Psychology & Psychiatry Services in Mankato

If you struggle with mental, addictive and emotional disorders, we can help you find answers and relief. Below, is a list of Psychiatry and Psychology services provided by Mayo Clinic Health System in Mankato.

View the services we provide:

• Addiction psychiatry
• Anger management
• Assertiveness skills training
• Bariatric surgery evaluations
• Biofeedback
• Domestic violence counseling
• Eye movement desensitization and reprocessing (EMDR)
• Gender identity
• Grief and loss counseling
• Health and lifestyle change
• Mindfulness-based stress reduction
• Neuropsychological testing
• Parent instruction and training
• Relationship counseling
• Stillborn birth
• Stress management
• Tobacco cessation

Addiction psychiatry

Comprehensive assessment of alcohol or other substance use issues, mental health concerns and medical status. Treatment recommendation is individualized and based on latest research findings to addresses substance use disorder and other mental health conditions.

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Anger management

Anger management is the process of learning to recognize signs that you're becoming angry, and taking action to calm down and deal with the situation in a productive way. Anger management doesn't try to keep you from feeling anger or encourage you to hold it in. Anger is a normal, healthy emotion when you know how to express it appropriately — anger management is about learning how to do this.

You may learn anger management skills on your own, using books or other resources. But for many people, taking an anger management class or seeing a mental health professional is the most effective approach.

Why it's done

Anger management helps you recognize frustrations early and resolve them in a way that allows you to express your needs — and keeps you calm and in control.

Some signs that you need help controlling your anger include:

• Regularly feeling that you have to hold in your anger
• Persistent negative thinking and focusing on negative experiences
• Constant feelings of irritation, impatience and hostility
• Frequent arguments with others that escalate frustrations
• Physical violence, such as hitting your partner or children or starting fights
• Threats of violence against people or property
• Out-of-control or frightening behavior, such as breaking things or driving recklessly
• Avoiding situations because of anxiety or depression about anger outbursts

How you prepare

Learning behavioral skills is an essential part of anger management. A number of books and websites offer information about ways to manage anger. But, if learning skills on your own isn't enough to help you stay calm and in control, you may benefit from seeing a mental health professional or by taking an anger management class.

It can take a little work to find an anger management program, a counselor specializing in anger management or other resources. Here are some places to start your search:

• Ask your primary care doctor or mental health professional for a referral to a program or counselor.
• Search trustworthy online sites for resources, such as blogs, support groups or books.
• Ask someone who completed an anger management program or took other steps to manage anger.
• Check with your employee assistance program (EAP) or church.
• Check your local library for books, videos or other resources.

What you can expect

Here's what you can expect from anger management education or counseling.

Anger management classes or counseling

Anger management classes or counseling for anger management can be done in a group or one-on-one with your partner or someone else. The setting, length and number of sessions vary, depending on the program or counselor and your needs. Anger management courses or counseling can be brief or last for weeks or months.

Beginning anger management

When you start working on anger management, identify your triggers and the physical and emotional signs that occur as you begin to get angry. Recognizing and managing these warning signs early is an important step in controlling your anger. Pay attention to and make a list of:

• Stressors that commonly trigger or worsen your anger, such as frustration with a child or partner, financial stress, traffic issues, or problems with a co-worker
• Physical signs that your feelings of anger are rising — for example, sleeping poorly, clenching your jaw, a racing heart or driving too fast
• Emotional signs that your anger is on the rise, such as the feeling you want to yell at someone or that you're holding in what you really want to say

During anger management sessions

Generally, counseling for anger management focuses on learning specific behavioral skills and ways of thinking so you can cope with anger. If you have any other mental health conditions, such as anxiety, depression or addiction, you may need to also work on these issues for anger management methods to be effective.

The aim of counseling and anger management classes is to teach you to:

• Manage factors that may make you more likely to get angry, such as improving sleep so you're not tired and keeping stress low by using stress management skills
• Identify situations that are likely to set you off and respond in nonaggressive ways before you get angry
• Learn specific skills to use in situations likely to trigger your anger
• Recognize when you aren't thinking logically about a situation, and correct your thinking
• Calm yourself down when you begin to feel upset, for example, by using relaxation skills or taking a break
• Express your feelings and needs assertively (but not aggressively) in situations that make you feel angry
• Focus on problem-solving in frustrating situations — instead of using energy to be angry, you'll learn how to redirect your energy to resolve the situation
• Communicate effectively to defuse anger and resolve conflicts

Results

Improving your ability to manage anger has several benefits. You'll feel as if you have more control when life's challenges turn up the heat. Knowing how to express yourself assertively means you won't feel the frustration of holding in your anger to avoid offending someone.

Anger management can help you:

• Communicate your needs. Learn how to recognize and talk about things that frustrate you, rather than letting your anger flare up. Knowing how to express yourself can help you avoid impulsive and hurtful words or actions, resolve conflicts, and maintain positive relationships.
• Maintain better health. The stress caused by ongoing angry feelings can increase your risk of health problems, such as headaches, difficulty sleeping, digestive issues, heart problems and high blood pressure.
• Prevent psychological and social problems linked to anger. Examples include depression, problems at work, legal difficulties and troubled relationships.
• Use your frustration to get things done. Anger expressed inappropriately can make it difficult for you to think clearly, and may result in poor judgment. You'll learn to use feelings of frustration and anger as motivators to work harder and take positive action.
• Help avoid addictive escapes. People who always feel angry may turn to alcohol, drugs or food to decrease feelings of anger. Instead, you can use anger management techniques to keep your cool and maintain control, without adding an additional problem to your life.

Read these 10 tips to tame your temper

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Assertiveness skills

Assertiveness can help you control stress and anger and improve coping skills. Recognize and learn assertive behavior and communication.

Being assertive is a core communication skill. Being assertive means that you express yourself effectively and stand up for your point of view, while also respecting the rights and beliefs of others.

Being assertive can also help boost your self-esteem and earn others' respect. This can help with stress management, especially if you tend to take on too many responsibilities because you have a hard time saying no.

Some people seem to be naturally assertive. But if you're not one of them, you can learn to be more assertive.

Why assertive communication makes sense

Because assertiveness is based on mutual respect, it's an effective and diplomatic communication style. Being assertive shows that you respect yourself because you're willing to stand up for your interests and express your thoughts and feelings. It also demonstrates that you're aware of the rights of others and are willing to work on resolving conflicts.

Of course, it's not just what you say — your message — but also how you say it that's important. Assertive communication is direct and respectful. Being assertive gives you the best chance of successfully delivering your message. If you communicate in a way that's too passive or too aggressive, your message may get lost because people are too busy reacting to your delivery.

Assertive vs. passive behavior

If your style is passive, you may seem to be shy or overly easygoing. You may routinely say things such as "I'll just go with whatever the group decides." You tend to avoid conflict. Why is that a problem? Because the message you're sending is that your thoughts and feelings aren't as important as those of other people. In essence, when you're too passive, you give others the license to disregard your wants and needs.

Consider this example: You say yes when a colleague asks you to take over a project, even though your plate is full, and the extra work means you'll have to work overtime and miss your daughter's soccer game. Your intention may be to keep the peace. But always saying yes can poison your relationships. And worse, it may cause you internal conflict because your needs and those of your family always come second.

The internal conflict that can be created by passive behavior can lead to:

• Stress
• Resentment
• Seething anger
• Feelings of victimization
• Desire to exact revenge

Assertive vs. aggressive behavior

Now consider the flip side. If your style is aggressive, you may come across as a bully who disregards the needs, feelings and opinions of others. You may appear self-righteous or superior. Very aggressive people humiliate and intimidate others and may even be physically threatening.

You may think that being aggressive gets you what you want. However, it comes at a cost. Aggression undercuts trust and mutual respect. Others may come to resent you, leading them to avoid or oppose you.

Assertive vs. passive-aggressive behavior

Now consider passive-aggressive behavior. If you communicate in a passive-aggressive manner, you may say yes when you want to say no. You may be sarcastic or complain about others behind their backs. Rather than confront an issue directly, you may show your anger and feelings through your actions or negative attitude. You may have developed a passive-aggressive style because you're uncomfortable being direct about your needs and feelings.

What are the drawbacks of a passive-aggressive communication style? Over time, passive-aggressive behavior damages relationships and undercuts mutual respect, thus making it difficult for you to get your goals and needs met.

The benefits of being assertive

Being assertive is usually viewed as a healthier communication style. Being assertive offers many benefits. It helps you keep people from walking all over you. It can also help you from steamrolling others.

Behaving assertively can help you:

• Gain self-confidence and self-esteem
• Understand and recognize your feelings
• Earn respect from others
• Improve communication
• Create win-win situations
• Improve your decision-making skills
• Create honest relationships
• Gain more job satisfaction

Learning to be more assertive can also help you effectively express your feelings when communicating with others about issues.

Learning to be more assertive

People develop different styles of communication based on their life experiences. Your style may be so ingrained that you're not even aware of what it is. People tend to stick to the same communication style over time. But if you want to change your communication style, you can learn to communicate in healthier and more effective ways.

Here are some tips to help you become more assertive:

• Assess your style. Do you voice your opinions or remain silent? Do you say yes to additional work even when your plate is full? Are you quick to judge or blame? Do people seem to dread or fear talking to you? Understand your style before you begin making changes.
• Use 'I' statements. Using "I" statements lets others know what you're thinking or feeling without sounding accusatory. For instance, say, "I disagree," rather than, "You're wrong." If you have a request, say "I would like you to help with this" rather than "You need to do this." Keep your requests simple and specific.
• Practice saying no. If you have a hard time turning down requests, try saying, "No, I can't do that now." Don't hesitate — be direct. If an explanation is appropriate, keep it brief.
• Rehearse what you want to say. If it's challenging to say what you want or think, practice typical scenarios you encounter. Say what you want to say out loud. It may help to write it out first, too, so you can practice from a script. Consider role-playing with a friend or colleague and ask for blunt feedback.
• Use body language. Communication isn't just verbal. Act confident even if you aren't feeling it. Keep an upright posture, but lean forward a bit. Make regular eye contact. Maintain a neutral or positive facial expression. Don't cross your arms or legs. Practice assertive body language in front of a mirror or with a friend or colleague.
• Keep emotions in check. Conflict is hard for most people. Maybe you get angry or frustrated, or maybe you feel like crying. Although these feelings are normal, they can get in the way of resolving conflict. If you feel too emotional going into a situation, wait a bit if possible. Then work on remaining calm. Breathe slowly. Keep your voice even and firm.
• Start small. At first, practice your new skills in situations that are low risk. For instance, try out your assertiveness on a partner or friend before tackling a difficult situation at work. Evaluate yourself afterward and tweak your approach as necessary.

When you need help being assertive

Remember, learning to be assertive takes time and practice. If you've spent years silencing yourself, becoming more assertive probably won't happen overnight. Or if anger leads you to be too aggressive, you may need to learn some anger management techniques.

If despite your best efforts you're not making progress toward becoming more assertive, consider formal assertiveness training. And if certain issues such as anger, stress, anxiety or fear are getting in your way, consider talking with a mental health provider. The payoff will be worth it. By becoming more assertive, you can begin to express your true feelings and needs more easily. You may even find that you get more of what you want as a result.

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Bariatric surgery evaluations

Assessment of your emotional readiness for bariatric surgery and preparation for lifestyle changes necessary for long-term success.

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Biofeedback

Biofeedback is a technique you can use to learn to control your body's functions, such as your heart rate. With biofeedback, you're connected to electrical sensors that help you receive information (feedback) about your body (bio).

This feedback helps you focus on making subtle changes in your body, such as relaxing certain muscles, to achieve the results you want, such as reducing pain. In essence, biofeedback gives you the power to use your thoughts to control your body, often to improve a health condition or physical performance.

Types of biofeedback

Your therapist might use several different biofeedback methods. Determining the method that's right for you depends on your health problems and goals. Biofeedback methods include:

• Brainwave. This type of method uses scalp sensors to monitor your brain waves using an electroencephalograph (EEG).
• Breathing. During respiratory biofeedback, bands are placed around your abdomen and chest to monitor your breathing pattern and respiration rate.
• Heart rate. This type of biofeedback uses finger or earlobe sensors with a device called a photoplethysmograph or sensors placed on your chest, lower torso or wrists using an electrocardiograph (ECG) to measure your heart rate and heart rate variability.
• Muscle. This method of biofeedback involves placing sensors over your skeletal muscles with an electromyography (EMG) to monitor the electrical activity that causes muscle contraction.
• Sweat glands. Sensors attached around your fingers or on your palm or wrist with an electrodermograph (EDG) measure the activity of your sweat glands and the amount of perspiration on your skin, alerting you to anxiety.
• Temperature. Sensors attached to your fingers or feet measure your blood flow to your skin. Because your temperature often drops when you're under stress, a low reading can prompt you to begin relaxation techniques.

Biofeedback devices

You can receive biofeedback training in physical therapy clinics, medical centers and hospitals. A growing number of biofeedback devices and programs are also being marketed for home use, including:

• Interactive computer or mobile device programs. Some types of biofeedback devices measure physiological changes in your body, such as your heart rate activity and skin changes, by using one or more sensors attached to your fingers or your ear. The sensors plug into your computer.
  Using computer graphics and prompts, the devices then help you master stress by pacing your breathing, relaxing your muscles and thinking positive thoughts. Studies show that these types of devices might be effective in improving responses during moments of stress, and inducing feelings of calm and well-being.
  Another type of biofeedback therapy involves wearing a headband that monitors your brain activity while you meditate. It uses sounds to let you know when your mind is calm and when it's active to help you learn how to control your stress response. The information from each session can then be stored to your computer or mobile device.
• Wearable devices. One type of wearable device involves wearing a sensor on your waist that monitors your breathing and tracks your breathing patterns using a downloadable app. The app can alert you if you're experiencing prolonged tension, and it offers guided breathing activities to help restore your calm.

The Food and Drug Administration has approved a biofeedback device, Resperate, for reducing stress and lowering blood pressure. Resperate is a portable electronic device that promotes slow, deep breathing.

However, many biofeedback devices marketed for home use aren't regulated by the Food and Drug Administration. Before trying biofeedback therapy at home, discuss the different types of devices with your doctor to find the best fit.

Be aware that some products might be falsely marketed as biofeedback devices, and that not all biofeedback practitioners are reputable. If a manufacturer or biofeedback practitioner claims that a biofeedback device can assess your organs for disease, find impurities in your blood, cure your condition or send signals into your body, check with your doctor before using it, as it might not be legitimate.

Why it's done

Biofeedback, sometimes called biofeedback training, is used to help manage many physical and mental health issues, including:

• Anxiety or stress
• Asthma
• Attention deficit hyperactivity disorder (ADHD)
• Chemotherapy side effects
• Chronic pain
• Constipation
• Fecal incontinence
• Fibromyalgia
• Headache
• High blood pressure
• Irritable bowel syndrome
• Motion sickness
• Raynaud's disease
• Ringing in the ears (tinnitus)
• Stroke
• Temporomandibular joint disorder (TMJ)
• Urinary incontinence

Biofeedback appeals to people for a variety of reasons:

• It's noninvasive.
• It might reduce or eliminate the need for medications.
• It might be a treatment alternative for those who can't tolerate medications
• It might be an option when medications haven't worked well.
• It might be an alternative to medications for some conditions during pregnancy.
• It helps people take charge of their health.

Risks

Biofeedback is generally safe. Biofeedback might not be appropriate for everyone, though. Be sure to discuss it with your doctor first.

How you prepare

You don't need special preparation for biofeedback.

To find a biofeedback therapist, ask your doctor or another healthcare professional with knowledge of biofeedback therapy to recommend someone who has experience treating your condition. Many biofeedback therapists are licensed in another area of healthcare, such as nursing or physical therapy, and might work under the guidance of a doctor.

State laws regulating biofeedback practitioners vary. Some biofeedback therapists choose to become certified to show their extra training and experience in the practice.

Ask a potential biofeedback therapist questions before starting treatment, such as:

• Are you licensed, certified or registered?
• What is your training and experience?
• Do you have experience providing feedback for my condition?
• How many biofeedback sessions do you think I'll need?
• What's the cost, and is it covered by health insurance?
• Can you provide a list of references?

What you can expect

During the procedure

During a biofeedback session, a therapist attaches electrical sensors to different parts of your body. These sensors monitor your body's physiological state, such as brain waves, skin temperature, muscle tension, heart rate and breathing. This information is fed back to you via cues, such as a beeping sound or a flashing light.

The feedback teaches you to change or control your body's physiological reactions by changing your thoughts, emotions or behavior. In turn, this can help the condition for which you sought treatment.

For instance, biofeedback can pinpoint tense muscles that are causing headaches. You then learn how to invoke positive physical changes in your body, such as relaxing those specific muscles, to reduce your pain. The ultimate goal with biofeedback is to learn to use these techniques at home on your own.

A typical biofeedback session lasts 60 to 90 minutes. The length and number of sessions are determined by your condition and how quickly you learn to control your physical responses. You might need at least 10 to 15 sessions, which can make it more expensive and time-consuming. Biofeedback might not be covered by insurance.

Results

If biofeedback is successful for you, it might help you control symptoms of your condition or reduce the amount of medication you take. Eventually, you can practice the biofeedback techniques you learn on your own. You might need to continue with standard treatment for your condition, though.

Keep in mind that learning biofeedback can take time and, if it's not covered by health insurance, it can be expensive.

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Domestic violence counseling

Your partner apologizes and says the hurtful behavior won't happen again — but you fear it will. At times you wonder whether you're imagining the abuse, yet the emotional or physical pain you feel is real. If this sounds familiar, you might be experiencing domestic violence.

Recognize domestic violence

Domestic violence — also called intimate partner violence — occurs between people in an intimate relationship. Domestic violence can take many forms, including emotional, sexual and physical abuse and threats of abuse. Men are sometimes abused by partners, but domestic violence is most often directed toward women. Domestic violence can happen in heterosexual or same-sex relationships.

Abusive relationships always involve an imbalance of power and control. An abuser uses intimidating, hurtful words and behaviors to control his or her partner.

It might not be easy to identify domestic violence at first. While some relationships are clearly abusive from the outset, abuse often starts subtly and gets worse over time. You might be experiencing domestic violence if you're in a relationship with someone who:

• Calls you names, insults you or puts you down
• Prevents or discourages you from going to work or school or seeing family members or friends
• Tries to control how you spend money, where you go, what medicines you take or what you wear
• Acts jealous or possessive or constantly accuses you of being unfaithful
• Gets angry when drinking alcohol or using drugs
• Threatens you with violence or a weapon
• Hits, kicks, shoves, slaps, chokes or otherwise hurts you, your children or your pets
• Forces you to have sex or engage in sexual acts against your will
• Blames you for his or her violent behavior or tells you that you deserve it

If you're lesbian, bisexual or transgender, you might also be experiencing domestic violence if you're in a relationship with someone who:

• Threatens to tell friends, family, colleagues or community members your sexual orientation or gender identity
• Tells you that authorities won't help a lesbian, bisexual or transgender person
• Tells you that leaving the relationship means you're admitting that lesbian, bisexual or transgender relationships are deviant
• Says women can't be violent
• Justifies abuse by telling you that you're not "really" lesbian, bisexual or transgender

Pregnancy, children, family members and domestic violence

Sometimes domestic violence begins — or increases — during pregnancy, putting your health and the baby's health at risk. The danger continues after the baby is born.

Even if your child isn't abused, simply witnessing domestic violence can be harmful. Children who grow up in abusive homes are more likely to be abused and have behavioral problems than are other children. As adults, they're more likely to become abusers or think abuse is a normal part of relationships.

You might worry that telling the truth will further endanger you, your child or other family members — and that it might break up your family — but seeking help is the best way to protect yourself and your loved ones.

Break the cycle

If you're in an abusive situation, you might recognize this pattern:

• Your abuser threatens violence.
• Your abuser strikes.
• Your abuser apologizes, promises to change and offers gifts.
• The cycle repeats itself.

The longer you stay in an abusive relationship, the greater the physical and emotional toll. You might become depressed and anxious, or begin to doubt your ability to take care of yourself. You might feel helpless or paralyzed.

You may also wonder if the abuse is your fault — a common point of confusion among survivors of domestic abuse that may make it more difficult to seek help.

Don't take the blame

You may not be ready to seek help because you believe you're at least partially to blame for the abuse in the relationship. Reasons may include:

• Your partner blames you for the violence in your relationship. Abusive partners rarely take responsibility for their actions.
• Your partner only exhibits abusive behavior with you. Abusers are often concerned with outward appearances, and may appear charming and stable to those outside of your relationship. This may cause you to believe that his or her actions can only be explained by something you've done.
• Therapists and doctors who see you alone or with your partner haven't detected a problem. If you haven't told your doctor or other healthcare providers about the abuse, they may only take note of unhealthy patterns in your thinking or behavior, which can lead to a misdiagnosis. For example, survivors of intimate partner violence may develop symptoms that resemble personality disorders. Exposure to intimate partner violence also increases your risk of mental health conditions such as depression, anxiety and post-traumatic stress disorder (PTSD).
  If healthcare providers focus on your symptoms, this may worsen your fear that you are responsible for the abuse in your relationship.
• You have acted out verbally or physically against your abuser, yelling, pushing or hitting him or her during conflicts. You may worry that you are abusive, but it's much more likely that you acted in self-defense or intense emotional distress. Your abuser may use such incidents to manipulate you, describing them as proof that you are the abusive partner.

If you're having trouble identifying what's happening, take a step back and look at larger patterns in your relationship. Then, review the signs of domestic violence. In an abusive relationship, the person who routinely uses these behaviors is the abuser. The person on the receiving end is being abused.

Unique challenges

• If you're an immigrant, you may be hesitant to seek help out of fear that you will be deported. Language barriers, lack of economic dependence and limited social support can increase your isolation and your ability to access resources.
  Laws in the United States guarantee protection from domestic abuse, regardless of your immigrant status. Free or low-cost resources are available, including lawyers, shelter and medical care for you and your children. You may also be eligible for legal protections that allow immigrants who experience domestic violence to stay in the U.S.
  Call a national domestic violence hotline for guidance. These services are free and protect your privacy.
• If you're an older woman, you may face challenges related to your age and the length of your relationship. You may have grown up in a time when domestic violence was simply not discussed. You or your partner may have health problems that increase your dependency or sense of responsibility.
• If you're in a same-sex relationship, you might be less likely to seek help after an assault if you don't want to disclose your sexual orientation. If you've been sexually assaulted by another woman, you might also fear that you won't be believed.

Still, the only way to break the cycle of domestic violence is to take action. Start by telling someone about the abuse, whether it's a friend, loved one, healthcare provider or other close contact. You can also call a national domestic violence hotline.

At first, you might find it hard to talk about the abuse. But understand that you are not alone and there are experts who can help you. You'll also likely feel relief and receive much-needed support.

Create a safety plan

Leaving an abuser can be dangerous. Consider taking these precautions:

• Call a women's shelter or domestic violence hotline for advice. Make the call at a safe time — when the abuser isn't around — or from a friend's house or other safe location.
• Pack an emergency bag that includes items you'll need when you leave, such as extra clothes and keys. Leave the bag in a safe place. Keep important personal papers, money and prescription medications handy so that you can take them with you on short notice.
• Know exactly where you'll go and how you'll get there.

Protect your communication and location

An abuser can use technology to monitor your telephone and online communication and to track your location. If you're concerned for your safety, seek help. To maintain your privacy:

• Use phones cautiously. Your abuser might intercept calls and listen to your conversations. He or she might use caller ID, check your cellphone or search your phone billing records to see your call and texting history.
• Use your home computer cautiously. Your abuser might use spyware to monitor your emails and the websites you visit. Consider using a computer at work, the library or at a friend's house to seek help.
• Remove GPS devices from your vehicle. Your abuser might use a GPS device to pinpoint your location.
• Frequently change your email password. Choose passwords that would be impossible for your abuser to guess.
• Clear your viewing history. Follow your browser's instructions to clear any record of websites or graphics you've viewed.

Where to find help

In an emergency, call 911 — or your local emergency number or law enforcement agency. The following resources also can help:

• Someone you trust. Turn to a friend, loved one, neighbor, co-worker, or religious or spiritual adviser for support.
• National Domestic Violence Hotline: 800-799-SAFE (800-799-7233). Call the hotline for crisis intervention and referrals to resources, such as women's shelters.
• Your healthcare provider. Doctors and nurses will treat injuries and can refer you to safe housing and other local resources.
• A local women's shelter or crisis center. Shelters and crisis centers typically provide 24-hour emergency shelter, as well as advice on legal matters and advocacy and support services.
• A counseling or mental health center. Counseling and support groups for women in abusive relationships are available in most communities.
• A local court. Your district court can help you obtain a restraining order that legally mandates the abuser to stay away from you or face arrest. Local advocates might be available to help guide you through the process.

It can be hard to recognize or admit that you're in an abusive relationship — but help is available. Remember, no one deserves to be abused.

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EMDR

EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.

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Gender identity

A person's sex assigned at birth, gender identity — the internal sense of being male, female, neither or both — gender expression and sexual orientation are separate things. They can happen in many combinations. Having a particular sex assigned at birth or gender expression doesn't mean a person has any specific gender identity or sexual orientation.

Learn more about these topics:

• Transgender facts
• Children and gender identity: Supporting your child
• Feminizing hormone therapy
• Masculinizing hormone therapy
• Masculinizing surgery
• Feminizing surgery
• Health concerns for transgender people

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Grief and loss counseling

When a loved one dies, grief can feel like a dagger in your heart. Often, grief triggers raw, intense emotions. You might wonder how you'll ever pick up the pieces and heal your wounds — yet not feel as if you're betraying your loved one's memory.

There are no quick fixes for the grief and anguish that follow a loved one's death. As you face your grief, acknowledge the pain and know that it's part of the healing process. Take good care of yourself, and seek support from friends, loved ones or your healthcare provider.

Although your life will never be quite the same, the searing pain of grief will eventually become less intense. Accepting your new "normal" can help you reconcile your losses and move on with your life.

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Health and lifestyle change

We can help you identify your personal values and provide practical recommendations to help you transform your goals into action and sustain the changes over time.

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Mindfulness-based stress reduction

If you've heard of or read about mindfulness — a form of meditation — you might be curious about how to practice it. Find out how to do mindfulness exercises and how they might benefit you.

What is mindfulness?

Mindfulness is the act of being intensely aware of what you're sensing and feeling at every moment — without interpretation or judgment.

Spending too much time planning, problem-solving, daydreaming, or thinking negative or random thoughts can be draining. It can also make you more likely to experience stress, anxiety and symptoms of depression. Practicing mindfulness exercises, on the other hand, can help you direct your attention away from this kind of thinking and engage with the world around you.

What are the benefits of mindfulness exercises?

Practicing mindfulness exercises can have many possible benefits, including:

• Reduced stress, anxiety and depression
• Less negative thinking and distraction
• Improved mood

What are some examples of mindfulness exercises?

There are many ways to practice mindfulness. For example:

• Pay attention. The next time you meet someone, listen closely to his or her words. Think about their meaning and uniqueness. Aim to develop a habit of understanding others and delaying your own judgments and criticisms.
• Make the familiar new again. Find a few small, familiar objects — such as a toothbrush, apple or cellphone — in your home or office. Look at the objects with fresh eyes. Identify one new detail about each object that you didn't see before. As you become more aware of your world, you might become fonder of the things around you.
• Focus on your breathing. Sit in a quiet place with your back straight, but relaxed. Feel your breath move in and out of your body. Let your awareness of everything else fall away. Pay attention to your nostrils as air passes in and out. Notice the way your abdomen expands and collapses with each breath. When your mind wanders, gently redirect your attention to your breath. Don't judge yourself. Remember that you're not trying to become anything — such as a good meditator. You're simply becoming aware of what's happening around you, breath by breath.
• Awaken your senses. Get a raisin. Sit in a quiet place with your back straight, but relaxed. Look at the raisin. Smell it, feel it and anticipate eating it. Taste the raisin, and slowly and deliberately chew it. Notice the way the raisin's taste changes, your impulse to swallow the raisin, your response to that impulse and any thoughts or emotions that arise along the way. Paying close attention to your senses and your body's reaction to the raisin might reveal insight into your relationship with eating and food.

When and how often should I practice mindfulness exercises?

It depends on what kind of mindfulness exercise you plan to do.

For example, if you choose to closely pay attention to another's words, you can repeat the exercise throughout the day. You might try it when you wake up and talk to your partner, at the beginning of a meeting with a co-worker, or during dinner with your friends or family. Avoid practicing this type of exercise while driving, however. Aim to practice for 15 to 20 minutes, four to eight times a day.

For other mindfulness exercises, such as focused breathing, you'll need to set aside time when you can be in a quiet place without distractions or interruptions. You might choose to practice this type of exercise early in the morning, before you begin your daily routine.

Aim to practice mindfulness every day for about six months. Over time, you might find that mindfulness becomes effortless. Think of it as a commitment to reconnecting with and nurturing yourself.

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Neuropsychological testing

A mental status test to assess your memory and other thinking skills to provide details about your mental function compared with others' of a similar age and education level. This assessment is often done to help your doctor make a judgment about whether Alzheimer's is most likely the cause of your symptoms.

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Parental instruction and training

As a parent, you quickly realize that your bundle of joy also is a bundle of responsibility. Suddenly, you’re looking for reliable information on everything from diapers to driver’s education. Parenting covers a lot of ground, and we offer information and perspectives on raising great kids.

• Children's nutrition: 10 tips for picky eaters

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Relationship counseling

We can help you recognize and resolve conflicts to improve your relationships. 

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Stillborn birth

Mayo Clinic Health System has collaborated with the Mac Initiative, which is a charitable organization that strives to help grieving parents and families cope with stillborn birth or infant loss.

The intention of the Mac Initiative is to help families open the door to healing. The collaboration eliminates barriers for individuals needing mental health support by connecting people with help and eliminating cost barriers.

Through the program, qualifying patients in Minnesota can get up to six free 1-hour therapy sessions. Providers who offer Mac sessions have attended special training to help families who have suffered this type of loss.

The one-hour visits can be held face-to-face or via video. Call 507-594-6955 to schedule an appointment and mention the Mac Initiative. In most cases, patients have their initial appointment within 48 hours of requesting services.

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Stress management

Stress is a normal psychological and physical reaction to the demands of life. A small amount of stress can be good, motivating you to perform well. But multiple challenges daily, such as sitting in traffic, meeting deadlines and paying bills, can push you beyond your ability to cope.

Your brain comes hard-wired with an alarm system for your protection. When your brain perceives a threat, it signals your body to release a burst of hormones that increase your heart rate and raise your blood pressure. This "fight-or-flight" response fuels you to deal with the threat.

Once the threat is gone, your body is meant to return to a normal, relaxed state. Unfortunately, the nonstop complications of modern life mean that some people's alarm systems rarely shut off.

Stress management gives you a range of tools to reset your alarm system. It can help your mind and body adapt (resilience). Without it, your body might always be on high alert. Over time, chronic stress can lead to serious health problems.

Don't wait until stress damages your health, relationships or quality of life. Start practicing stress management techniques today.

Stress relief

The pace and challenges of modern life make stress management necessary for everyone.

To monitor your stress, first identify your triggers. What makes you feel angry, tense, worried or irritable? Do you often get headaches or an upset stomach with no medical cause?

Some stressors, such as job pressures, relationship problems or financial concerns, are easy to identify. But daily hassles and demands, such as waiting in a long line or being late to a meeting, also contribute to your stress level.

Even essentially positive events, such as getting married or buying a house, can be stressful. Any change to your life can cause stress.

Once you've identified your stress triggers, think about strategies for dealing with them. Identifying what you can control is a good starting point. For example, if stress keeps you up at night, the solution may be as easy as removing the TV and computer from your bedroom and letting your mind wind down before bed.

Other times, such as when stress is based on high demands at work or a loved one's illness, you might be able to change only your reaction.

Don't feel like you have to figure it out on your own. Seek help and support from family and friends, whether you need someone to listen to you, help with child care or a ride to work when your car's in the shop.

Many people benefit from practices such as deep breathing, tai chi, yoga, meditation or being in nature. Set aside time for yourself. Get a massage, soak in a bubble bath, dance, listen to music, watch a comedy — whatever helps you relax.

Maintaining a healthy lifestyle will help you manage stress. Eat a healthy diet, exercise regularly and get enough sleep. Make a conscious effort to spend less time in front of a screen — television, tablet, computer and phone — and more time relaxing.

Stress won't disappear from your life. And stress management needs to be ongoing. But by paying attention to what causes your stress and practicing ways to relax, you can counter some of the bad effects of stress and increase your ability to cope with challenges.

Relaxation techniques

Relaxation techniques are an essential part of stress management. Because of your busy life, relaxation might be low on your priority list. Don't shortchange yourself. Everyone needs to relax and recharge to repair the toll stress takes on your mind and body.

Almost everyone can benefit from relaxation techniques, which can help slow your breathing and focus your attention. Common relaxation techniques include meditation, progressive muscle relaxation, tai chi and yoga. More-active ways of achieving relaxation include walking outdoors or participating in sports.

It doesn't matter which relaxation technique you choose. Select a technique that works for you and practice it regularly.

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Tobacco cessation

Nicotine dependence ― also called tobacco dependence ― is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence means you can't stop using the substance, even though it's causing you harm.

Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and lead to dependence. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety.

While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers do.

Regardless of how long you've smoked, stopping smoking can improve your health. Many effective treatments for nicotine dependence are available to help you manage withdrawal and stop smoking for good. Ask your doctor for help.

Symptoms

For some people, using any amount of tobacco can quickly lead to nicotine dependence. Signs that you may be addicted include:

• You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop.
• You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhea.
• You keep smoking despite health problems. Even though you've developed health problems with your lungs or your heart, you haven't been able to stop.
• You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these locations or situations.

When to see a doctor

You're not alone if you've tried to stop smoking but haven't been able to stop for good. Most smokers make many attempts to stop smoking before they achieve stable, long-term abstinence from smoking.

You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the behavioral aspects of nicotine dependence. Using medications and working with a counselor specially trained to help people stop smoking (a tobacco treatment specialist) will significantly boost your chances of success.

Ask your doctor, counselor or therapist to help you develop a treatment plan that works for you or to advise you on where to get help to stop smoking.

Causes

Nicotine is the chemical in tobacco that keeps you smoking. Nicotine is very addictive when delivered by inhaling tobacco smoke into the lungs, which quickly releases nicotine into the blood allowing it to get into the brain within seconds of taking a puff. In the brain nicotine increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior.

Dopamine, one of these neurotransmitters, is released in the "reward center" of the brain and causes improved mood and feelings of pleasure. Experiencing these effects from nicotine is what makes tobacco so addictive.

Nicotine dependence involves behavioral (routines, habits, feelings) as well as physical factors. These behavioral associations with smoking may act as triggers — situations or feelings that activate a craving for tobacco, even if you have not smoked for some time.

Behaviors and cues that you may associate with smoking include:

• Certain times of the day, such as first thing in the morning, with morning coffee or during breaks at work
• After a meal
• Drinking alcohol
• Certain places or friends
• Talking on the phone
• Stressful situations or when you're feeling down
• Sight or smell of a burning cigarette
• Driving your car

To overcome your dependence on tobacco, you need to become aware of your triggers and develop a plan to deal with the behaviors and routines that you associate with smoking.

Risk factors

Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent. Factors that influence who will use tobacco include:

• Genetics. The likelihood that you will start smoking and keep smoking may be partly inherited — genetic factors may influence how receptors on the surface of your brain's nerve cells respond to high doses of nicotine delivered by cigarettes.
• Home and peer influence. Children who grow up with parents who smoke are more likely to become smokers. Children with friends who smoke also are more likely to try cigarettes. Evidence suggests that smoking shown in movies and on the internet can encourage young people to smoke.
• Age. Most people begin smoking during childhood or the teen years. The younger you are when you begin smoking, the greater the chance that you'll become a heavy smoker as an adult.
• Depression or other mental illness. Many studies show an association between depression and smoking. People who have depression, schizophrenia, post-traumatic stress disorder (PTSD) or other forms of mental illness are more likely to be smokers.
• Substance use. People who abuse alcohol and illegal drugs are more likely to be smokers.

Complications

Tobacco smoke contains more than 60 known cancer-causing chemicals and thousands of other harmful substances. Even "all natural" or herbal cigarettes have chemicals that are harmful to your health.

Smoking harms almost every organ of your body and impairs your body's immune system. About half of all regular smokers will die of a disease caused by tobacco.

Women smokers are now at equal risk to men smokers of dying from lung cancer, COPD and cardiovascular disease caused by using tobacco.

The negative health effects include:

• Lung cancer and other lung diseases. Smoking causes nearly 9 out of 10 lung cancer cases. In addition, smoking causes other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
• Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and is related to cancers of the bladder, pancreas, kidney and cervix, and some leukemias. Overall, smoking causes 30 percent of all cancer deaths.
• Heart and circulatory system problems. Smoking increases your risk of dying of heart and blood vessel (cardiovascular) disease, including heart attack and stroke. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have heart or blood vessel disease, such as heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
• Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications, such as kidney disease and eye problems.
• Eye problems. Smoking can increase your risk of serious eye problems such as cataracts and loss of eyesight from macular degeneration.
• Infertility and impotence. Smoking increases the risk of reduced fertility in women and the risk of impotence in men.
• Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, lower birth weight and sudden infant death syndrome (SIDS) in their newborns.
• Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis.
• Weakened senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing.
• Teeth and gum disease. Smoking is associated with an increased risk of developing inflammation of the gum (gingivitis) and a serious gum infection that can destroy the support system for teeth (periodontitis).
• Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails.
• Risks to your family. Nonsmoking spouses and partners of smokers have a higher risk of lung cancer and heart disease compared with people who don't live with a smoker. If you smoke, your children will be more prone to SIDS, worsening asthma, ear infections and colds.

Prevention

The best way to prevent tobacco dependence is to not smoke in the first place.

The best way to prevent your children from smoking is to not smoke yourself. Research has shown that children whose parents do not smoke or who successfully quit smoking are much less likely to take up smoking.

Here are steps you can take to prevent future generations from nicotine addiction and the many diseases associated with smoking:

• Talk to your children about smoking. Tell them about the dangers of tobacco. Encourage them to value good health. You can be a great influence on whether your children smoke, despite what they see in movies and on the web.
• Stay in touch with your teens. Studies show that smoking is most likely to become a habit during the teen years. Ask whether their friends smoke. Those who have friends who smoke are more likely to start smoking than those who don't. Help them plan ways to handle peer pressure. Let your child know that other forms of tobacco, including cigars and smokeless tobacco, also carry significant health risks.
• Promote smoke-free environments. Ban smoking in your home. Support legislation to make all workplaces smoke-free. Encourage smoke-free public places, including restaurants. Become active in community and school-based stop-smoking programs.
• Support legislation to increase taxes on tobacco products. Higher prices discourage teens from starting to smoke. Higher prices on tobacco products, coupled with smoke-free workplace laws, are the most effective public health policies to reduce smoking in adults and prevent young people from ever starting.

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