices is sustainable in the long run, you’ll have to learn additional coping and reframing skills so you can adequately assess when it may be appropriate to seek reassurance.
• Implement relaxation as a regular practice. What usually helps you reduce anxiety? Finding a healthy outlet for stress and anxiety can be a useful tool to have at your disposal, regardless of the stressors you face.

Glad you’ve reached out!

Best wishes,

Marni Amsellem, PhD

Dear GoodTherapy.org,

For years now, I’ve had a problem with grinding my teeth, and it only seems to be getting worse. I think it might be hereditary because my mom says she grinds her teeth, too. It used to only happen at night, but lately it’s almost constant, and I have to consciously stop myself from clenching my jaw even during normal daily tasks (like writing this letter, for example).

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I know things like biting cheeks and the skin on your lips can be linked to anxiety or other mental health issues. Is it the same with grinding teeth or jaw clenching? So far, amazingly, my dentist says my teeth haven’t been affected too much—but they always still try to sell me on expensive mouth guards. I’ve tried store-bought mouth guards and had a retainer for a while, but obviously they’re not really stopping the jaw tension even if they’re protecting my teeth. Sometimes I fall asleep biting my tongue and wake up with really pronounced indents from my molars. And I think sometimes the tension is related to how stressful my dreams are. But I don’t always remember my dreams, so I can’t say for sure.

Anyway, do you have any suggestions for things I can try? I wake up with a dull headache from this nearly every morning, and I’d really like to stop popping painkillers. I do think I have a more-stressful-than-average life, but honestly I prefer staying busy, and I don’t think my stress level is likely to change. Besides, I know people who lead lives with far more responsibilities and stress who don’t have this issue. Any ideas? —Ground Down

Dear Ground Down,

You’re not alone in this! Many people grind or clench their teeth, often in their sleep but also often in the daytime as well. Fortunately, there are many things you can try to help yourself overcome this issue and prevent more significant damage as a result of teeth grinding. I will provide some suggestions of things you can do, but first I’ll share a little more information about grinding teeth, how and why it happens and persists, and the role of anxiety in clenching or grinding teeth.

Clenching or grinding teeth without awareness, also known as bruxism, affects many (the incidence at any one time is around 10% of the population) and can range in severity from mild (no physical evidence of consequences) to severe. More notable effects of grinding or clenching include facial pain, tired jaw muscles or the development of jaw disorders, sensitive or damaged teeth, damage to tongue or inside of mouth walls, headaches, or earaches. It has been found to happen more frequently during periods of high stress, though it can become habitual and happen regardless of stress level. It also appears to have a hereditary link and happens more frequently in women than men.

Teeth Grinding and Anxiety

Does this mean you have anxiety? It’s hard to accurately assess that without information that can only be gleaned by talking to you in person. I recommend making an appointment with a therapist near you to discuss the issues you may be experiencing.

Certainly, grinding or clenching teeth can be one manifestation of holding tension and responding to stress, and many individuals who experience anxiety (and depression) do also grind their teeth. Grinding teeth does not necessarily mean you are experiencing anxiety (or depression), however. That said, one way to treat this is by using many of the same behavioral techniques you might use to help manage anxiety.

How Can Teeth Grinding Be Treated?

The first step in overcoming grinding or clenching teeth is to become aware of the issue. How did you discover you were doing this? Have you experienced headaches or tightness in your facial muscles? Has your dentist remarked about damaged teeth or suspect you might be grinding or clenching? Are you hearing from your partner that you are grinding teeth in your sleep? Ask yourself questions about the frequency and nature of this behavior. When are you grinding or clenching your teeth? Are you doing other activities at the same time (e.g., sleeping or working)? Do you notice you are feeling stressed when you are clenching your teeth? You may want to keep a journal for a period of time to track this behavior and when it occurs. This information can inform your strategies to help overcome these behaviors.

Essentially, a pattern has developed over time. For example, you have trained yourself to engage in teeth clenching if you automatically start clenching your jaw when doing things like typing on your keyboard or stepping out into the winter cold. Now is the time to break this habit, before you notice more significant consequences. 

Essentially, a pattern has developed over time. For example, you have trained yourself to engage in teeth clenching if you automatically start clenching your jaw when doing things like typing on your keyboard or stepping out into the winter cold. Now is the time to break this habit, before you notice more significant consequences.

Be aware of your mouth position. Believe it or not, there is a correct way to position your jaw. With your lips closed, you want to keep a gap between your top and bottom jaw, which can he assisted by placing the tip of your tongue just behind your front teeth on top. This may take some practice and regularly checking in to modify your habit of how you typically position your mouth. If, as you are reading this, you notice you are clenching your jaw, start to make a change. Begin by opening your mouth as if you are about scream, which is a great stretch for these muscles, followed by adopting the correct mouth position. This correct position will likely reduce tension in the jaw.

Implementing Relaxation Is Key

How do you know whether you are holding tension in your body? It is not always obvious. One thing to do is to scan your body for tension. Deliberately think about every muscle group in your body. Are muscles in your back or shoulders holding tension? Muscles in your jaw? Take a deep breath in and exhale. Let go of the tension where you notice you are holding it. Various relaxation techniques, centered on mindful breathing, can be especially effective. You may want to end every day by scanning your body for tension. You may want to do some yoga stretches. Additionally, try placing a warm washcloth on the muscles of your jaw to relax them before bedtime.

There are some suggested “don’ts” as well. Because this is a habit, be mindful of nonfood items you may “chew” on. Chewing pencils, straws, toothpicks, etc. may increase your tendency to engage in that behavior when you are not aware of it. Be aware of your chewing all around. Also, some experts would recommend reducing caffeine, nicotine, or alcohol before bed.

Other strategies to consider are what your dentist has been suggesting to you. If relaxation strategies and retraining your behavioral patterns are not the approach you would like to try, many individuals do utilize bite plates and find that custom plates are useful. If you are reluctant to try this approach, first try the behavioral strategies suggested above.

Knowing potential damages or consequences can be enough to motivate many to try to make a change. It sounds like you are quite motivated to overcome this on your own. Good luck!

Kind regards,

Marni Amsellem, PhD