Guided Solutions Therapy SC

11/13/2025

We are currently hiring. Click on the link to find out more.

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09/22/2025

September is Su***de Prevention Month: Let's raise awareness, support one another, and break the stigma surrounding mental health. You are not alone. Find out more here: https://wix.to/0UsLWMe

05/21/2025

Take a few minutes to read this fantastic article written by our very own Brenda Hunter that talks about why May is such an important month.

May is Mental Health Awareness Month 2025: Why It Matters More Than Ever
May marks Mental Health Awareness Month—a time dedicated to breaking the stigma, starting conversations, and encouraging support for mental wellness. At Guided Solutions Therapy, S.C., we believe that healing starts with connection. This is a time to raise our voices, break the stigma, and prioritize well-being.
At Guided Solutions Therapy, S.C., we believe that mental health is just as important as physical health—and that everyone deserves access to care, compassion, and community.

Understanding the Landscape

Mental health challenges are more common—and more openly discussed—than ever before. According to the latest data from the National Institute of Mental Health:

• 1 in 5 U.S. adults (over 57 million people) experience a mental illness each year.
• 1 in 20 adults experience serious mental illness annually.
• 1 in 6 youth (ages 6-17) experience a mental health disorder annually.
• Anxiety disorders remain the most common, affecting over 30% of adults at some point in their lives.
• In 2024, over 35% of adults reported symptoms of anxiety or depression—nearly double the pre-pandemic rate.

These numbers are not just statistics. They represent real people—our friends, coworkers, neighbors, and loved ones—often suffering in silence.
Despite the high prevalence, treatment rates remain concerning. In 2020, only 46.2% of adults with mental illness received treatment, and 64.5% of adults with serious mental illness received treatment.

Why Mental Health Awareness Month Still Matters

Although we’ve made progress, stigma and misinformation still prevent many from seeking help. Mental Health Awareness Month is a chance to:

• Encourage open dialogue around mental well-being.
• Educate others about the signs and symptoms of common mental health conditions.
• Promote access to professional care, especially in underrepresented communities.
• Remind everyone that help is available—and healing is possible.

The Role of Private Practices

Private mental health practices play a crucial role in bridging the treatment gap. They offer personalized care, flexible scheduling, and a range of therapeutic modalities tailored to individual needs. Private practices play a vital role in:

• Offering safe, personalized spaces for growth and healing
• Providing early intervention and ongoing support
• Empowering individuals through education, therapy, and evidence-based care
• Reducing stigma by normalizing help-seeking behaviors

Ways You Can Participate This Month

1. Start a conversation. Ask a friend or coworker how they’re really doing.
2. Share resources. Use your platform to post mental health tips, crisis hotlines, or local services.
3. Take care of yourself. Prioritize rest, boundaries, and connection.
4. Seek support. Therapy isn’t just for crises—it’s for growth and self-awareness too.

We’re Here for You

At Guided Solutions Therapy, S.C., we’re committed to walking alongside our clients through every season. Whether you’re facing anxiety, depression, burnout, or simply need a space to talk, our licensed therapists are here to support you.

This Mental Health Awareness Month, let’s honor the courage it takes to ask for help—and the strength in seeking healing.

Together, we can build a culture that cares.

Need someone to talk to? Reach out to us at www.guidedsolutionstherapy.com.

This month, and every month, we’re here to walk beside you on your journey toward wellness. You’re not alone.



Looking Ahead

As we observe Mental Health Awareness Month, it’s essential to recognize the ongoing challenges and opportunities in mental health care. Private practices are at the forefront of providing accessible and compassionate care.

For more information and resources, consider visiting organizations such as the National Alliance on Mental Illness (NAMI) and the Substance Abuse and Mental Health Services Administration (SAMHSA). These organizations offer valuable tools and support for both mental health professionals and the individuals they serve.

References:

• National Alliance on Mental Illness. (n.d.). Mental Health by the Numbers. Retrieved from https://www.nami.org/mhstats
• Substance Abuse and Mental Health Services Administration. (n.d.). Mental Health Awareness Month. Retrieved from https://www.samhsa.gov/
• Centers for Disease Control and Prevention. (2021, June 28). About Mental Health. Retrieved from https://www.cdc.gov/mentalhealth/learn/index.htm

Learn basic public health information about mental health including causes and types of mental illness.

05/19/2025

We would like to take a moment to announce our newest hire, Luccas Contreras. Luccas not only brings a much needed male presence to our practice but he also brings along a wealth of knowledge of working with a wide range of people's ages. Luccas is starting off part time with us as we work on getting him settled in and start to get a client load for him. Welcome to the family Luccas. You can read more about Luccas here: https://www.gstwi.com/informational-pages

02/13/2025

Are you just not feeling it today? Here are some ways to feel better for the common things we are feeling on a daily basis.

01/13/2025

In today's times, we either know or know of someone that struggles with substance use.
In this article, Brenda talks about the use of harm reduction strategies in private mental health clinics.

What is Harm Reduction in the Treatment of Substance Use?

Harm reduction is a compassionate and pragmatic approach to addressing the complex
challenges of alcohol and substance use disorders. Rather than focusing solely on prevention and abstinence, harm reduction recognizes the reality of alcohol and drug use and aims to minimize its harmful effects on individuals and communities. By offering a range of strategies, from safer use to managed use and abstinence, harm reduction seeks to improve health, dignity, and human rights for those affected by substance use.

Harm reduction originated as a response to the HIV/AIDS crisis in the 1980s, primarily focused on reducing disease transmission among people who inject drugs. Since then, it has evolved into a global public health movement, encompassing diverse strategies tailored to different cultural, social, and economic contexts. The approach acknowledges that substance use is complex and multifaceted, requiring compassionate, nonjudgmental solutions.

Incorporating harm reduction strategies into private mental health practice involves tailoring evidence-based techniques to meet the unique needs of clients within a safe, nonjudgmental therapeutic environment. While traditional substance use treatment often emphasizes abstinence, harm reduction acknowledges that small, incremental changes can significantly improve a client’s quality of life. Some commonly used strategies include:

1. Building a Nonjudgmental Therapeutic Alliance

Establishing a trusting and empathetic relationship is foundational to harm reduction in private practice. Therapists can focus on meeting clients where they are in their recovery journey, respecting their autonomy, and fostering collaboration.

2. Psychoeducation on Safer Practices

Therapists can educate clients about the risks associated with substance use and introduce safer alternatives without pushing for immediate cessation.

Example: For a client who drinks heavily, the therapist might discuss strategies like alternating alcoholic beverages with water, setting limits, or identifying triggers to reduce harm.

3. Goal Setting and Motivational Interviewing

Using motivational interviewing, therapists can help clients identify and prioritize their goals related to substance use. Goals can range from reducing use to improving health or relationships, depending on the client’s readiness to change.

Example: A client might aim to avoid using substances before work or reduce usage on weekends, which can lead to greater self-efficacy and gradual progress.

4. Integration of Mental Health and Substance Use Treatment

Clients with co-occurring mental health disorders may benefit from an integrated approach that addresses both conditions simultaneously. Harm reduction can guide the conversation about how substance use impacts their mental health and vice versa.

Example: A therapist might help a client with anxiety recognize how substances are used as self-medication and collaboratively explore healthier coping mechanisms.

5. Supportive Tools and Resources

Therapists can provide resources such as referrals to needle exchange programs, naloxone training, or low-barrier access to medication-assisted treatment (MAT). For alcohol-related harm, therapists might recommend smartphone apps to track drinking or connect clients to support groups.

Example: Introducing a client to mindfulness techniques or Cognitive Behavioral Therapy (CBT) to manage cravings or stress.

6. Addressing Shame and Stigma

Private practice therapists are uniquely positioned to address shame and stigma surrounding substance use. Reducing stigma is critical to encouraging people to seek help without fear of judgment or discrimination. Normalizing the challenges of addiction and reinforcing a strengths-based perspective can empower clients to make healthier decisions.

7. Family and Systemic Work

For clients whose substance use affects their family dynamics, therapists can involve loved ones in the harm reduction process. Family education and systemic approaches can help create a supportive environment for change.

Example: Encouraging families to shift their focus from stopping substance use to supporting the client’s overall well-being, such as celebrating reductions in use or improved mental health.

8. Using Technology in Harm Reduction

Technology can play a pivotal role in supporting harm reduction. Apps that track substance use, provide access to support networks, or offer guided therapeutic exercises can complement in-session work.

Example: Introducing a client to apps like MyDrinkControl or Reduction Assistant for monitoring and managing their substance use patterns.

Benefits of Harm Reduction in Private Practice
• Client-Centered Approach: Empowers clients by valuing their goals and readiness for change.
• Enhanced Engagement: Reduces defensiveness and increases trust between clients and therapists.
• Improved Outcomes: Gradual change can lead to long-term improvements in health and well-being.

In conclusion, harm reduction offers a humane and effective framework for addressing substance use disorders. By prioritizing health, dignity, and human rights, harm reduction strategies not only mitigate the adverse effects of drug and alcohol use but also empower individuals to make informed choices about their health and well-being. As we continue to confront the challenges of substance use, it is essential to support and expand harm reduction initiatives, recognizing their vital role in building healthier communities.

01/13/2025

Are you someone that absolutely dreads the holidays because of all of the drama and stress that it can produce?
In this article, Angelina talks about ways to navigate the holidays so it can be a little less stressful.

Surviving the Holidays: A Trauma Informed Guide to Navigating a Challenging Season
The holiday season can be a time of joy, but for many, it also brings heightened stress, anxiety, depression, and emotional strain. We idealize the holidays as a time for togetherness and celebration. However, the holidays can be especially difficult for those who are grieving, experiencing financial strain, or dealing with past trauma. External pressures and internal challenges can make this time of year feel overwhelming. If you’re finding the season hard to navigate, you’re not alone. Here’s a trauma-sensitive guide to help you survive and even thrive during the holidays.
Why the Holidays Are So Stressful for Many
There are several reasons the holiday season can feel particularly stressful, especially for those with a trauma history:
• Heightened Expectations: Society often promotes an idealized version of the holidays—perfect family gatherings, flawless decorations, and endless joy. This can lead to feelings of inadequacy, especially if your reality doesn’t match these ideals.
• Family Dynamics: The holidays often bring people together, but for some, this means confronting difficult family relationships or painful memories. Unresolved conflicts or toxic dynamics can make gatherings feel emotionally exhausting and hurtful.
• Financial Pressure: With the emphasis on gift-giving, travel, and elaborate meals, the financial strain can be overwhelming, particularly if you’re already struggling.
• Grief and Loss: The holidays may intensify feelings of grief for those who have lost loved ones, creating a sense of loneliness or sadness that may not be as prevalent at other times of the year.
• Sensory Overload: The lights, sounds, and crowds associated with the season can be overstimulating, especially for those who struggle with anxiety, PTSD, or sensory challenges.

Strategies for Navigating the Holidays
1. Set Realistic Expectations: The pressure to create a "perfect" holiday can be unrealistic and overwhelming. It’s okay if your experience doesn’t match commercials or your friends’ social media posts. You don’t have to participate in everything, and it’s important to honor your emotional and physical limits.
2. Prioritize Self-Care: Self-care is not selfish—it’s essential. If you’re feeling overwhelmed, don’t hesitate to cancel plans, take a day off, or retreat to a quiet space. Engage in activities that help you recharge, whether that’s reading, taking walks, or simply resting.
3. Establish Boundaries: Family gatherings can bring up unresolved conflicts, and it’s important to set boundaries to protect yourself. This might include limiting time with certain people, avoiding triggering topics, or politely declining invitations to events that feel too emotionally taxing.
4. Create a Calm Environment: If the external world feels chaotic, create a sanctuary at home. Surround yourself with things that soothe you—a cozy blanket, your favorite music, or calming scents. A peaceful space can provide a sense of control and help you feel more grounded.
5. Reach Out for Support: You don’t have to face the holidays alone. Reach out to trusted friends, family members, or a therapist who understands what you're going through. Online communities or support groups can also provide a sense of connection and comfort when you need it most.
6. Practice Mindfulness: Mindfulness practices, like deep breathing, meditation, or grounding exercises, can help you stay present and manage feelings of anxiety or overwhelm. These tools can also help you navigate intense emotions that might arise during the holiday season.
7. Honor Your Emotions: The holidays can bring up grief, anger, or sadness—especially if you're mourning a loss or struggling with your past. Allow yourself to feel these emotions without judgment. You don’t need to "fake it" or force yourself into a celebratory mood. Take time to be with your feelings and figure out what you need to soothe yourself.
8. Try Not to Compare: Social media and holiday commercials often highlight the "perfect" holiday moments, but these snapshots aren’t reality. Your holiday experience doesn’t have to match anyone else’s. It’s okay to do things differently and on your own terms.
The holidays don’t have to be a time of heightened stress. By acknowledging why this season can be difficult and using trauma-informed strategies to care for yourself, you can find ways to cope and even enjoy the moments that bring you peace. Whether it’s setting boundaries, practicing self-care, or seeking support, remember: your emotional well-being matters, and it’s okay to navigate the season in a way that feels right for you.
You are not alone—take the holidays at your own pace and give yourself the gift of kindness and understanding.

01/13/2025

Do you have a hard time with the winter months? Here is a great article from our clinician Brenda that talks about Seasonal Affective Disorders.

Seasonal Affective Disorder (SAD): Understanding and Treating SAD in Private Mental Health Practice

As the seasons change, many people experience shifts in their mood and energy levels. While it’s common to feel a slight dip in energy during the darker, colder months, some individuals experience a more significant impact. Seasonal affective disorder (SAD) is a form of depression that typically occurs during the fall and winter months, with symptoms that can severely affect one’s daily life and mental health. Understanding and addressing SAD is vital, particularly for mental health practitioners in private practice who often serve individuals struggling to cope with this cyclical condition.

What is Seasonal Affective Disorder?

Seasonal affective disorder is a subtype of depression linked to the change in seasons, most commonly occurring during the late fall and winter months. The exact cause of SAD isn’t fully understood, but it is believed to be related to reduced exposure to sunlight. The shorter days and limited daylight hours disrupt the body’s internal clock (circadian rhythm), leading to changes in mood, sleep, and energy levels.

SAD is more than just “winter blues.” Individuals with this disorder may experience symptoms similar to major depressive disorder, including:
• Persistent feelings of sadness, hopelessness, or emptiness.
• Fatigue or low energy, even after a full night’s rest.
• Difficulty concentrating or making decisions.
• Changes in appetite, often with a preference for carbohydrates, leading to weight gain.
• Withdrawal from social activities or decreased interest in hobbies.

While SAD primarily affects individuals during the winter months, a smaller subset of people experience a reverse pattern, with symptoms emerging in the spring or summer.

Treatment Options for SAD

Effective treatment for SAD focuses on alleviating depressive symptoms and helping individuals regain a sense of control over their mental health. In a private mental health practice setting, treatment plans are personalized to address each client’s unique experiences and needs. Here are some of the most common and evidence-based treatment approaches:

1. Light Therapy

One of the hallmark treatments for SAD is light therapy, which involves exposure to a light box that simulates natural sunlight. Clients are encouraged to use the device for 20-30 minutes daily, preferably in the morning, to help regulate their circadian rhythm and boost serotonin levels. Mental health practitioners can guide clients on choosing a medically-approved light box and incorporating this routine into their daily lives.

2. Psychotherapy

Cognitive-behavioral therapy (CBT) has been shown to be particularly effective in treating SAD. This form of therapy helps individuals identify negative thought patterns and behaviors that contribute to their symptoms. By working with a therapist, clients can develop healthier coping strategies, such as challenging irrational beliefs about the winter months and engaging in enjoyable activities despite the season.

3. Medications

For individuals with moderate to severe symptoms, antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs), may be prescribed. These medications help increase serotonin levels in the brain, improving mood and energy. Private practitioners help monitor clients taking medications to ensure compliance and address any side effects.

4. Lifestyle Modifications

Encouraging clients to make small but meaningful changes to their lifestyle can have a significant impact on managing SAD. Regular exercise, even just 30 minutes a day, has been shown to improve mood and reduce stress. Additionally, spending time outdoors during daylight hours, maintaining a consistent sleep schedule, and incorporating a balanced diet can all contribute to symptom relief.

Addressing SAD in Private Practice

Private mental health practitioners are uniquely positioned to provide individualized and comprehensive care for clients with SAD. Building awareness about this condition can encourage clients to seek help early. Practitioners can also offer seasonal support groups, workshops on managing winter depression, or resources such as relaxation techniques and journaling prompts.

It’s essential to normalize conversations around SAD and emphasize that it is a treatable condition. Many clients feel relief simply by understanding the biological and environmental factors contributing to their symptoms and learning that they are not alone.

Conclusion

Seasonal affective disorder is a challenging condition that affects millions of individuals each year. Through a combination of light therapy, psychotherapy, medication, and lifestyle changes, mental health practitioners can provide clients with the tools and support they need to thrive during every season. By addressing SAD proactively in private practice, clinicians can empower individuals to navigate the darker months with resilience and hope.

11/16/2024

In conjunction with the Deforest Area Needs Network, we are happy to announce that we have put up a Giving Tree in our waiting room. The tags on the tree represent different children’s needs in our community. Yes, this program directly benefits the children in our community and undoubtedly put a smile on a deserving child’s face this holiday season. You can message us for details if you would like to help out or you can just stop by our office and grab a tag, there are instruction sheets by the tree to explain what to do. Thank You!

08/20/2024

Angelina wrote this excellent article that talks about EDMR and the benefits of using this process in trauma therapy.

Understanding EMDR: A Breakthrough Therapy for Trauma

In mental health therapy, Eye Movement Desensitization and Reprocessing (EMDR) has emerged as a powerful tool in helping individuals process and heal from trauma. Initially developed by psychologist Dr. Francine Shapiro in the late 1980s, EMDR has gained widespread recognition for its effectiveness in treating various forms of psychological distress, including post-traumatic stress disorder (PTSD), anxiety, phobias, and more.

How Does EMDR Work?
EMDR is based on the idea that traumatic experiences can get "stuck" in the brain, causing ongoing distress long after the event has passed. EMDR aims to help the brain reprocess these memories in a way that reduces their negative impact. Unlike traditional talk therapy, EMDR integrates elements of cognitive therapy with bilateral stimulation of the brain, often achieved through side-to-side eye movements or other forms of rhythmic stimulation such as hand-tapping or auditory tones.

The process of EMDR typically involves several phases:
1. History Taking and Treatment Planning: The therapist gathers information about the client's history and identifies specific traumatic memories or current issues that need to be addressed.
2. Preparation: The client learns relaxation techniques and coping skills to manage emotional distress during the therapy sessions.
3. Assessment: The therapist selects specific memories or targets for reprocessing and identifies the negative beliefs associated with these memories.
4. Desensitization: During this phase, the client focuses on the targeted memory while simultaneously engaging in bilateral stimulation (eye movements, taps, or sounds). This step aims to facilitate the brain's processing of the memory, reducing its emotional intensity.
5. Installation: Positive beliefs and emotions are strengthened to replace the negative beliefs associated with the traumatic memory.
6. Body Scan: The client checks for any remaining tension or discomfort related to the memory.
7. Closure: Each session ends with a review of progress and relaxation techniques to ensure the client feels stable before leaving.
8. Reevaluation: In subsequent sessions, the therapist assesses progress and addresses any new material that may arise.

Who Can Benefit from EMDR?
EMDR is particularly effective for individuals who have experienced:
• Trauma: Including childhood abuse, accidents, combat experiences, natural disasters, and more.
• Anxiety Disorders: Such as panic attacks, phobias, and generalized anxiety.
• PTSD: EMDR is recognized as a frontline treatment for PTSD by organizations such as the American Psychiatric Association and the World Health Organization.

What are the Benefits of EMDR?
• Efficiency: EMDR often produces results more rapidly than traditional therapy, with some individuals experiencing significant improvement in as few as three sessions.
• Minimally Invasive: Unlike exposure therapies that require detailed retelling of traumatic events, EMDR can be less distressing for clients while still achieving effective results.
• Long-lasting Effects: Many individuals report that the benefits of EMDR are enduring, reducing symptoms over the long term.

Criticisms and Considerations
While EMDR has gained widespread support, it's not without criticism. Some researchers question the exact mechanisms by which EMDR works, suggesting that bilateral stimulation may not be essential for therapeutic benefit. Others argue that further research is needed to understand its full efficacy across different populations and cultural contexts.

Additionally, not everyone responds to EMDR in the same way. Factors such as the severity of trauma, underlying mental health conditions, and individual differences in response to therapy can influence outcomes.

Conclusion
In conclusion, EMDR represents a significant advancement in trauma therapy, offering hope and relief to countless individuals struggling with the aftermath of disturbing experiences. Its innovative approach, blending elements of cognitive therapy with unique bilateral stimulation techniques, continues to evolve as researchers refine and expand its applications. For those seeking effective treatment for trauma-related disorders, EMDR is a beacon of healing and recovery in mental health.

As awareness grows and more clinicians receive training in EMDR techniques, the potential for broader accessibility and improved outcomes continues to expand, promising a future where trauma survivors can find solace and reclaim their lives with the support of this groundbreaking therapy.

08/20/2024

A fantastic article written by our own Angelina talking about the impacts of social media on our mental health.

The Impact of Social Media on Mental Health

In the age of digital connectivity, social media has become a key part of our daily lives. Platforms like Instagram, Facebook, Twitter, and TikTok offer unprecedented opportunities for communication, self-expression, and community building. However, a growing body of research highlights the complex and often detrimental effects of social media on mental health. Understanding these impacts is crucial for navigating the digital landscape in a healthy way.

The Allure of Social Media

Social media captivates our attention and keeps us engaged. The instant gratification of likes, comments, and shares can create a powerful sense of validation and connection. For many, these platforms provide a space to share achievements, seek support, and maintain relationships. However, this constant connectivity also brings challenges.

Anxiety and Depression

One of the most concerning impacts of social media is its association with increased anxiety and depression, particularly among adolescents and young adults. Excessive use of social media can lead to feelings of inadequacy and low self-esteem. The curated nature of social media feeds, where individuals often present an idealized version of their lives, can create unrealistic expectations and a constant comparison trap.

The phenomenon known as “FOMO” (fear of missing out) exacerbates these feelings. Seeing friends or influencers engaging in exciting activities can lead to a sense of exclusion and dissatisfaction with one’s own life. This perpetual comparison can contribute to anxiety, depression, and a negative self-image.

Body Image and Self-Esteem

Social media also plays a significant role in shaping body image perceptions. The prevalence of edited and filtered images sets unrealistic beauty standards, which can lead to body dissatisfaction and unhealthy behaviors. This is particularly harmful for young women, girls, gender-nonconforming, disabled people, and people of color. Consumers of social media are often bombarded with images promoting what bodies “should” look like. Studies have linked social media use with eating disorders and body dysmorphia. The pressure to conform to these idealized images negatively impacts body image and self-esteem. It’s important to recognize and teach children that these images often do not reflect reality. A more diverse and inclusive representation of beauty is needed on social media platforms.

Cyberbullying and Online Harassment

Another critical issue is the rise of cyberbullying and online harassment. Social media platforms can provide a shield of anonymity for bullies, making it easier to harass, intimidate, or belittle others without immediate consequences. The impact of cyberbullying can be severe, leading to increased stress, anxiety, and even suicidal thoughts and actions among victims.

The pervasive nature of social media means that bullying can occur around the clock, making it difficult for victims to find respite. It's essential for both social media companies and users to take a stand against online harassment, and to promote a culture of respect and empathy online.

Addiction and Mental Well-Being

The addictive nature of social media is another area of concern. Platforms are designed to promote endless scrolling and ping notifications, which can lead to compulsive use. This in turn interferes with daily activities, sleep, and overall mental well-being. The constant need to check social media can create a cycle of dependency, reducing productivity and increasing stress levels.

Misinformation and Mental Health

Social media also plays a role in spreading misinformation about mental health. While there is a wealth of valuable information available, there is also a significant amount of inaccurate and potentially harmful content. This can lead to misunderstandings about mental health conditions and treatments, while also discouraging those in need of professional support.

Navigating the Digital Landscape

Despite these challenges, social media can also be a powerful tool for mental health awareness. Many individuals find communities and resources online that provide validation and help them cope with struggles. Mental health professionals and advocates use these platforms to share information, reduce stigma, and offer support.

To navigate social media in a healthy manner, it’s essential to set boundaries. Limiting screen time, curating your feed to include positive and supportive content, and taking regular breaks can help mitigate the negative impacts. Additionally, promoting digital literacy and critical thinking can empower individuals to discern credible information from misinformation.

The impact of social media on mental health is multifaceted, with both positive and negative aspects. By understanding these dynamics and adopting healthy online habits, we can harness the benefits of social media while protecting our mental well-being. Let’s strive for a balanced digital life where social media serves as a tool for connection and growth, rather than a source of stress and anxiety.