Tag: health

Embrace Change: The Power of Identity in Personal Growth

Posted on by David Zerella, LCSW in anxiety, cognitive behavioral therapy, personal-growth

A pair of black and blue basketball shoes placed on a stone surface with green grass in the background.

I shared this story with someone recently who was struggling with identity, confidence, and feeling stuck. The more I thought about it, the more I realized it applies to a lot of people—personally and professionally.

Some people will remember the early days of me doing all-out sprints in Jordans. I’m lucky my knees survived.

At the time, it made perfect sense to me.

Not because they were built for running. They weren’t. It made sense because they matched who I believed I was.

Basketball was my sport. Basketball had culture. It had confidence, energy, familiarity. It was part of my history. Running, on the other hand, was something you did for conditioning. It wasn’t something I identified with. It belonged to a different type of person.

That distinction mattered more than I understood.

Because many of us do this in life.

We step into something new while trying to preserve an old identity. We say we want growth, but we bring outdated self-perceptions into new environments. We want new results while staying emotionally attached to the version of ourselves that feels familiar.

That creates friction.

Eventually, after enough feedback, my stubborn ass bought real running shoes.

Small purchase.

Big shift.

The shoes didn’t magically change my life. They didn’t make me faster overnight. They didn’t transform me into a runner.

What they did do was signal that I was ready to take this new chapter seriously.

They helped me stop relating only to who I had been and become more open to who I was becoming.

That’s an important distinction.

Real change usually starts with action. You show up. You practice. You make better choices. You build consistency.

But sustainable change often requires something deeper: a shift in identity.

You stop saying, “I’m trying to do this.”

And start saying, “This is part of who I am now.”

That applies everywhere:

The person trying to become healthier while still seeing themselves as someone who always quits. The professional stepping into leadership while still thinking like they need permission. The person rebuilding after divorce, loss, or burnout while still defining themselves by the old chapter. The entrepreneur trying to grow while still attached to the safety of playing small.

Behavior matters.

But behavior becomes more powerful when it aligns with identity.

I had already started running before I bought those shoes. But it wasn’t until I changed how I saw myself that it started to feel meaningful.

Sometimes the next level of growth isn’t more effort.

It’s updating the story you keep telling yourself.

You don’t need to start running.

You don’t need to buy new shoes.

But if you’re stuck between who you’ve been and who you want to become, remember:

You don’t have to run in Jordans.

Behavioral Activation: Acting Despite Our Feelings

Posted on by David Zerella, LCSW in anxiety, burnout, cognitive behavioral therapy

A male runner wearing a red athletic outfit and number 1950, sprinting on a dry, cracked landscape with a cloudy sky.

People often assume that “feeling better” come before doing better. We tell ourselves:

  • “I feel too anxious to go out.”
  • “I don’t feel motivated enough to exercise.”
  • “I’m too depressed (or negative) to be around others.”

Unfortunately, this approach strengthens our our negative emotions. It rarely works to wait for the emotional change to occur organically. Waiting to feel right usually means waiting indefinitely.

As much as our feelings (and thoughts) can affect our behavior; a core principle of psychology is that our behaviors can also directly affect our feelings. It’s an interactive relationship.

Behavioral activation, is a well-established psychological approach, that relies on the latter principle:

Action often precedes emotional change. We gradually increase our sense of capability as we take more action. We can rewire our perspective on the desired tasks. Instead of I can’t do this, I’m not feeling it: It’s I did this even though I wasn’t feeling it.

The Decision-Making Problem

In therapy, people frequently explain their behavior through their feelings.

  • “I didn’t go to the event because I was anxious.”
  • “I stayed in bed because I was too depressed.”
  • “I said that because I was angry.”

The reasoning feels intuitive.

But it creates a predictable cycle.

  • – Avoiding anxiety strengthens anxiety.
  • – Withdrawing from others reinforces depression.
  • – Reacting in anger escalates conflict.

When behavior is consistently organized around emotions, those emotions can grow stronger rather than weaker.

The Order of Operations

Part of the issue is what I often describe as a reversed order of operations.

Many people live according to this sequence:

Feel → Act → Think

An emotion appears.

Behavior follows quickly.

Reflection happens afterward and usually with disappointment or regret.

This pattern tends to produce impulsive decisions, avoidance, and reinforce a lack of motivation.

A more effective sequence looks different:

Stop → Think → Act → Feel

Pause.

Consider your values or long-term goals.

Decide what would be the preferred way of acting. Then do it regardless. Even if you don’t like it or feel sub-optimal, it’s allowing for your emotional state to adjust over time. The feeling does not need to change first. The behavior does.

Acting Despite How You Feel

Behavioral activation is not about ignoring emotions.

It’s about not allowing them to dictate behavior.

For example:

  • “I went to the event despite feeling anxious.”
  • “I went to the gym despite feeling unmotivated.”
  • “I didn’t react despite feeling angry.”

None of these choices guarantee an immediate improvement in mood.

But they create room for change.

Avoidance almost guarantees the feelings continue and nothing improves.

Action at least allows improvement to occur.

Why Behavior Changes Emotion

Emotions are influenced heavily by behavior and environment.

When someone withdraws, avoids, or reacts impulsively, the environment tends to confirm the original feeling.

  • Isolation reinforces depression.
  • Avoidance reinforces anxiety.
  • Conflict reinforces anger.

When behavior changes, the environment often changes as well.

New experiences create opportunities for different emotional outcomes.

Feelings Are Valid — But Not Always Useful

Acknowledging emotions is important. But it doesn’t mean feelings always win. Feeling are not always helpful for making decisions, partly because they are not always accurate.

They provide information, not necessarily direction. The feeling can be a response to a problem but it isn’t the solution.

In many situations, the most productive approach is simple:

Act according to your values, not according to your temporary emotional state. Start with identifying those values and the version of yourself you would like to be.

The positive feelings will follow.

When Behavioral Activation Helps Most

Behavioral activation is particularly helpful for:

The common theme is the same:

behavior shrinks while negative emotions expand.

Reversing that pattern is where change begins.

An Actionable Step

The next time a difficult feeling appears, pause and ask one of these questions:

“If I were feeling better, what would I do?”

“How will I feel afterwards?”

“What would success look like?”

Then try doing the behavior that most aligns with your answer.

Not because you feel like it.

But despite how you feel.

Why Insight Alone Can’t Change Your Mental Health

Posted on by David Zerella, LCSW in anxiety, cognitive behavioral therapy, psychotherapy
A 3D illustration of a human brain with mechanical gears integrated into its structure, glowing with a soft red light against a pale background.

Most of my clients have incredible insight into their mental health. Many people who attend CBT therapy for anxiety or depression already know what they’re supposed to do. They understand it intellectually but still struggle.

They know when their thoughts are irrational.

They know avoidance worsens anxiety.

They know isolation feeds depression.

And yet—nothing changes.

This gap between knowing and doing isn’t a lack of intelligence. It’s certainly not for lack of effort. It’s a misunderstanding of how psychological change actually happens.

Insight Alone Rarely Creates Change

Cognitive Behavioral Therapy (CBT) emphasizes the connection between thoughts, emotions, and behavior. Understanding your thinking patterns matters. Learning how to challenge unhelpful beliefs matters.

But insight alone rarely leads to sustainable growth.

Many people can accurately identify their cognitive distortions. They can explain why their anxiety “doesn’t make sense.” They may intellectually understand why avoidance keeps them stuck. Yet, they still feel anxious, depressed, or unmotivated. Sitting alone with your thoughts and repeatedly trying to think happy thoughts is not CBT. In fact, trying to think ourselves out of emotional distress often becomes exhausting.

Knowing what would help doesn’t automatically make it easier to do it.

Practice Over Theory

My clinical approach is grounded in Rational Emotive Behavior Therapy (REBT). This is a form of CBT that places particular emphasis on how rigid beliefs and internal demands fuel emotional distress.

From an REBT perspective, we work to replace demands (“shoulds,” “have tos,” and “musts”) with preferences. So we don’t have to do the work—we prefer to do the work, because we prefer to see progress.

But simply put, we still have to practice what we know.

Don’t just talk about it—be about it.

This applies to me as well. I can’t just preach mental health and wellness; I have to actively work at living by it. (Maybe that’s why they call it a private practice). What I practice in private tends to show up in the therapy office.

If I’m burned out, overextended, or ignoring my own limits, that doesn’t stay neatly contained outside of session. Practicing self-care isn’t just something I encourage—it’s something I actively work on. Being present, emotionally attuned, and grounded with clients requires ongoing practice, not just theoretical understanding. I am not alone, nor am I special. This is part of the human experience.

“I Give Great Advice—Just Not to Myself”

Many clients describe themselves as the wise friend—the one who gives thoughtful advice. They validate others’ emotions and see situations clearly from the outside. Yet, they struggle when it comes to their own life.

Often this happens because we:

  • Validate others’ emotions while minimizing our own
  • Apply compassion outward but demand perfection internally
  • Know what helps in theory but avoid it when it feels uncomfortable
  • Let ego convince us we “shouldn’t have to do the work”

This isn’t hypocrisy. It’s human behavior. And it reinforces the same idea: knowing is not the same as practicing.

When You Know What to Do—but Still Can’t Do It

A common frustration I hear in therapy sounds like this:

“I know I shouldn’t isolate, but when I’m depressed I don’t want to burden others.”
“I know structure or exercise would help, but I can’t get myself to start—or even get out of bed.”
“I know no one is judging me at this party, but I’m still worried I’ll look foolish.”

At this point, many people assume something is “wrong” with them. In reality, they’re encountering a very normal limitation of insight-based change.

CBT isn’t about waiting to feel better before acting. It’s about learning how to act while uncomfortable. Or, as I like to say, the beauty is in the work.

Midsteps: Acting Without Needing to Feel Ready

When anxiety or depression is present, meaningful change rarely comes from trying harder or thinking more rationally first. Instead, we focus on midsteps—small, intentional actions that are possible even when motivation is low.

For example:

You don’t go to the crowded store, but you walk to the mailbox
You don’t socialize for hours, but you step outside briefly
You don’t feel confident, but you take action anyway

These steps aren’t about eliminating discomfort. They’re about moving through it—gradually demonstrating to yourself that you can withstand it.

Experiential Knowledge Is What Changes Beliefs

In CBT and REBT, beliefs change most reliably through experience—not logic alone. While we may brainstorm cognitive reframes in session to reduce stress and anxiety, long-term growth comes from experiential learning and resilience-building.

Experiential knowledge is built by:

  • Doing difficult things while anxious
  • Acting while depressed, unmotivated, or self-critical
  • Learning firsthand that discomfort is tolerable
  • Developing resilience to frustration

Sometimes those actions feel empowering. Other times they come with sweating, self-doubt, tears, or a pit in your stomach.

It all counts.

Each experience provides evidence that:

“I can tolerate discomfort and still function. I can withstand this.”

Over time, this weakens avoidance and reshapes emotional responses—not through positive thinking, but through repeated practice.

Therapy as a Place to Practice, Not Just Understand

Therapy isn’t about convincing yourself you shouldn’t feel anxious or depressed.

It’s about learning how to act effectively while you do.

For clients seeking CBT therapy for anxiety or depression, this approach often resonates with people. It particularly appeals to those who value self-improvement. They emphasize personal responsibility and intellectually honest change.

That’s why knowing isn’t enough—and why meaningful progress comes from practice over theory.

High-Functioning Anxiety: Identifying Burnout Early

Posted on by David Zerella, LCSW in anxiety, burnout, perfectionism
An abstract image depicting a person in a thoughtful pose, symbolizing high-functioning anxiety and burnout, with a blue and grey color palette. The text overlay reads 'High-Functioning Anxiety' and 'Identifying Burnout Early.'

High-functioning anxiety often goes unnoticed—not because it isn’t painful, but because it works.

From the outside, it can look like success. Competence. Leadership. Reliability.

On the inside, it often feels like never being able to fully exhale.

Many people with high-functioning anxiety don’t realize they’re burning out until their nervous system forces a stop.

What High-Functioning Anxiety Can Look Like

A close-up of a young businessman with blue eyes and styled hair, looking serious in an office setting, with a blurred figure in the background holding a document.

High-functioning anxiety doesn’t always show up as panic or avoidance. More often, it shows up as traits that are rewarded.

  • Reliability: Always following through. Always doing what you said you would do—often driven by internal pressure, perfectionism, or fear of letting others down.
  • Productivity: A strong need to prove yourself. Seeking reassurance through achievement, output, or external validation.
  • Leadership Skills: Being highly attuned to other people’s needs, moods, and expectations—sometimes at the expense of your own.
  • Problem-Solving: Constantly scanning the environment for potential issues or threats. Always thinking ahead. Always preparing.

These traits can lead to professional or financial success. This is why it’s so hard to identify them and reduce them when needed.

When Functioning Turns Into Exhaustion

Over time, this way of operating takes a toll.

High-functioning anxiety often leads to burnout marked by:

  • Always having to be on.
  • Difficulty enjoying success because you’re focused on preserving it.
  • Impostor syndrome—worrying you’ll be “found out”
  • Future-tripping instead of being present
  • A persistent lack of joy, satisfaction, or ease
  • Rarely stopping to enjoy what you’ve already achieved

You may technically be doing well—yet feel disconnected, restless, or chronically tired.

Why Letting Go Feels So Hard

One of the biggest challenges with high-functioning anxiety is that the anxiety has worked.

It may have helped you:

  • reach goals
  • advance your career
  • create stability
  • earn respect

So the idea of loosening control can feel dangerous.

Many people worry:

“If I stop pushing myself, everything will fall apart.”

From Demands to Preferences

A key shift in reducing burnout and perfectionism is learning to move from demanding thinking to preference-based thinking. We identify demand thinking with buzz words like: should, have to, or must.

Demanding thoughts sound like:

I must succeed to justify my position in life.

I have to hit this metric to prove my worth.

I should be doing more or I am going to fail.

Preference-based thoughts sound like:

I prefer to succeed. (I do not have to succeed in all aspects of my life to be valuable)

I’d like to hit this metric. (I can adapt if I don’t hit each metric for each task. I don’t have to prove my worth)

I want to achieve this goal. (I can accept if I don’t achieve goals exactly when I want. Failure is not fatal)

The difference matters.

When goals become demands, your worth gets tied to outcomes.

When goals remain preferences, effort and value can coexist—even when things don’t go ideally.

Your worth does not increase when you achieve more, and it does not disappear when you fall short.

A close-up of a handwritten note that says 'You are enough' on a lined notebook page.
Photo by Bich Tran on Pexels.com

Learning to Be “Good Enough” on Purpose

For many people with high-functioning anxiety, healing doesn’t come from trying harder—it comes from intentionally doing less.

This can include:

  • Allowing small mistakes
  • Letting yourself under-perform occasionally
  • Resisting the urge to always max out
  • Practicing being uncomfortable without fixing it

This isn’t about lowering standards—it’s about increasing flexibility.

In therapeutic work, this often looks like a form of exposure:

learning to tolerate imperfection and uncertainty so your nervous system can finally stand down.

The Goal Isn’t Less Success—It’s More Presence

A hiker standing atop a rocky peak with arms outstretched, basking in the sunlight against a scenic mountain backdrop.

Reducing high-functioning anxiety doesn’t mean giving up ambition.

It means creating space to:

  1. enjoy what you’ve already built
  2. feel present in your life
  3. experience satisfaction without immediately chasing the next goal
  4. increase self-esteem or self worthiness

Burnout is not a personal failure.

It’s often a signal that the system you’ve been using no longer serves you.

A Gentle Next Step

If this resonates, you’re not broken—and you’re not alone.

You don’t have to wait until everything collapses to get support.

Learning to relate differently to achievement, pressure, and self-worth can restore energy, presence, and a sense of ease that anxiety quietly steals.

Home for the Holidays: Handling Family Stress

Posted on by David Zerella, LCSW in Uncategorized

The holidays have a funny way of amplifying everything—joy, nostalgia, expectations, and yes… family stress. Old roles resurface, familiar buttons get pushed (often expertly), and suddenly you’re reacting like you’re 14 again instead of the well-adjusted adult you worked so hard to be.

The goal isn’t to eliminate stress or conflict entirely (good luck with that!). It’s to manage it in a way that protects your energy, your values, and your sanity—while still allowing for connection, meaning, and maybe even a little fun.

Here are a few grounded (and realistic) ways to get through it:

1. Set boundaries for yourself

Have a game plan for how you want things to go. Boundaries aren’t about controlling other people. They’re about deciding what you will participate in.

This can look like:

  • Having a firm plan for how long you’ll stay somewhere
  • Deciding in advance, “If things escalate or get draining, I’m leaving”
  • Giving yourself permission to step away without over-explaining

Instead of trying to convince others to behave differently, you’re setting parameters for your own behavior. This shifts boundaries from confrontational to self-protective—and that’s usually far more effective.

2. Some conflict is okay (even during the holidays)

The holidays aren’t a conflict-free zone, and they don’t need to be.

People need feedback. If someone is pressuring you, ignoring your limits, or resorting to guilt, it’s reasonable to name what’s happening. You don’t have to shut down, explode, or silently endure it.

Sometimes the most regulated response sounds like:

  • “I’m not going to participate in this conversation.”
  • “That feels like guilt, and I’m opting out.”
  • “I’m open to talking, but not like this.”

Not everyone realizes their behavior is rude—or manipulative—or crossing a line. And even if they do, you’re allowed to acknowledge it in real time. I’m not a big believer in pretending things aren’t happening. You can “let them” do what they’re going to do and still name it.

3. Look for what you like. (Focus on the Fun)

When stress rises, attention narrows. We fixate on what’s annoying, uncomfortable, or disappointing. Focus less on who deserves coal and more on who deserves your presence 😉 

Intentionally look for:

  • People you genuinely enjoy talking to
  • Small moments of calm 
  • Opportunities for humor
  • Environmental pleasures (quiet snow, lights, a warm drink, the family pet)

This isn’t denial—it’s balance. You can acknowledge what’s hard and still orient toward what’s pleasant. Don’t just focus on the problem; focus on the fun, however small or fleeting it may be.

4. Keep nurturing your needs daily

Sacrifice is part of relationships. Losing yourself entirely is not.

Continue doing things that regulate you:

  • Reading
  • Exercising
  • Writing
  • Listening to music…that’s not Mariah Carey (unless that’s your thing—no judgment)

The holidays don’t require you to pause your identity or abandon the habits that keep you grounded. Protecting your energy isn’t selfish—it’s preventative care.

5. Lower the expectation bar (just a little or..)

Many people arrive at holiday gatherings with an unspoken script: This should be meaningful, memorable, peaceful, and deeply connecting.

That’s a lot of pressure.

Sometimes success looks like:

  • No major blowups
  • A few decent conversations
  • Leaving with your nervous system mostly intact
  • Advocating for yourself 

Connection doesn’t have to be profound to be real. Let “good enough” count.

6. Remember: you don’t have to process everything in the moment.

Just because you notice something doesn’t mean it needs to be resolved over mashed potatoes.

Some insights are best saved for:

  • Later reflection
  • Therapy
  • A journal
  • A walk the next day

You’re allowed to observe without immediately engaging. Not every realization needs an audience.

Final Thought

The holidays don’t magically change family dynamics—they just put them under brighter lights. The aim isn’t perfection or total harmony. It’s showing up in a way that aligns with your values, protects your well-being, and leaves room for moments of connection where they naturally exist.

And if all else fails? You can always step outside, take a deep breath, and remind yourself: This is temporary.

Combating the Winter Blues: Understanding Seasonal Affective Disorder and How to Push Back

Posted on by David Zerella, LCSW in Uncategorized

As sunlight fades and winter closes in, many people begin to feel heavier, slower, and less motivated. For some, this shift goes beyond the typical “winter slump.” It becomes Seasonal Affective Disorder (SAD) or seasonal affective disturbances—a recurrent form of depression linked to changes in light exposure and circadian biology.

SAD affects millions of people each year and often presents with symptoms such as:

Lowered mood or irritability

Fatigue or increased sleep

Cravings for carbohydrates or weight gain

Difficulty concentrating

Social withdrawal or decreased interest in activities

These symptoms arise because winter disrupts three key biological systems:

Circadian Rhythm – Reduced daylight throws off the internal clock that regulates sleep, hormones, and mood.

Serotonin Function – Less sunlight can reduce serotonin activity, a neurotransmitter tied to emotional stability.

Melatonin Production – Longer nights may cause melatonin to surge at the wrong times, increasing fatigue and slowing the body.

Understanding the science behind SAD helps reinforce why small, intentional behaviors can make such a meaningful difference.

Below are five research-supported strategies to help combat seasonal affective disturbances:

1. Do One Small Thing You Don’t Want to Do

Why it works:

This technique draws directly from behavioral activation, an evidence-based treatment for depression. When mood dips, the brain reduces activity in the prefrontal cortex (responsible for planning, focus, and action). Taking even a small step—washing one dish, responding to one email, walking for five minutes—re-engages those circuits.

Action precedes motivation.

The brain receives a reward signal (dopamine) when we complete small tasks, gradually lifting energy and mood.

2. Prioritize Sunlight to Reset Your Brain

Why it works:

Sunlight triggers specialized cells in your retina called intrinsically photosensitive retinal ganglion cells (ipRGCs) that communicate directly with the brain’s circadian clock. Just 5–10 minutes of sunlight in the morning can:

Boost serotonin production

Suppress excessive melatonin

Strengthen circadian rhythm regulation

Improve alertness and mood

Sunlight also helps regulate vitamin D, which plays a role in mood and immune function.

Many people experience deficiencies in winter, which may worsen depressive symptoms.

Even brief, intentional exposure makes a measurable difference.

3. Exercise to Activate the Mind–Body System

Why it works:

Physical activity increases levels of endorphins, dopamine, and brain-derived neurotrophic factor (BDNF)—chemicals associated with mood improvement, motivation, and cognitive clarity. Exercise also:

Regulates stress hormones such as cortisol

Improves sleep quality

Enhances neuroplasticity, helping the brain adapt more effectively to stress

Mindful movement (walking, yoga, weight training, stretching) forces presence and interrupts the sedentary patterns that winter often promotes.

Even 10 minutes of daily movement can shift brain chemistry.

4. Tap Into Creative Endeavors to Engage Reward Pathways

Why it works:

Creative activities stimulate the brain’s default mode network (DMN) and enhance dopaminergic pathways, which are tied to pleasure, meaning, and motivation. Engaging in creative expression:

Reduces rumination by occupying cognitive bandwidth

Activates flow states, which increase emotional regulation

Strengthens a sense of purpose, which buffers against depressive symptoms

Writing, painting, crafting, building—these activities create tangible evidence of agency and accomplishment during a season that often feels stagnant.

5. Socialize Outside of Holiday Obligations

Why it works:

Human connection triggers the release of oxytocin, reduces stress responses, and protects the brain against depressive patterns. Social interaction also:

Increases dopamine and serotonin activity Regulates the nervous system through co-regulation

Reduces perceived isolation, a major contributor to SAD symptoms

These interactions don’t need to be deep or long.

A brief chat with a cashier, waving to a neighbor, or engaging someone at the gym can meaningfully stimulate neural pathways linked to belonging.

Micro-social interactions count.

Final Thought

Winter may dim the sunlight, but it does not have to dim you. By understanding the biological roots of seasonal affective disturbances—and pairing that knowledge with small, consistent, science-backed actions—you can build resilience, boost your emotional well-being, and stay connected through the darker months.