Making Your Mental Health a Priority in 2020

As we begin a new decade, 2020 is testing the mental health of humanity. After the world mourned the loss of Kobe Bryant to start the new year,  we are now in the midst of a global corona virus pandemic with looming public health and economic consequences so severe experts are unable to quantify its impact. With social distancing, stay at home orders, and a host of economic challenges, humanity’s resolve is being stretched past our normal limits. Maybe you made a list of resolutions or life changes you wanted to make in 2020. But, one the is for sure, collectively we must be more diligent in protecting our mental health and develop coping mechanisms to help us endure these turbulent times. 

Based on surveying individuals, it was estimated that, in 2018, 19.1 percent of Americans 18 years old and up had a mental illness in the last year. Maybe you have a mental illness, maybe you don’t. Either way, your mental health is important. So what are some practical things you can work on?

Get sufficient sleep.

The Centers for Disease Control and Prevention (CDC) conveys that a person might have an elevated likelihood of poor mental health, some physical health problems, and dying prematurely if the person regularly doesn’t sleep for sufficient time. They indicate that it is advised for individuals ages 18 to 60 to sleep at least 7 hours a night.

If you’re not making enough time for sleep, now is the time to start. As hard as it may be, tell yourself you’ll finish that television show or those household chores tomorrow.

If you’re having trouble sleeping, there are things you can try. Commit yourself to a regular sleep schedule, going to bed and waking up at the same time every day (yes, even on the weekends). Don’t drink too much caffeine, especially later in the day. Stop using devices that produce blue light (like your smartphone, laptop, and television) at least an hour before bed. Practice relaxation techniques, such as deep breathing exercises.

Exercise.

One of the many reasons to exercise is that it might improve your mental health. Try to find something that you’ll enjoy, so you’ll actually stick with exercising. You might decide to start regularly playing a sport with friends, going to a fitness class, or enthusiastically dancing to some of your favorite music. 

If you have any health conditions that might be made worse by exercising, make sure to talk with your healthcare provider first. Together you can develop a plan that is right for you.

Plan ways to reduce stress.

The National Institute of Mental Health (NIMH) conveys that being stressed long-term could be detrimental: it might play a part in mental and physical illnesses, for instance anxiety, heart disease, and depression. Some things that stress us out are beyond our control. A family member might fall ill or a car might suddenly break down. However, some stressful situations can be avoided with better planning. 

If you find it stressful to do all of your household cleaning on Saturday, make time to do a little bit at a time during the week. If you are stressed as soon as you start reading those class syllabi, sit down with a planner and figure out when you will allot time to work on each thing you need to do (maybe you can start working on that final paper a little earlier so you then have time to focus on studying for exams). Yes, it takes some upfront time investment to plan, and it takes commitment to stick to the plan. However, it might help you feel less stressed (and maybe you’ll do better on those exams too!).

Another important thing to plan? Time to do things that you enjoy. Maybe its hiking or crafting or reading. Determine when you are going to do these things, whether it’s planning to do a specific activity or simply planning to do something enjoyable. Make sure it’s a plan that’s reasonable for your life, and then stick to it.

What about those things that are out of your control, or times when you’re working on what is in your control but still stressed? Relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or mindfulness, might be helpful for you. Research how to do these things, and practice them when you are not feeling stressed.

Take care of your physical health.

Mental health and physical health are connected. Physical health conditions can affect a person’s mental health. For instance, hypothyroidism might make a person feel depressed, and hyperthyroidism might make a person feel anxious. Low vitamin D levels could contribute to feeling depressed.

If it’s been a while since you’ve seen a healthcare provider for a physical, schedule one now. Even if you feel good physically and mentally, a healthcare provider might detect a health concern before it starts causing issues, and some conditions are easily treatable.

Assess your substance use.

For persons who don’t consume alcohol, beginning is not advised by the Dietary Guidelines for Americans 2015-2020. If a person is going to drink and is old enough to do so legally, for men they advise two drinks or less a day and for women they advise one drink or less a day.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides limits for “low-risk” drinking. Low-risk drinking is drinking 7 or fewer drinks in a week as well as drinking 3 or fewer in a day for women. For men, it’s drinking 14 or fewer drinks in a week as well as 4 or fewer in a day. It is recommended that men older than 65 do not exceed 7 drinks a week and 3 a day. For some individuals, it is recommended to not drink at all.

If you are drinking more than these limits, it’s time to reduce how much you drink or quit drinking entirely. However, NIAAA conveys that you shouldn’t try to quit drinking on your own if you might have a dependence on alcohol, as withdrawal could be deadly. Talk with a healthcare provider if you think you might be dependent.

If you are using any illegal substances or misusing any medications, talk with a healthcare provider. It’s important to stop using/misusing these, but stopping without supervision may be dangerous, depending on the substance and other factors.

Seek help.

If you think you might have a mental illness, reach out for help. You can talk with your primary care provider or schedule an appointment with a mental healthcare provider, such as a therapist, psychologist, psychiatrist, or psychiatric nurse practitioner.

A healthcare provider can talk to you about your symptoms and work with you to develop a plan. Therapy and/or medication might be beneficial for you. 

If you are having thoughts of suicide, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255.

Depressed Kids Do Not Have A Look – Identifying Children in Crisis

As the lead social worker in charge of the behavioral health screening protocol at Nemours/Alfred I. duPont Hospital for Children in Delaware, Jessica Williams, MSS, LCSW is responsible for educating clinicians, staff, and families about the one thing they can do to identify kids in crisis: ask them the right questions. “Kids that appear to be depressed, whatever you think that might look like, they might not actually be depressed,” she explains. “And sometimes the kid with a suicide plan has tons of friends and makes straight A’s. We can’t make assumptions based on how a child appears.” As “champion” of the behavioral health screening protocol, Williams manages and evaluates the program, working concurrently with stakeholders at the Delaware Department of Services for Children, Youth, and Their Families.

The program, which went live in November of 2017, aims to screen all patients 12 years of age and older who are admitted to the emergency room. The protocol is first triggered when a nurse receives a best practice alert (BPA) for an eligible patient in the EMR. The nurse then asks the patients to complete a behavioral health assessment on an iPad using a software program called BH-Works. The web-based survey asks patients questions to identify risk level for things like depression, trauma, substance use disorder, bullying, abuse, and suicidal ideation. Responses are automatically scored, summarized, and ready for review in the EMR, helping providers determine when a patient requires additional support. As a licensed clinical social worker, Williams is one of the team members who provides in-person clinical mental health assessments for patients who screen positive for risk.

Williams trains all staff and providers who interact with the BH-Works tool in some way. This roster includes about 150 nurses, social workers, attending physicians, fellows, residents, physician assistants, and nurse practitioners. Additionally, Williams educates ancillary staff who may not interact directly with the tool, but who need to understand the screening process. This includes child life specialists, unit clerks, flow supervisors, and nursing leadership. When Williams joined the ED team in early 2019, she was tasked with reaching out individually to each associate, confirming they knew about the protocol and understood their part in the process.

In addition to reaching out to individual staff members, Williams attends huddle meetings to answer questions, listen to feedback, and share case examples. One of the cases she talks about regularly involves a patient who was put into the fast track section of the ER for a sports injury. When the teen was screened before discharge, he was flagged for critical risk. The teen was severely depressed, experiencing current suicidal ideation, and had made a suicide plan. Hearing these types of stories helped the ER team understand the importance of the protocol. “Initially, the nurses and providers were surprised by those patient stories,” she recalls. “Surprised at first that the protocol was working, and then surprised there were so many kids at risk.”

Williams wanted to help her associates through the inevitable growing pains of a new workflow, so she began troubleshooting issues with the help of an interdisciplinary team, working through a process she coined “collaborative implementation.” Her team actively involved providers and fellow associates as they worked to address kinks in the technology, workflows, and communication plan. “Sure, they know that they have to do this for their job,” she states. “But we’re asking them to do something that isn’t always the easiest or most comfortable thing, so it helps to bring them into the process.”

Based on those suggestions, the team created algorithms to guide nurses and providers through common scenarios, posting them in high-traffic areas. Williams is careful to point out that these algorithms are not hard and fast rules. She explains, “With behavioral health, we can’t always say, ‘Do a,b, and c’ every time a patient screens positive for severe depression. Sometimes that patient is on medication and working with a therapist, and the doctor doesn’t necessarily need to call down a social worker immediately.”

Although the protocol aims to screen all eligible patients, many variables can stop or slow the process. To provide an appropriate course of action in all situations, the team worked with the hospital’s Epic analyst to add buttons to categorize a nurse’s response to the BPA. Armed with that information, Williams was able to audit individual patient charts to understand issues on a case-by-case basis. She identified six common problems and worked with emergency department management to address them. For example, in order to remind providers to review the results, the team’s Epic analyst incorporated the screening report into the discharge process, a time that fit better into some of their workflows.

These collaborative efforts helped to quickly increase the number of patients being screened in the emergency room. The month before the team started their collaborative implementation plan, only 20 patients had been screened using BH-Works. After their first month of strategic efforts, that monthly screening number increased to 180. By the third month, the numbers had jumped to 507. Currently, the team consistently screens between 32-49% of clinically appropriate cases monthly, which is an above average number compared to other emergency departments with similar protocols. The department plans to improve the screening process through 2020, with a goal of screening 100% of clinically appropriate patients.

By the end of 2019, over 3,000 patients had been screened in the emergency room. Out of those patients, twenty-three percent (715 kids) reported symptoms of moderate to severe depression, twenty percent (609 kids) reported significant trauma, fifteen percent (479 kids) reported a history of suicide ideation, and 117 kids were actually contemplating suicide at the time of screening.

Williams is now educating other departments about the program, seeing potential for behavioral health screening throughout the Nemours Health System. She also urges providers across the country to consider implementing similar protocols. “Kids are literal beings,” she explains. “I can’t tell you how many times I’ve asked a kid why they hadn’t shared their feelings with someone before taking this screen, and they tell me it’s because no one had ever asked them. That’s why we have to do things like this. Because there’s no other way to know other than to ask.”

Hardship During the Great Recession Linked with Lasting Mental Health Declines

People who suffered a financial, housing-related, or job-related hardship as a result of the Great Recession were more likely to show increases in symptoms of depression, anxiety, and problematic drug use, research shows. The research findings, published in Clinical Psychological Science, a journal of the Association for Psychological Science, reveal declines in mental health that were still evident several years after the official end of the recession, but were obscured when examining trends in population-level data (e.g., the number of people overall with each mental health outcome).

“Our study provides a new perspective on the impact of The Great Recession, showing that population-level analyses likely miss important patterns in the data,” says lead researcher Miriam K. Forbes, who began the research at the University of Minnesota and now works at Macquarie University in Sydney, Australia. “By looking at individuals’ mental health and experiences of the recession, we could see a different picture.”

“Individuals who experienced even a single recession impact still had higher odds of nearly all of the adverse mental health outcomes we examined – including clinically significant symptoms of depression, generalized anxiety, panic, and problems with drug use – three years after the recession,” Forbes explains. “And these odds were higher still in specific sociodemographic groups who suffered marked losses during the recession or without a strong safety net.”

Forbes and University of Minnesota colleague Robert F. Krueger examined data collected as part of the longitudinal Midlife in the United States study of adults aged 25 to 75. To investigate the impacts of the Great Recession, which officially lasted from December 2007 to June 2009, the researchers focused on data collected in the 2003-2004 wave, three years before the recession began, and the 2012-2013 wave, three years after the recession ended.

Forbes and Krueger examined participants’ symptoms of depression, anxiety, and panic disorder and their symptoms of problematic alcohol and drug use. In the 2012-2013 wave, participants also reported whether they had experienced a variety of recession-related impacts, including financial impacts (e.g., missed mortgage or credit card payments, declared bankruptcy), job-related impacts (e.g, took on an additional job, lost a job), and housing impacts (e.g., moved in with family/friends, threatened with foreclosure).

As observed in previous studies, the prevalence of each mental-health outcome in the full sample remained stable or decreased slightly from 2003-2004 to 2012-2013. But when the researchers looked at mental-health outcomes in relation to the hardships individuals experienced as a result of the Great Recession, the analyses told a different story. Specifically, each hardship experienced was associated with an increased likelihood of having symptoms of depression, generalized anxiety, panic, or problems with drug use. This pattern held even when Forbes and Krueger accounted for participants’ previous symptoms and their sociodemographic characteristics.

The researchers also found that individuals who did not have a college education were more likely to show increased anxiety in relation to job-related hardships. And people not living with a spouse or partner were more likely to have problems with drug use associated with housing-related hardships. These associations may reflect the relative lack of safety net available to people in the job market who have fewer qualifications, or who rely on a single income.

The analyses also showed that people with greater financial advantage were particularly affected by some hardships. Compared with their less-advantaged peers, participants who were well off were more likely to have anxiety symptoms associated with housing-related hardships and were also more likely to have drug use problems associated with financial hardships. These associations may reflect that fact that experiences such as “moving in with friends or family to save money” or “selling possessions to make ends meet” likely signal a substantial loss of assets and a considerable level of hardship for people who were previously living comfortably.

The researchers note that the observational nature of the MIDUS data does not allow them to conclude that recession hardships caused an increase in participants’ symptoms. However, the findings do reveal the limited perspective afforded by aggregate-level analyses – understanding people’s actual lived experiences requires analyses that examine individual-level outcomes and changes over time.

The Great Recession of 2007 to 2009 resulted in huge losses to employment, earnings, assets, and income in the United States and this research shows that those losses were associated with lasting negative mental health outcomes for many individuals.

“These findings suggest the adverse effects of the Great Recession on individuals’ mental health likely compounded and prolonged its economic costs, highlighting that government-funded mental health support following financial recessions may not only ease individuals’ burdens, but could be a sound financial investment that may act to stimulate faster economic recovery following future recessions,” says Forbes.

“These findings may be particularly pertinent given some indications that the next period of economic contraction might begin as early as 2020,” she adds.

Smartphones Help UB Researcher Better Understand the Nature of Depression and Anxiety

Decades of research into anxiety and depression have resulted in the development of models that help explain the causes and dimensions of the two disorders.

For all of their well-established utility however, these models measure differences between individuals and are derived from studies designed using few assessments that can be months or even years apart.

In other words, the models are highly informative, but not optimal for examining what’s happening emotionally in a particular person from moment to moment.

Now, a University at Buffalo psychologist is extending that valuable research to repeatedly and frequently measure symptoms of specific individuals, in real time, to learn how immediate feelings relate to later symptoms.

The research casts anxiety and depression in a manner not previously studied and the results suggest that some emotions linger in a way that predicts feelings beyond what’s happening at specific times. This information could provide treatment benefits for patients struggling with the disorders, according to Kristin Gainey, an assistant professor in UB’s psychology department and the study’s author.

“Clinicians aren’t primarily interested in how one person’s symptoms compare to someone else, which is what most studies focus on. Rather, they’re most interested in how to shift the feelings of someone with anxiety or depression. In other words, they want to understand how to change the emotional experiences of a given individual over time and across different situations,” says Gainey, an expert on emotion and affect in mood and anxiety disorders and a recent recipient of one of the American Psychological Association’s Early Career Distinguished Scientific awards. “The only way to get at that directly is to measure these processes repeatedly within a person as they’re happening.”

To do that, Gainey conducted baseline assessments on 135 participants, each of whom were already seeking some kind of psychological treatment.

Three times a day for 10 weeks, the participants received surveys on their smartphones about their feelings and symptoms. They completed the survey within 20 minutes of its arrival.

“That generated enough reports to provide a good sense for each person’s fluctuations and trajectories of symptoms and affect (defined as the objective feeling state that’s part of an emotion),” says Gainey.

A smartphone provides a portrait of immediacy that questionnaires distributed in a lab that summarize feelings over extended periods are unable to achieve.

“We can’t always remember accurately how we felt days and weeks ago, especially if there were some days you felt really bad and other days you felt great,” she says. “That’s not easy to summarize in a single index.”

Anxiety and depression are each unique disorders, but they often appear together in a single patient. Both disorders share high levels of negative emotions, such as fear, sadness, and anger, while low levels of positive emotions, like excitement and interest, are unique to depression.

Gainey says it’s not surprising that particular affective states, like feeling happy or feeling sad, might be responsible for symptoms experienced soon afterward. What researchers don’t know much about is how long those effects tend to persist, and which specific symptoms they lead to hours or days later.

“This study let us see that some effects were short-lived, but for depression, if you were feeling high levels of negative affect, even if we control for how depressed a participant was at that time, it was still predictive of increased depression 24 hours later,” says Gainey.

That might suggest that clinicians could track peoples’ positive and negative affect in real time and plot trajectories that are indicative of increased risk.

“If we can identify specific risk factors for increased symptoms in real time, we could even use smartphones to send suggestions about helpful strategies or alert the person’s mental health care provider,” she says.

Strong Committed Relationships Can Buffer Military Suicides

Can being in a strong committed relationship reduce the risk of suicide? Researchers at Michigan State University believe so, especially among members of the National Guard.

Suicide rates for members of the military are disproportionally higher than for civilians, and around the holidays the number of reported suicides often increases, for service members and civilians alike. What’s more alarming is the risk of suicide among National Guard and reserve members is even greater than the risk among active duty members.

When returning from a deployment, National Guard members in particular are expected to immediately jump back into their civilian lives, which many find difficult to do, especially after combat missions. Some suffer from post-traumatic stress disorder, depression or high anxiety in the months following their return. These mental health conditions are considered at-risk symptoms for higher rates of suicide.

The researchers wanted to know what factors can buffer suicide risk, specifically the role that a strong intimate relationship plays. They discovered that when the severity of mental health symptoms increase, better relationship satisfaction reduces the risk of suicide.

“A strong relationship provides a critical sense of belonging and motivation for living – the stronger a relationship, the more of a buffer it affords to prevent suicides,” said Adrian Blow, family studies professor, and lead author. “If the relationship is satisfying and going well, the lower the risk. National Guard members don’t typically have the same type of support system full-time soldiers receive upon returning home, so it’s important that the family and relationships they return to are as satisfying and strong as possible.”

The researchers surveyed 712 National Guard members who lived in Michigan, had been deployed to Iraq or Afghanistan between 2010-2013 and reported being in a committed relationship. The study measured three main variables – mental health symptoms, suicide risk and relationship satisfaction – each on a separate ranking scale. The soldiers were asked questions such as how enjoyable the relationship is, if they ever thought about or attempted suicide, how often they have been bothered by symptoms of depressive disorder, etc.

Results showed significant associations between each of the mental health variables (PTSD, depression and anxiety) and suicide risk, indicating that higher symptoms were predictive of greater risk.

However, once couple satisfaction and its interaction with mental health was factored in, the association between mental health symptoms and suicide risk was changed. Specifically, for those with higher couple satisfaction, the increased symptoms of PTSD, depression and anxiety were no longer a risk for suicide.

“Our findings show that more needs to be done to enhance the quality of relationships to improve the satisfaction level and through this decrease the suicide risk,” Blow said. “Having a partner who understands your symptoms may help the service member feel understood and valued. There are family support programs available, but we need to do more to enhance relationships post deployment. Relationships do not get enough consideration in the role they play in preventing military suicides, and I would love to see more attention devoted to this issue.”

Other co-authors included Adam Farero from MSU; Heather Walters and Marcia Valenstein from University of Michigan; and Dara Ganoczy from the Veterans Health Administration. The study was funded by the Veterans Administration. The study was published in the official journal of the American Association of Suicidology.

Music: The Secret to Mental Health and Balance While Aging

No matter where you travel, you’ll notice one universal truth — music has a very particular and powerful hold on us all. Cultures everywhere make and love music. This has been the case throughout history. We have used music to relax, communicate and celebrate — the human brain is hard-wired to react to music. According to Kimberly Sena Moore, a neurologic music therapist, “Your brain lights up like a Christmas tree when you listen to music.”

The magic of music goes much further than entertainment — there a surprising number of health benefits for the elderly, and there is a lot of evidence to support the fact that music is a secret weapon when it comes to maintaining optimal mental health and balance in our old age.

Boost Memory by Learning to Play an Instrument

If you want to ensure your memory is strong well into your winter years, consider picking up an instrument. Regardless of what you prefer to play, the act of learning how to play will sharpen your memory recall. This is because the process of learning and playing an instrument requires a great number of complex tasks, such as reading musical notes and knowing where to place your fingers. In time, this expands your working memory capacity and your ability to multiprocess without feeling overloaded. You will also be able to remember information for longer periods.

Music Can Act as a Stress Reliever

Coping with stress can become more difficult as we get older. We have less resilience to it, and it can affect us differently, which is stressful in and of itself. On top of changes in response to stress, we can experience changes in triggers as the years go by, so it is important we all find a way to cope.

There have been many studies to show music has a notable (and positive) effect on our stress and blood pressure levels. In fact, this is the case even if we’re not conscious. One study involving surgery patients found the use of music before an operation reduced stress levels to an even greater degree than anti-anxiety medication. The act of singing sends small vibrations throughout the body, which lowers cortisol (the stress hormone) levels and releases endorphins, thereby helping to keep you calm and collected in trying times.

Music Can Reduce Falls in the Elderly

Remarkably, studies show when the elderly exercise while listening to music, it helps them maintain balance and reduce the risk of falling. Falling is a huge concern for those over the age of 65, and music might well be the answer. According to a 2011 Swiss study, where participants were trained to walk and perform certain movements in time to music, they experienced 54% fewer falls when compared to the control group. The study also found that walking speed and stride length increased as a result.

A Good Drum Beat Can Kickstart Brain Function

The brain instinctively syncs to a rhythm. Because of this, therapists use drumming to get through to patients with severe dementia who don’t normally respond to external stimulus. When dementia patients hear music, you can detect a noticeable shift. They show more of an interest in their surroundings, they clap to the beat or even sing. This is because music can stimulate many parts of the brain simultaneously. Music which was popular when the patient was between the ages of 18 and 25 generally gets the most positive response.

Music Can Soothe Physical and Emotional Pain

Swedish researchers have found your favourite music can be a great pain reliever, as it can distract us and boost positive emotions. Interestingly, by evoking nostalgia, music can help us get through the pain, both physical and emotional.

Music Can Combat Depression and Boost Happiness

A serotonin imbalance in the brain causes depression. When you listen to music, you experience a boost in serotonin, so music can be used as a tool to combat depression in the elderly. Doctors claim the simple act of singing can release oxytocin, providing a significant mood booster. So while music alone may never entirely relieve the symptoms brought about by depression, it can certainly do its bit to enhance wellbeing.

Music Provides Opportunities for Social Interaction

Music can provide an essential source for social contact, which promotes interaction and a sense of belonging. This is increasingly important as we age. By incorporating music therapy and joining a choir, the opportunities to socialise and collaborate let us make new friendships and create new bonds.

Music Can Improve Quality and Quantity of Sleep

Many seniors don’t get as much sleep as they need, which can cause serious medical issues in time. Lack of sleep has been shown to have a profound and negative impact on mental health and wellbeing. A 2009 meta-analysis found music can improve the quality and quantity of sleep. Of course, the benefits may not happen overnight. But if you persist, in as little as three weeks, you should notice a pay off from this relaxation technique. Some of these include falling asleep faster and remaining asleep for longer.

The Mind-Body Connection

One of the most important things I learned from my experience of depression was how closely linked my physical and mental well-being are.  In the thick of it, I remember many days of trying to figure out why I felt so low.  I talked through with my therapist all the various stressors which could have been affecting me that day. This included all my thoughts and feelings, and possible resolutions to my troubles. Only to figure out later on that I hadn’t had enough sleep the night before…and when I got enough sleep the next night, my mood was hugely improved.

It’s still true if I don’t sleep well, I’ll invariably feel a bit low the next day.  Not to the extent that I’m depressed, but I definitely notice being more irritable and sensitive to things which wouldn’t normally bother me that much.  Being sick is another example of when not feeling great physically affects my emotional resilience and makes everything else that much harder.  On one occasion, when I was horribly sick and sleep deprived, I burst into tears because I dropped my toast, butter side down, on the kitchen floor!

And who hasn’t heard of the phenomenon of being “hangry” ie: getting so hungry you start getting angry.  I’m sure this is a regular for me coming up to lunchtime at work.

The Mind-Body Connection

It seems so obvious now, the mind-body connection is important, but it took me such a long time to figure it out.  For the longest time, I didn’t realise every little fluctuation in my level of happiness didn’t necessarily indicate anything major going wrong other than my body trying to say, “take care of me, please!”  Of course, sometimes there are other things going on when you’re feeling down. But I guess I found it useful to realise that my physical health is connected to my emotional well-being, too.

Now that I’m working as a therapist, I’ve noticed this theme with clients as well.  Whenever someone says to me they are having a bad day, the first thing I ask about is how they’ve slept, whether they’ve eaten, or if they are sick at the moment.  Of course, the answer is not always this simple but I’ve been surprised at the number of people who will say, “Actually, I didn’t sleep at all last night…and now you mention it, no wonder I’m feeling a bit crappy today.”

Separating Mind and Body

These days we are very good at separating mind and body.  Our mind – our thoughts, perspectives, moods, and emotions – almost seems like a completely different thing to our physical experience of the world.

These days, it’s essential to think about our physical and mental well-being as interconnected and it’s equally important to take care of both.  I’m not one to preach about what this might mean for you. I’d be the last person to advocate that everyone should stick to any particular health regime – I’m firmly from the school of doing whatever works for you!

But I think what it boils down to is a little self-care (and for me personally, a healthy dose of balance) is good for both body and mind. I find noticing the effect of one on the other is helpful in understanding my experience of the world.

What are your thoughts on the mind-body connection?

Framing Mental Health from the Biopsychosocial Model

As someone who now works with people experiencing depression, anxiety, addiction and a range of other issues, and being a person who has experienced my own battle with depression, I have my own unique perspective.

Reflecting on his experience at a preview session from the Health Promotion Agency’s National Depression Initiative, Phillip shared his own common and unique experience of depression and anxiety.

Philip talked about his objections to the idea that depression is “an illness, not a weakness” because, in his view, the causes of depression and anxiety are often social factors – and that these problems (and other mental health concerns) need a “social model” rather than a medical one.

Firstly, like Philip, I can see why someone would classify anxiety or depression as “an illness, not a weakness”.  I agree that no mental health problem comes about as the result of a weakness of character and that anyone, anywhere, at any time, can experience these kinds of problems (and indeed, one in five New Zealand’s do in their lifetime).

I think that experiences like depression and anxiety get called “illnesses” as a way of signaling the vast difference between someone when they feel mentally “well”, compared to when they don’t.  Indeed, most of the diagnostic criteria for mental “illnesses” include the fact that the symptoms either cause significant distress to a person, or significant impairment in their day-to-day functioning.

So my take is that “illness” is perhaps used as an inadequate shorthand for “not functioning in the way that I do when I’m feeling whole, connected, supported, complete and satisfied with my life – I’m struggling, help!”

But I agree too, that “illness” also does not feel like quite the right term.  Philip suggests that depression, anxiety, and other mental health concerns can be valid emotional responses when a person is struggling with the state of their life.  As both a therapist and a person who has experienced significant depression, I completely agree.

Philip goes on to suggest that rather than a medical model, we need a “social model” of mental illness.  The thing is, that is exactly what we have and use in mainstream mental health.  We base most modern, evidence-based mental health intervention on what is called the “bio-psycho-social” model of mental illness.  I’ll break this down briefly, with examples.

The Biopsychosocial Perspective

The “bio” part of the model refers to the fact that we are pretty sure that some mental health problems have a genetic component.  Now, this doesn’t mean that if you have a particular gene you are guaranteed to get a particular disorder, rather than your brain chemistry might just be a little bit more vulnerable to developing one, given the right life circumstances.  It’s a bit like heart disease.  Two people can have the same healthy (or not so healthy) diet.  One, who has a particular genetic marker in their family, may have a heart attack; while the other goes on to live a long life with no heart problems.

It’s a bit like heart disease.  Two people can have the same healthy (or not so healthy) diet.  One, who has a particular genetic marker in their family, may have a heart attack; while the other goes on to live a long life with no heart problems.

“Bio” also refers to the fact that experiences like anxiety and depression do affect your physical body just as much as your mental health.  In terms of treatment, many people will find that particular medications help (others don’t, and that’s okay too).  We also know things, like getting enough sleep and exercising a little, can help people manage these problems too.

The “psycho” part refers to your internal functioning – your mind, mental and emotional experience.  When I was growing up, I learned particular ways to think about and manage my emotional experiences, that didn’t really serve me so well as an adult. For example, thinking “negative” emotions like sadness or anger are a bad thing and should not be experienced or expressed…that’s a pretty common right across Kiwi culture, I think.

Part of my recovery involved learning a different way of understanding and managing my emotions. This is generally where therapy can be the most helpful and can heap other benefits as well.

The last is the “social” part of the model.  This is the acknowledgment of the idea that crappy life experiences or a not-so-great situation can significantly contribute to mental health concerns.

Again, treatment often involves helping someone to get themselves into a better or more stable environment, and connecting to good support.  I’ve had many clients realize they needed to do things like end relationships, quit a job or move house, as I did myself, to help improve their mental health.

Now, our mental health system is far from perfect.  There is a massive shortage of resource and funding, as well as an ongoing battle with stigma and discrimination, amongst other issues.  But, for better or worse, that’s a super short summary of the model that the majority of mainstream mental health support services are based on.

So given that we are supposed to be acknowledging, integrating and working with all the parts of a person and their situation – why is it that the message is still out there in the media that mental health problems are a medical, not a social issue?  Is it short-hand, a simplified way of raising awareness that mental health problems are common, and not a character flaw?

Or is it is lack of understanding as to how mental health problems develop, and how we treat them? I’m really not sure on this one – but I’d love to find out.

Loneliness Found to Be High in Public Senior Housing Communities

Older adults living in public senior housing communities experience a large degree of loneliness, finds a new study from the Brown School at Washington University in St. Louis.

Nevertheless, senior housing communities may be ideal locations for reducing that loneliness, the study finds.

“There are many studies on loneliness among community-dwelling older adults; however, there is limited research examining the extent and correlates of loneliness among older adults who reside in senior housing communities,” wrote Harry Chatters Taylor, doctoral student at the Brown School and lead author of “Loneliness in Senior Housing Communities,” published in the Journal of Gerontological Social Work.

The study was co-authored by Yi Wang, doctoral student at the Brown School, and Nancy Morrow-Howell, the Bettie Bofinger Brown Distinguished Professor of Social Policy and the director of the Harvey A. Friedman Center for Aging.

The study examines the extent of loneliness in three public senior housing communities in the St. Louis area. Two of the three complexes were in urban neighborhoods, and the last was located in a suburban neighborhood. All were publicly funded under Section 202 Supportive Housing for the Elderly Program. Data for the project was collected with survey questionnaires with a total sample size of 148 respondents. Loneliness was measured using the Hughes 3-item loneliness scale. Additionally, the questionnaire contained measures on socio-demographics, health/mental health, social engagement and social support.

‘We believe that senior housing communities could become ideal locations for reducing loneliness among older adults.’

Results showed approximately 30.8 percent of the sample was not lonely; 42.7 percent was moderately lonely, and 26.6 percent was severely lonely. In analyzing the data, researchers found loneliness was primarily associated with depressive symptoms.

“We speculate that loneliness may be higher in senior housing communities for a few important reasons,” Taylor said. “The first is older adults residing in senior housing communities often have greater risk for loneliness. In order to qualify to live in these senior housing communities, older adults must have a low income, and having a lower income is a risk factor for loneliness.

“Additionally, most of the residents we interviewed identified their marital status as single, which is another risk factor for greater loneliness. Many older adults living in senior housing communities also have greater health and mental health vulnerabilities, which increases the likelihood that an older adult will experience loneliness.”

Despite all that, the study finds, senior housing communities may be better suited to combat loneliness than traditional residential homes.

“We believe that senior housing communities could become ideal locations for reducing loneliness among older adults,” Taylor said. “Senior housing communities are embedded in communities with peers who may have similar age and life experiences. There are occasional activities and support from senior housing management to encourage the building of friendships, bonds and social support among senior housing residents.

“Most senior housing communities also have a common space or multipurpose room available for use, which can also help facilitate building bonds between residents. Senior housing communities are frequently located close to public transportation, which provides access to transportation for residents without automobiles.”

Still, loneliness is frequently a stigmatized condition, he said.

“We often do not like to talk about our feelings of loneliness,” Taylor said. “For practitioners, it is important to be patient when working with older adults, and it could take a while for an older adult, regardless if they reside in a senior housing facility, to admit they are feeling lonely.

“Whether you are a child, relative or family member to an older adult, or provide services to older adults, be patient when discussing issues of loneliness and mental health with older adults.”

Anxiety in Children: How Can You Help?

Mental health issues amongst children are becoming more and more common, and this is a trend that doesn’t show any signs of slowing down. If you’re a parent or caregiver, it’s a good idea to become familiar with signs of mental ill-health, and think about how you might be able to help.

The first step is to recognize the symptoms. While small experiences of anxiety are a natural part of life, it’s important to recognize when it’s becoming more prevalent, and when it’s having a negative impact on a child. Symptoms might include an irrational and ongoing sense of worry, an inability to relax, general uneasiness and irritability, as well as difficulty sleeping, difficulty concentrating or sudden, unprovoked feelings of panic. Anxiety and depression are not always obvious in children and symptoms can vary significantly depending on the child. Because of this, it’s really important to involve professional medical help if you’re worried about someone in your care.

The second step is to work out if and how to talk about it. Simply letting them know you care can make a big difference. You might like to share a story about times you’ve experienced anxiety. This can be an avenue into a discussion around anxiety, and can provide an opportunity to ask if they have similar worries.

If you’re going to try to help a child with anxiety, there are a few key things to avoid as they can end up being accidentally unhelpful. Avoid phrases like ‘just relax’, or ‘calm down’ as they can escalate the feelings of anxiety and make the child feel like they are doing something wrong. Also consider and be aware of situations that might exacerbate your child’s anxiousness, for example being in loud, crowded places could evoke feelings of uneasiness or panic. It’s important that you can find the balance between understanding and supporting what your child might be going through and acting as a self-assigned counsellor – don’t be afraid to seek professional help if you need to.

The next thing you can think about is how to empower your child to deal with particular triggers. For example, if your child is feeling anxious about a certain event – an exam, public speaking at school, or an upcoming sports game, you may be able to talk with them about whether you can help them to practice or prepare in a way that they might find helpful.

Perhaps practicing a speech in front of you could help them to pinpoint what it is about the experience that’s making them feel anxious. You can’t promise that they’ll ace their presentation or win their sports day, but you can help them practice what they’re concerned about and provide them with tools to manage the anxiety they may feel in these situations. You don’t want to create further anxiety-inducing situations though, so make sure your child is happy to try this out, and mix it up with fun activities too. Revisiting things that they are familiar with and good at can help to develop a sense of capability and foster self-esteem.

When dealing with anxiety, this three-step breathing exercise can be used as a tool to interrupt anxiety as it builds, and it is something you can practice together.

  • Step 1: When you feel tension and anxiety building, stop and close your eyes and take a slow, deep breath in through your nose for 6 seconds.
  • Step 2: Hold it for 2 seconds, then slowly breathe out through your mouth for 4 seconds.
  • Step 3: Repeat this as many times as necessary, gently bringing your focus back to the breath.

If you’re worried about your child, or someone close to you, it’s important to get the advice of a qualified healthcare professional. Anxiety and depression are illnesses that often benefit from a range of treatment options, and often professional support is key to management and recovery.

Depression: Youth, Counseling and Antidepressants

The advent of modern antidepressant medication has been a lifesaver to many. Recent research demonstrates that a combination of counselling and medication can provide the most effective treatment for youth suffering from depression.

However, there is evidence to suggest that in the early stages of medication treatment, there is an elevated risk of suicidal thought, which for some persons may lead to suicidal behaviour. This is causing a great many people to reconsider their use of medication, even when indicated.

This issue is determining which youth will benefit from one or the other or both treatments. To this end a good assessment will look for exogenous factors and endogenous factors.

Exogenous factors are those things outside of the individual that may contribute to depression. These include; family dysfunction, abuse or neglect, parental separation, school related problems and relationship problems. If it can be determined that one or more of these kinds of factors are at play, then counselling alone may be sufficient to treat depression.

Such counselling includes family therapy, or in the case of separated and fighting parents, mediation to help them resolve their conflict, so that the youth is no longer subject to their turmoil. If the youth is in a difficult interpersonal relationship, then counselling for the youth to address the difficulty may be in order. If the youth is abused or neglected, these issues must be addressed and the youth’s safety must be attained.

Endogenous factors generally relate to biological or neurobiochemical factors. If there is a history of depression in the family and there are no known exogenous factors, then medication alone may be the treatment of choice. Often though, with endogenous depression, the sufferer has difficulty controlling depressive thoughts and as such, in this situation a very specific form of counselling, CBT or Cognitive Behavioural Therapy, is also indicated.

There are times of course when both endogenous and exogenous factors are at play. In these circumstances a combination of counselling and medication could be in order and should seriously be considered.

Parents and youth are cautioned against making their decision solely on the basis of newspaper articles proclaiming the good or the bad about any treatment. Depression is a serious disorder, which left untreated can lead to suicidal thoughts, action, injury and death.

If you or your child is depressed, obtain a good assessment by qualified professionals that will look at both endogenous and exogenous factors and devise a treatment plan accordingly. Further, the counsellor and the prescribing physician should be working hand-in-glove following the individual to manage safety issues and communicating regularly about progress.

It is important to know that with antidepressant medication, it can take a good thirty days before the therapeutic effect is achieved. During this time, counselling may be of benefit to resolve other issues as listed above or to simply provide support until the medication reaches effectiveness.

If you or your child is depressed, get help. It is often advisable to start with your family doctor or community clinic. A physician can make the diagnosis and direct you to treatment.

Yoga Effective at Reducing Symptoms of Depression

People who suffer from depression may want to look to yoga as a complement to traditional therapies as the practice appears to lessen symptoms of the disorder, according to studies presented at the 125th Annual Convention of the American Psychological Association.

“Yoga has become increasingly popular in the West, and many new yoga practitioners cite stress-reduction and other mental health concerns as their primary reason for practicing,” said Lindsey Hopkins, PhD, of the San Francisco Veterans Affairs Medical Center, who chaired a session highlighting research on yoga and depression. “But the empirical research on yoga lags behind its popularity as a first-line approach to mental health.”

Hopkins’ research focused on the acceptability and antidepressant effects of hatha yoga, the branch of yoga that emphasizes physical exercises, along with meditative and breathing exercises, to enhance well-being. In the study, 23 male veterans participated in twice-weekly yoga classes for eight weeks. On a 1-10 scale, the average enjoyment rating for the yoga classes for these veterans was 9.4. All participants said they would recommend the program to other veterans. More importantly, participants with elevated depression scores before the yoga program had a significant reduction in depression symptoms after the eight weeks.

Another, more specific, version of hatha yoga commonly practiced in the West is Bikram yoga, also known as heated yoga. Sarah Shallit, MA, of Alliant University in San Francisco investigated Bikram yoga in 52 women, age 25-45. Just more than half were assigned to participate in twice-weekly classes for eight weeks. The rest were told they were wait-listed and used as a control condition. All participants were tested for depression levels at the beginning of the study, as well as at weeks three, six and nine. Shallit and her co-author Hopkins found that eight weeks of Bikram yoga significantly reduced symptoms of depression compared with the control group.

In the same session, Maren Nyer, PhD, and Maya Nauphal, BA, of Massachusetts General Hospital, presented data from a pilot study of 29 adults that also showed eight weeks of at least twice-weekly Bikram yoga significantly reduced symptoms of depression and improved other secondary measures including quality of life, optimism, and cognitive and physical functioning.

“The more the participants attended yoga classes, the lower their depressive symptoms at the end of the study,” said Nyer, who currently has funding from the National Center for Complementary and Integrative Health to conduct a randomized controlled trial of Bikram yoga for individuals with depression.

Elsewhere at the meeting, Nina Vollbehr, MS, of the Center for Integrative Psychiatry in the Netherlands presented data from two studies on the potential for yoga to address chronic and/or treatment-resistant depression. In the first study, 12 patients who had experienced depression for an average of 11 years participated in nine weekly yoga sessions of approximately 2.5 hours each.

The researchers measured participants’ levels of depression, anxiety, stress, rumination and worry before the yoga sessions, directly after the nine weeks and four months later. Scores for depression, anxiety and stress decreased throughout the program, a benefit that persisted four months after the training. Rumination and worry did not change immediately after the treatment, but at follow up rumination and worry were decreased for the participants.

In another study, involving 74 mildly depressed university students, Vollbehr and her colleagues compared yoga to a relaxation technique. Individuals received 30 minutes of live instruction on either yoga or relaxation and were asked to perform the same exercise at home for eight days using a 15-minute instructional video. While results taken immediately after the treatment showed yoga and relaxation were equally effective at reducing symptoms, two months later, the participants in the yoga group had significantly lower scores for depression, anxiety and stress than the relaxation group.

“These studies suggest that yoga-based interventions have promise for depressed mood and that they are feasible for patients with chronic, treatment-resistant depression,” said Vollbehr.

The concept of yoga as complementary or alternative mental health treatment is so promising that the U.S. military is investigating the creation of its own treatment programs. Jacob Hyde, PsyD, of the University of Denver, gave a presentation outlining a standardized, six-week yoga treatment for U.S. military veterans enrolled in behavioral health services at the university-run clinic and could be expanded for use by the Department of Defense and the Department of Veterans Affairs.

Hopkins noted that the research on yoga as a treatment for depression is still preliminary. “At this time, we can only recommend yoga as a complementary approach, likely most effective in conjunction with standard approaches delivered by a licensed therapist,” she said. “Clearly, yoga is not a cure-all. However, based on empirical evidence, there seems to be a lot of potential.”

Geriatric Depression: Symptoms, Risk Factors and Treatments

By: Brian Neese

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Around 7 million of the nation’s 39 million adults ages 65 years and older are affected by depression, according to the Centers for Disease Control and Prevention (CDC). Although a majority of older adults are not depressed, they have an increased risk of developing depression, which is a persistent sad, anxious or empty feeling, or a feeling of hopelessness and pessimism.

Unfortunately, depression in older adults is often not recognized or treated. Symptoms may be mistaken for natural reactions to illness or life changes that occur during aging. Geriatric depression is associated with an increased risk of suicide, decreased physical, cognitive and social functioning, and greater self-neglect, reports the Annual Review of Clinical Psychology.

Due to its consequences, geriatric depression is regarded as a major public health problem. On a more positive note, the CDC says that it is “fairly easy to detect” and “highly treatable.”

Symptoms

Depression can cause feelings of sadness or anxiety that last for weeks at a time. Additionally, a wide range of other symptoms may be present.

  • Feelings of hopelessness, pessimism, guilt, worthlessness and helplessness
  • Irritability and restlessness
  • Loss of interest in activities once pleasurable
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Sleeping difficulties or irregular sleeping patterns
  • Overeating or appetite loss
  • Thoughts of suicide
  • Persistent aches or pains that do not get better, despite treatment

Depressed individuals over the age of 65 are less likely than younger individuals to exhibit dysphoria, which is a state of unease or general dissatisfaction with life, a study in the Journal of Gerontology found. Older individuals with depression are more likely than younger individuals to experience sleep disturbance, fatigue, psychomotor retardation, loss of interest in living and hopelessness, according to Psychological Medicine.

Additionally, older depressed individuals commonly complain of poor memory and concentration. The Archives of General Psychiatry found that patients with late-life depression had slower cognitive processing speed and performed poorer in all cognitive domains.

Risk Factors

“Non-genetic biological risk factors for depression are particularly important in old age,” says the Annual Review of Clinical Psychology. Several factors have been associated with late-age depression.

  • Endocrine dysregulation, bone loss and certain medications (beta blockers, central nervous system medications, hormones, anti-Parkinson agents, certain cancer medications and others) may cause late-life depression.
  • Around 20 to 25 percent of heart disease patients experience major depression, and another 20 to 25 percent experience symptoms of depression not meeting criteria for major depressive disorder, according to Biological Psychiatry.
  • Dementia may be a risk factor for depression, but diabetes is not. Rather, the evidence suggests that depression is a risk factor for diabetes.
  • Stroke patients have the highest rates of major depression (20 to 25 percent) among other neurological disorders. Rates are intermediate (15 to 20 percent) for Parkinson’s disease compared to Alzheimer’s disease (10 to 15 percent).
  • Anxiety disorder and sleep disturbance are also risk factors for depression among older adults.

Social risk factors for depression, though less important in old age, can become more significant in very old age when individuals face greater losses and fewer resources. As with other ages, Psychology and Aging found that late-life depression is linked to the number of stressful life events experienced. Also, troubled relationships can explain depressed older individuals, including spousal depression, marital conflict and perceived family criticism. In The Journals of Gerontology, financial trouble is one of the most common stressful life events experienced by older adults.

Treatment and Prevention

In a review of evidence-based therapies for depression in older adults, Clinical Psychology: Science and Practice named the following as beneficial: behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and reminiscence therapy. A behavioral treatment plan for depression in nursing homes was successful in Clinical Case Studies. It found a strong increase in positive affect and activity level after a 10-session program for increasing pleasant activities was administered. In the Journal of Mental Health and Aging, a meta-analysis found that psychotherapeutic interventions changed self-rated depression and other measures of psychological well-being in older adults by about one half standard deviation and clinician-rated depression by more than one standard deviation.

In 2007, an expert panel recommended home- or clinic-based depression care management (DCM) along with cognitive behavioral therapy for older adults with depression, the American Journal of Preventive Medicine reports. DCM uses a team approach with a trained social worker, nurse or other practitioner alongside a primary care provider who prescribes treatments in consultation with a psychiatrist. Clinical trials link DCM to a reduction in depression symptoms, higher remission rates and improvements in health-related quality of life, reports the CDC.

Prevention efforts are often directed to those who are at an increased risk of disorder. The American Journal of Psychiatry found that treating all patients with subsyndromal depressive symptoms could prevent 24.6 percent of new depression onsets in that period. In Aging & Mental Health, cognitive behavioral therapy demonstrated significant benefits in the prevention of depression in nursing home residents. Treatment of insomnia and other sleep disturbance is a valuable opportunity to prevent depression in older adults, given the highly effective nature of cognitive behavioral treatments for insomnia in this age group. The American Journal of Geriatric Psychiatry identified that individual educational interventions for subjects with chronic illness, individual therapy for at-risk bereaved older adults, cognitive-behavioral interventions to reduce negative thinking and life review were interventions with the most empirical support. Programs to reduce social isolation may also help prevent depression in older adults.

Helping Seniors in the Community

Human services professionals can join healthcare professionals and families to provide support for older adults who have or are at risk for depression. From clinics and nursing homes to homeless shelters, a variety of environments exist where individuals are particularly at risk for developing depression. Professionals trained to work with older adults and lead initiatives in the community can make a difference.

Southeastern University offers an online B.S. in Human Services and an online M.A. in Human Services to positively impact seniors. Both programs equip graduates with the knowledge and skills needed to work in and lead human service environments. The master’s program offers a gerontology specialization, and both degree options take place in a convenient online format.

Journey through the Grief of Homelessness

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Subprime loans, adjustable rate mortgages, unregulated equity lines of credit, mentally ill, physically and verbally abused, veterans, runaway children, drug addicts, and prostitutes are all part of the collectively vulnerable voices journeying through the grief of homelessness.

Homelessness is not prejudiced it crosses socio-economic, religious, educational, mental capacity, gender, veteran status, sexual preference and racial barriers; this destitution occurs in urban, rural and suburbia. Unfortunately, homelessness is an equalizer that causes one to lose hope and pride in the American dream as it becomes more elusive to the average Joe citizen.

Statistically speaking the National Coalition for Homeless Veterans reported that last year 12% of the adult population is veterans and of that total 20% are homeless with co-occurring disabilities and severe mental illnesses. Moreover, the state of our current economic situation and housing condition within the United States has created a social epidemic and high-risk population demographic.

The Tarrant County Homeless Coalition (TCHC) of Fort Worth, Texas, was established to serve the homeless population in Tarrant and Parker Counties. This agency annually conducts a point in time count of homeless individuals. On January 23, 2014, over 2400 people including children were homeless. Moreover, a systemized national survey revealed that over 84,000 were experiencing chronic homelessness. It was 30 degrees. Homelessness is a national crisis.

The Services for Ending Long-Term Homelessness Act (H.R. 1293) was introduced to the House of Representatives on March 4, 2015, by Democratic Alcee Hastings from Florida and currently has 21 cosponsors.  As of March 6, 2015, the health subcommittee received a referral for committee consideration from the House Committee on Energy and Commerce. As of this date, H.R. 1293 has not moved any further through the legislative process.

This Act (H. R. 1293) was proposed to amend the Public Health Service Act of 1944 by establishing sponsorship for supportive services in permanent supportive housing for chronically homeless individuals and families, and for other purposes.  Moreover, organizations that receive funding must treat individuals and families that are identified as chronically homeless and provide mental health and substance abuse treatment; treatment for co-occurring disorders; education on self-sufficiency and other services aimed at eradicating chronic homelessness.

The need for H.R. 1293 to become adopted is of an urgent nature to assist in eliminating homelessness. It is vital that you write, call or visit your local political representatives to ensure that they are aware of this Act and take action to address the issue of transitioning from homelessness to mainstream society it became a never-ending cycle.

This specific legislation could complement the Stewart B. McKinney Homeless Assistance Act, which was the preliminary phase to eradicating homelessness in America. Although this was an attempt to address the issue it was meant for short-term use only; however, few programs did not address the issue of transitioning from homelessness to mainstream society it became a never-ending cycle. Therefore, by enacting H.R. 1293, this amendment would address the gaps in services that exist within McKinney Act. Allowing for funding for advocacy groups, national programs, nonprofit and for-profit organizations to work collectively with heightened public awareness will eventually produce solutions to this global dilemma.

Supporting a National Priority to Eliminate Homelessness stated that the persisting numbers of homeless people in America are an indictment of our collective failure to make the essential ingredients of civilized society accessible to all citizens. Having the public’s best interest in mind and limited resources elected official must focus on the vital needs affecting their communities. The voice and influence in support of H.R. 1293 must come from the public against this grievous offense of homelessness.

Call, email and write your local, state, and federal elected officials and ask why H.R. 1293 has not moved any further through the legislative process. Let them know that we this amendment passed immediately!

Report Provides Rates of Major Depressive Episodes Among Adolescents Across the US

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A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides state-by-state results on adolescents (ages 12-17) who experienced at least one major depressive episode in the past year. Based on combined 2013 and 2014 data, the report shows the prevalence of major depressive episodes among adolescents residing in various states – from a high of 14.6 percent (annual average) in Oregon to a low of 8.7 percent (annual average) in the District of Columbia. Differences over time are also reported.

A major depressive episode occurs when a person experiences a depressed mood or loss of interest or pleasure in daily activities and has at least some other symptoms such as problems with sleeping, eating or concentrating for a period of two or more weeks.

Nationally, 2.7 million adolescents (11 percent) experienced a major depressive episode in the past year – roughly one out of every nine adolescents.

Among the 10 states with the highest rates of adolescents experiencing a major depressive episode four were in the West (listed in order of highest prevalence – Oregon, Arizona, Utah and Washington), three were in the Northeast (Rhode Island, Maine and New Hampshire), two were in the Midwest (Wisconsin and Indiana) and one was in the South (Virginia).

Among the 10 states with the lowest rates, four were in South (Tennessee, Georgia, Kentucky and the District of Columbia), three were in the West (Alaska, New Mexico and Hawaii), two in the Midwest (North Dakota and South Dakota) and one in the Northeast (Connecticut).

The overall rate of major depressive episodes among adolescents rose from 9.9 percent in 2012-2013 to 11 percent in 2013-2014 Thirteen states experienced a statistically significant increase during this period, with the remaining 37 states and the District of Columbia experiencing no real change in the level of adolescents experiencing a past year major depressive episode.

“Adolescence is a critical time in a person’s development, and battling with depression can be devastating for teens unless they receive effective treatment,” said Paolo del Vecchio, Director of SAMHSA’s Center for Mental Health Services. “Effective treatment is available, but parents, teachers and all concerned members of the community must work to assure that adolescents in need get help.”

SAMHSA is helping states, tribes, and communities address this issue through a number of grant programs:

  • The Safe Schools/Healthy Students State Grant Program supports states and communities in their efforts to build early identification and referral systems, to improve access to care, and to implement policy and programming to help children succeed.
  • Project AWARE: Advancing Wellness and Resilience in Education grant programs support widespread mental health literacy training of adults who interact with youth to help them understand the signs and symptoms of adolescents who may be experiencing a mental health problem, and how to connect them to help.
  • The Comprehensive Community Mental Health Services for Children and Their Families Program supports states, tribes and communities to create, expand, and sustain community-based, collaborative, individualized services for children and youth with a serious emotional disturbance that are family-driven, youth-guided, strength-based, and culturally and linguistically competent.

The report entitled, State Estimates of Major Depressive Episodes among Adolescents: 2013 and 2014, is available at: http://www.samhsa.gov/data/sites/default/files/report_2385/ShortReport-2385.html. It is based on data from SAMHSA’s 2012 to 2014 National Survey on Drug Use and Health (NSDUH) reports.

For more information about SAMHSA and NSDUH please visit: .

For more information, contact the SAMHSA Press Office at 240-276-2130.

Paradigm Shift Urgently Needed In Education

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Childhood stress levels are at an all time high. According to the Healthy Young Minds report, around 10 percent of the world’s children today are suffering from diagnosable mental health problems; mainly anxiety, depression, and stress. That’s around 220 million children and young people suffering. And what’s worse, this number is expected to rise. The World Health Organisation states that by 2030, depression will be the number one global health risk. If we don’t act now, this will have a profound negative impact on the world. Our global economy and humanity will feel the brunt of this crisis.

This is a cry for help. Will we answer the call? 

The way to combat this childhood suffering is by creating a paradigm shift in how we currently educate our children. One which addresses both the universoul nature (our inner essence) and intellectual development of children. In the 21st century, children need hope and inspiration. They need guidance toward inner peace as much as they need guidance towards academic achievement.

Parents – including myself – are increasingly stressed and under pressure from longer working hours and less down time. Social media and the internet have shaped a sense of urgency and immediacy in replying to emails; which means the work life has been seeping deeper and deeper into the home life. This makes it nearly impossible to switch off. Children are like sponges. They feel and sense what’s happening around them. It’s no wonder children are also becoming stressed and under pressure themselves.

What is the meaning, purpose and function of education? 

The general purpose of education is to teach children to think critically. In order to attain standards set by the national curriculum, schools put children under pressure to achieve certain outcomes. The Guardian recently reported that stress caused by exams is at an all time high with a 200% rise in requests for counselling specifically because of exams says the NSPCC.

The irony is that whether a child will become a happy and functioning adult with social and emotional capacity is not measured through academic achievement. We might have children coming out of the education system with great intellect but if they are suffering from stress, anxiety, and a lack of emotional competence it does more harm than good. Currently, not enough time is spent on what makes us human beings.

Shifting education in the 21st century

Educators can be pioneers in transforming humanity by providing a curriculum enriched with both universoul and intellectual objectives. Love, empathy, compassion, forgiveness, tolerance, responsibility, harmony and a concern for others are at the crux of the values of humanity and yet it’s missing from education.

Schools need an ethos that promotes children’s universoul well being by providing yoga, meditation, mindfulness, and promoting happiness in schools, as Wellington College has been successfully running since 2006. Teaching children about altruism is another fundamental character trait in healthy social development.

Stress is inevitable in life but if children and young people are able to learn how to understand and manage their own emotions they will become emotionally, mentally, socially, and physically more healthy.

For the sake of our common humanity we must act now. Our future depends on it.

More Than 500,000 Childless Adults to Lose SNAP Benefits This Year

Credit: Mohammad Ali Fakheri/Flickr Creative Commons
Credit: Mohammad Ali Fakheri/Flickr Creative Commons

Within the next year, between 500,000 and 1 million childless adults without disabilities will be dropped from their SNAP, or food stamp, benefits. A three-month time limit exists on benefits for this population, which has been in place since the welfare reform legislation in 1996. Currently, childless adults aged 18-49 without disabilities are the only population subject to this time limit.

The reasons that single, childless adults find themselves on food stamps are varied, as is the group itself. Some of these individuals are chronically homeless, stuck deeply in a cycle of poverty that could feel impossible to break. However, many of them are working, but in either low wage or unstable jobs because their income is either quite low or sporadic. It can be difficult to sustain a stable budget, which leads to the need for SNAP and other forms of assistance.

The welfare reform package of 1996 included a work provision that has made it more difficult for many groups to remain on assistance, even if their income has not increased. During the great recession, which started in 2007 and has had lasting impacts on the economy since, many states received a waiver from the federal government that temporarily allowed benefit recipients to remain in the program while the economy stabilized. Now that the economy has improved, these waivers no longer apply.

The overarching goal of the 1996 welfare reform package was to provide incentives and assistance for people to find work. As a result of this, job training programs should be set up in most places, and many benefits can be kept for the duration of an unemployment period, as long as that individual is looking for work, willing to accept any kind of work that comes along, works less than twenty hours a week, or is in a job training program. While these provisions do apply to SNAP benefit recipients, if they cannot find a spot in a job training program or is working twenty one hours a week, they then become ineligible.

This will have hugely detrimental effects on both the individuals who lose their benefits and their wider community. Being subjected to deeper poverty and food insecurity will almost certainly effect the mental health of these individuals. Being anxious and/or depressed can make it more difficult to find and keep employment, and being unemployed can lead to feelings of anxiety and/or depression, creating a cycle that may feel impossible to break. Additionally, being hungry can make it more difficult to concentrate and impacts memory and overall cognitive functioning, all things that can make finding and keeping work more difficult.

As is often the case in politics, the three-month limit on food stamps for adults without children was not meant to cause long term, systemic harm. In theory, when the economy is strong, people will be able to find jobs that lift and keep them out of poverty and hunger. However, when these jobs are unstable, low-paying, or just plain unavailable, the ruling causes great harm to this population.

First Responder Mental Health: It’s Not All In The Mind

IN THE MIND web2

Our police, paramedics, firefighters and rescue personnel help keep our communities safe. However, the general public does not view this population group as vulnerable. While in the mental health field, doctors, psychologists and social workers are seeing a very different picture with alarming suicide rates and a high incidence of Post Traumatic Stress Disorder (PTSD). Emergency services responders are trained to look after others, but not themselves. It’s a global issue, one that is being increasingly brought to light by the courage of those who suffer and their supporters speaking out.

With many helping professionals working from a traditional medical model, mental health issues among first responders tend to be identified primarily as a response to attending traumatic incidents. Treatment is inclined to be focused on therapies such as CBT, DBT, EMDR and mindfulness. These approaches focus on individual change and evidence certainly suggests that these types of treatments are invaluable in terms of strengthening the individual’s coping and resilience skills.

However, we must be mindful how the systems in which the individual functions will also have an impact on their mental health. When working with emergency services responders and their families, it is vital that therapists and health promotion workers understand ALL the factors which impact wellbeing, not just in response to mental health issues but also in developing prevention strategies.

So, what are some of these “other” factors, or determinants warranting attention when dealing with emergency services wellbeing?

1) Emergency services culture – historically emergency services culture has fostered the ‘toughen up’ attitude, deeming the admission of mental health issues as a ‘weakness’ . Admitting this weakness not only reflects on the individual but also on the ‘brotherhood’ which values pride and strength.

2) Organisational culture- whilst changes are being made in some organisations, there are ingrained fears (real or perceived) from responders that any admission of mental health issues will either deem them unfit for work, or will stop them from getting promoted.

3) Workplace Stigma– there are real and perceived fears of work colleagues judging a responder as ‘weak’, particularly if a number of them have been to the same call outs, but only one speaks out about struggling. A lack of understanding of stress responses and the individuality of conditions such as depression, anxiety and PTSD leads to judgement and alienation of the individual affected, rather than what is needed – support.

4) Societal Expectations – Let’s face it, we all grew up thinking of police, firefighters and paramedics as heroes. They’re the people who protect us, and save our lives! We’ve been taught to listen to their instructions, trust their judgement in crisis and look to them for guidance when in danger. Somehow it doesn’t make sense to acknowledge that these ’heroes’ are human just like us!

5) Lifestyle changes Whether the responder is full time, part time or a volunteer, from the moment of recruitment personal and family lifestyle require changes. Inconvenient rosters, critical incidents, unexpected call outs and changes in household roles and routines are just some of the challenges faced by emergency services responders and their families.

6) Family Support– families of first responders have unique stresses and unique expectations. But it’s difficult to discuss these stresses and expectations outside emergency services circles. Firstly there is this feeling that the general public won’t understand. More significantly, divulging that their responder family member is suffering in some way feels like they’re breaching an unwritten ‘confidentiality code’ such as don’t embarrass the organisation, the crew or the individual by speaking about individual or family mental health issues. What happens on the job stays on the job which extends to family members. There is also the old belief that telling your family about any incidents affecting you will adversely impact that family member’s mental health. Organisational confidentiality regulations support that notion – yet talking about and processing traumatic incidents is critical in any recovery process.

7) Relevant Social Support. When responders experience work related stress, they have a number of barriers to disclosing struggles to friends who are not part of the emergency services culture. One barrier is confidentiality – they are not supposed to discuss the details of their work with anyone from the general public. Secondly, there is the notion (real or perceived) that those who haven’t done the job could not possibly understand what they’ve experienced. Thirdly, there is the reluctance to ‘burden’ civilians with the graphic details of incidents for fear they may end up suffering vicariously as a result of the disclosures.

What advice can those in the helping professions take from this?

If you treat an emergency services person with depression, anxiety or PTSD without understanding the context in which their illness or injury occurred, then you are not only doing your client a disservice, but you could in fact be damaging their potential for an effective recovery. It is vital that you have a genuine understanding of emergency services culture both today and historically.

Secondly, should we as professionals not be advocating on behalf of this group? In Australia alone there are over 400,000 paid, part time and volunteer emergency services responders – add their family members and that’s a huge population group affected by unique stresses! To advocate effectively, helping professionals need to understand the systems their lives function in, and systems which impact on wellbeing and recovery.

Thirdly, there is a strong need to focus on prevention – on a global level the media are telling us there is a “mental health crisis among emergency services workers.” We’ve seen these sorts of reports for years. What is actually happening to prevent mental health issues among emergency services responders? What sorts of consultations are happening? Who is invited to these consultations? Who is the information from these consultations being disseminated to? And what are the results of these consultations “on the frontline”?

No matter what field of practice you are in, I urge you to educate yourself on ALL the factors impacting the mental health of those who keep us, our families and our communities safe.

Holiday Depression and Our Elderly

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When we think of the holiday’s we often think of joyful times with family and friends but for some of our elderly it can be a time of sadness, isolation and loneliness. Seasonal affective disorder (SAD) is prevalent during the holidays and winter season due to issues such as being confined indoors, missing loved ones (living or deceased) or chronic illness/pain.

Depression in the elderly looks different than the younger generations as it can mask itself as health related issues which often causes the depression to go on untreated. For example, symptoms like decreased or no appetite, sleep disturbances, incontinence, chronic pain, memory loss/confusion, mood disturbances and fatigue can be signs physical illness like diabetes or an urinary tract infection but they are also signs of depression.

According to the Center for Disease Control ) approximately 6 million elderly seniors suffer from depression and have the highest rate of suicide because as only 10% get treated for it. If you suspect that your loved one may be suffering from depression express concerns to their doctor as soon as possible. You may also ask for a referral to a psychiatrist for a second opinion.

Signs of depression are sadness, fatigue, loss of interest in socializing, poor appetite, sleep disturbances, loss of self-worth, feelings of hopelessness and increased use of alcohol/drugs and fixation on death.

OTHER RED FLAGS TO LOOK FOR

Unexplained or aggravated aches and pains

Anxiety and worries

Memory problems

Lack of motivation and energy

Slowed movement and speech

Irritability

Neglecting personal care

WHAT TO DO WHEN SOMEONE IS IN IMMINENT DANGER?

Call 911 for emergency services

Go to nearest hospital emergency room

Call National Suicide Hotline toll-free, 1-800-273-8255 or TTY 1-800-799-4889

Call your doctor

What to do when someone is not in immediate danger?

Acknowledge that their pain is legitimate and offer to work together on getting help.

WHERE TO GET HELP?

Family physicians, clinics and health organizations: Can provide treatment or referrals

to mental health specialists.

Mental health specialists: psychiatrists, psychologists, therapists and social workers.

Psychiatrists can prescribe medications as they are actual doctors but the therapist

and social workers work together with doctors to make sure seniors are getting medications and care they need.

Community mental health centers: provide treatment based on ability to pay, and usually have a variety of mental health specialists.

Hospitals and university medical schools: May have research centers that study and treat depression.

What is Superhero Therapy?

Superman-couch

Did you ever want to be a Superhero? Did you ever wish that you could possess magical powers, like Harry Potter, or travel around the world in a time machine, called the T.A.R.D.I.S. with an alien who calls himself The Doctor? What if you could, in a way?

Many of us wish we had some kind of magical or extraordinary abilities, and many of us strongly identify with fictional characters, like Batman, Superman, Buffy the Vampire Slayer, characters from Harry Potter, Firefly, and many others. Recent research findings suggest that identifying with fictional characters can actually be extremely beneficial as it can teach us empathy, remind us that we are not alone in our painful experience, inspire us to eat healthier, and allow us to better cope with difficult life transitions.

The goal of Superhero Therapy, therefore, is to help patients who identify with a particular fictional character to use that relationship with that character in order to identify and process their own experiences and feelings, as well as to encourage them to make meaningful changes in their lives. Thus, the goal of Superhero Therapy is to teach us how to become the very magical Superhero-Jedi that we need in order to become the very best versions of ourselves. Superhero Therapy refers to using examples of Superheroes, as well as characters from fantasy and science fiction in research supported therapy, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Why Superhero Therapy?

Many people have a hard time identifying their own thoughts and emotions, either because it’s too painful, or they’ve never thought about it. I see many patients with posttraumatic stress disorder (PTSD), including active duty service members, Veterans, and non-military civilians. I find that a lot of the time when I ask my patients how they felt at the time of the traumatic event, or even about which emotions they are experiencing in the present moment, many state that they aren’t sure or do not wish to answer.

However, discussing how a specific character felt at a given moment can be helpful in understanding our own emotions. For example, in the Defense Department’s recent efforts to assist Veterans with PTSD, they’ve contracted an independent company, Theater of War, to put on theatre plays for Veterans with combat-related themes, based on Ancient Greek plays. One of these plays, Ajax, for example, tells a story about a character struggling with his symptoms after the war and eventually committing suicide. Veterans and their spouses who saw the play reported that the play helped them understand their own emotions by relating to the characters. One Veteran in particular was moved by the play, stating: “I’ve been Ajax. I’ve spoken to Ajax.”

Talking about fictional characters’ emotional experiences might seem safer than talking about our own, so with my patients, that is where we often start, later drawing parallels to their own feelings and subsequently switching over to focusing on those. For instance, many service members and Veterans I’ve worked with strongly identify with Superheroes, in particular, Batman, Superman, and The Hulk. Let’s take a look at Superman.

Superman (real name Kal-El) is a comic book character who is an alien from another planet, Krypton, who was sent to Earth as a child. His Earth name is Clark Kent, and while in the Solar System, including Planet Earth, he appears to have superhuman abilities: he possesses super strength, super speed, he can fly, he can fight, he has X-ray vision, and many other cool powers. It is no surprise that Superman is a role model to many service members and Veterans, who believe him to be invincible. The phrase or a variation of the phrase I often hear in this population is “I wanted to be Superman… I failed.” This is a common response many people have, harshly judging their own experiences of having PTSD. This is a common dialogue I’ve engaged in with many of my patients:

Patient: “I just feel like such a failure.”

Therapist: “What makes you say that?”

Patient: “I wanted to be like Superman, you know? Strong.”

Therapist: “And now you don’t feel that way?”

Patient: “No, I have PTSD.”

Therapist: “And what does that mean about you?”

Patient: “It means that I’m weak.”

Therapist: “Wow, that’s harsh. Let me ask you this, did Superman have any vulnerabilities?”

Patient: “No.”

Therapist: “No?”

Patient: “Well, there’s Kryptonite…”

Therapist: “Right. What is it and what does it do?”

Patient: “Kryptonite is this radioactive material from Krypton, where Superman was born. It takes away his powers and can kill him.”

Therapist: “So Kryptonite makes him vulnerable?”

Patient: “Yes.”

Therapist: “And does this make him any less of a Superhero?”

Patient: “No, of course not… Oh, I see what you mean, that having PTSD doesn’t mean I’m not Superman.”

This is an example of how cognitive behavioral therapy (CBT) could look when using Superhero examples in session. CBT is a type of therapy that looks at the relationship between thoughts, feelings, and behaviors, which are bidirectional, meaning that they affect one another. In the example above, the patient’s thought: “because I have PTSD, that means I’m weak, and I failed in being Superman” is affecting his feelings (making him feel more depressed) and is affecting his behavior (for example, not wanting to socialize with others).

Some of the thoughts we have might not be 100% accurate, often leading to some painful emotions, and maladaptive behaviors. By challenging the validity of the thoughts (testing to see whether or not the thought is accurate), we can get out of the maladaptive loop. A CBT therapist’s job is to teach a patient how to implement the skill of challenging their own thoughts, to change the maladaptive behaviors in order to help the patient recover, as well as become their own therapist, to be able to help themselves in the future.

The other type of therapy that lends itself nicely to Superhero Therapy is acceptance and commitment therapy (ACT). I often describe it as Superhero Training, as ACT teaches us to become the very Superhero (or witch/wizard, vampire slayer, Jedi, or any other title that seems most helpful) that we wish to be by following our values, (the most important things to us, like family, friends, creativity, altruism, spirituality, and others), and by facing whatever dragons show up along the way (thoughts, feelings, personal stories we tell ourselves, such as “I’m a failure” or “I’m not good enough”) and practicing the Jedi-like skill of mindfulness.

Let’s take a look at how Harry Potter can be used in therapy to teach us some of these skills. Briefly, Harry Potter is a young wizard in training, whose parents were killed by Lord Voldemort, an evil wizard. Harry and his friends, Ron and Hermione, are studying magic at Hogwarts School of Witchcraft and Wizardry. When Lord Voldemort and his followers, the Death Eaters, start to come back to power, aiming to exterminate all non-magical humans (called Muggles), as well as all Muggle-born witches and wizards, it is up to Harry and his friends to stop them.

In the first book of the Harry Potter series, Harry, Ron, and Hermione find out that Lord Voldemort is attempting to come to power by trying to steal the Philosopher’s Stone, which grants immortality to its owner. In trying to stop him, Harry and his friends have to undergo a series of dangerous tests. One of them, the Devil’s Snare, is a magical plant that uses its tentacle-like branches to suffocate the person that touches it.

The Devil’s Snare presents a great ACT metaphor of acceptance and experiential avoidance: the plant seems to respond to tension levels, the more one struggles with it, the tighter its grip and the more likely it is to choke them. This is experiential avoidance, trying to escape the present experience, and just like the Devil’s Snare, in most cases, the more we try to escape, the deeper our struggle becomes. However, if we stop struggling and are willing to experience this discomfort (acceptance), then we are more likely to survive – when Hermione lets go of the struggle with the plant, for example, the Devil’s Snare releases her.

Here is how Superhero Therapy using ACT can look in a clinical setting. One of my clients was struggling with panic disorder and was too scared to go to places where a panic attack might take place and where escape might be difficult (this is called agoraphobia). The patient (let’s call her “Lucy”) stated that as a result of her fears of getting additional panic attacks she had to drop out of college, move back in with her parents, was unable to spend time with her friends, was unable to volunteer in a community theatre, which was something she really enjoyed, and essentially put her life on hold. While she did not have many panic attacks when staying at home, Lucy’s life became constricted, based solely around her anxiety disorder. Lucy stated that she would not be willing to go to unfamiliar places until her panic attacks went away completely and she was absolutely sure that they would not happen again. Her thoughts, such as “if I go out, I will have a panic attack” and “I’m weak” prevented her from living the kind of life she wanted.

In our sessions together we talked about the Harry Potter series; her favorite character was Harry’s friend, Ron Weasley. She said that she identified with Ron because of his fear of spiders. While Lucy herself did not have a fear of spiders, she stated that she could relate to Ron because “he knows what it’s like to be really scared, he gets so overwhelmed by spiders that he can’t even move. That’s exactly how I feel.”

In discussing Ron in therapy, Lucy was able to identify that as scared as Ron was of the spiders, when it was really important, specifically, when Hermione was Petrified (turned to stone) by an unknown monster in Harry Potter and the Chamber of Secrets, Ron (as well as Harry) followed the spiders into the Forbidden Forest in order to get the information needed to save Hermione and other Petrified students. This is a great example of the ACT concept of values. No one who read the books can deny that Ron was terrified when he followed and interacted with the spiders. He was probably also doubting his own abilities and might have had many insecure thoughts, such as “I will fail,” or “I’m not good enough,” or maybe even “I’m a coward.” And yet, despite his fear he was able to follow through, he was willing to experience whatever terrifying emotions and thoughts showed up in order to save his friend, showing true courage and heroism.

I will never forget the first time that Lucy and I drove around her block as a part of her facing her fears. She was trembling and was saying that she did not think that she could do it. However, she got behind the wheel, tightened her Gryffindor scarf, and turned on the engine. It took less than 5 minutes to go around the block and when we were finished Lucy was ecstatic. She was in tears, she was laughing, and saying, “I can’t believe I just did that!”

Lucy and I continued working on taking “superhero steps” in her valued direction and practiced driving to a movie theatre and other locations. Lucy still gets anxious sometimes but just like a true Superhero that she is, she courageously goes out with her friends, she’s back in school, and has even traveled abroad with her family.

I always say that the bravest people I know are my patients. It takes a lot of courage to experience overwhelming, and at times, incapacitating, anxiety, to come to treatment, and to face our fears. Many people believe that fear is bad, something that needs to go away for us to live a normal life. However, fear can actually be quite advantageous. In a recent Doctor Who episode, Listen, we learn that fear can be a Superpower. Doctor Who is a British science fiction TV show about an alien, who calls himself The Doctor. The Doctor travels around the universe in a time machine, called the T.A.R.D.I.S. (which stands for Time and Relative Dimension in Space) and saves those in need.

The Doctor is over 2,000 years old, and seems to know a thing or two about fear. His take is this: Fear is a Superpower. Fear causes the release of adrenaline, which makes us think faster and fight harder, suggesting that we don’t need to run away from fear, fear might actually be helpful.

The bottom line is that running away from fear and not living our lives according to our values isn’t helpful, whereas learning how to face our fears in the service of what’s most important to us, that’s what being a Superhero is all about.

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