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“I had more people crying in my office the day after the election than honestly I’ve had since the day after 9/11,” Dan Hartman, a Philadelphia-based psychiatrist, told Philly.com about his patients’ reactions to Donald Trump becoming president. Four months in, the wounds are still fresh, and the Trump administration, with its trampling of rights, unending legislative chaos and wholesale disregard for the truth, continues to cause millions of heart palpitations, insomniac nights and untreatable migraines.

The White House occupants also remain steadfastly committed to wreaking havoc on our mental states. As Republicans pushed an insurance bill that would have done lasting damage to Americans’ mental and behavioral health well-being, clinicians reported the psychic wages of the Trump war against U.S. citizens. “Add up the additional medications prescribed, extra ER visits, delayed procedures, missed work, plus the fallout from other illnesses being relegated to the back burner, and you have the makings of a major medical toll from this election,” Danielle Ofri, a physician at Bellevue Hospital and professor of medicine at New York University, warned at Slate.

So how exactly is Trump harming our mental states in this moment and for the foreseeable future? Here are five ways, representing just a drop in the bucket, if that bucket were dropped in the middle of the Pacific ocean.

1. Trump Anxiety Disorder

Months before election results came in, nearly a year ago exactly, massage therapists and mental health clinicians began reporting increases in patient anxiety specifically related to fears of a Trump presidency. In a Washington Post article from March 2016, a bipartisan cross-section of Trump Anxiety Disorder sufferers describe coping with panic attacks, insomnia and a cluster of other symptoms one woman rightly summed up as “not a pathological response to a normal situation, but a normal response to a pathological situation.” One therapist interviewed for the piece admitted she was wrestling with her own fright over the prospect of having Trump in the White House. “I’m terrified that he could win,” Mary Libbey, a New York City psychologist told the Post, nailing the horror that is now our reality. “His impulsivity, his incomplete sentences, his strange, squinty eyes — to my mind, he’s a loosely held-together person.”

Writing at Psychology Today, clinical therapist Jeremy Clyman offers advice with a heavy dose of reality: “This new Trump era brings with it a predictable and concrete increase in risk of societal incompetence which, in turn, will create greater sources of distress and injustice and more instances of avoidable harm and stunted progress for all, especially the disenfranchised,” Clyman writes. “In other words, this f**king sucks.”

He goes on to suggest “radical acceptance” of this “painfully harsh reality” as the first step to healing. The next step, according to Clyman, is “to channel [negative] emotions constructively.” He advises against “apathy, withdrawal or violent protest,” instead asserting the afflicted might be helped by “joining peaceful groups and organizations, dispassionate debates with others, and assertions of personal political power (e.g. vote, and blow up your congressman’s cell phone and email, etc.).”

2. The Trump 15

As the name implies, this is a lot like the freshman 15, but without any upsides like losing your virginity at the same time. The Trump 15 is the effect of emotional binge eating and drinking undertaken to blunt the pain caused by witnessing—in real time—the destruction of civilization by a treasonous conman, his band of alt-right ideologues and thieving billionaires, and 63 million accomplices whose voting habits are based in fear and spite. It helps in the short term. “Sugars and fats release opioids in our brains, meaning they basically mimic the effect of the active ingredients in cocaine, heroin and other narcotics,” writes Ivey DeJesus in an explainer of the Trump 15 phenomenon. “The calming, soothing effects we feel when we eat ice cream and mac and cheese are real.”

Art Markman, who teaches psychology at UT Austin, told DeJesus that the best way to curb your cupcake and booze cravings is to distract yourself with activities that make you feel like you have agency and control in this time of crisis and chaos. “Find a charity, nonprofit, or religious group that shares your values and volunteer,” Markman advises. “Help in the community.”