Category: Stress

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Times are uncertain. The world feels scary. Our normal day to day life has been turned upside down. Let me just start by saying this, if you are feeling anxious, scared, overwhelmed, frustrated… you are allowed to feel these emotions, it makes total sense why you feel this way, you are not alone, and you are not weak. Remember, pain in life is unavoidable, but suffering is a choice. Meaning, we are going to experience stress in our life, every person on this planet will, but it is ultimately how we respond to that stress that influences exactly how much pain we will experience. Let’s walk through some ways we can live with anxiety during times of stress.

Mindfulness of Emotions. When it comes to managing our anxiety during times of stress, an important first step that we tend to overlook is mindfulness. In order to reduce anxiety, we must first acknowledge that it is there. Allow yourself to pause and put a name on what you are feeling, notice if you feel it physically in your body, observe what thoughts are running through your mind. Try using the stem “I am aware of the emotion of ______, I am aware of the thought that _______.”  By bringing mindful awareness to our anxiety in this way, we are bravely choosing to face our discomfort while also seeing it as something that we are experiencing in that given moment, not who we are or the way things will always be.

Self-Compassion. Now that you are observing your anxious mind in action, practice some self-compassion by normalizing the experience, validating its’ presence, being “kind to your mind.” We tend to create more suffering for ourselves when we judge ourselves for our emotions, when we tell ourselves we should not be feeling that way, or try to just “suck it up.” You are an amazing human doing the best you can with some really hard human things right now!

Changing Emotional Response. While part of our goal is accepting the anxiety through mindfulness and self-compassion, we also have the ability to create change in our emotional state and our response to it. First, we need to “check the facts” and get a good look at what our mind is telling us. Our minds tend to be great storytellers, mind readers, and fortune tellers. While these seem like super powers, these are actually mind tricks and traps that create more suffering. Checking the facts is seeing if your emotion and its’ intensity actually match reality (i.e., are valid), or if you are responding to a mind trick.

Next, ask yourself if the action urge associated with the emotion you are feeling is effective? For example, is being angry with your partner because they did not clean the house then throwing a shoe at them actually helpful here??  If the emotion is invalid and/or ineffective, we want to act opposite to what the emotion is telling us to do. So instead of avoiding work responsibilities because we are stressed, make a specific schedule to complete tasks. Instead of spending hours reading the news because we are scared, watch one news program then spend the rest of the day playing with the kids or watching movies.

Acceptance. Consider what is and what is not in your control. If there is a stressor that is in your control, practice problem solving. For stressors we cannot control, accept that we cannot change that reality and focus instead on what in the here and now is in your power. Remember, rejecting reality does not change reality. Instead of dwelling on how terrible it is to be stuck at home, make plans for a game night, clean out that room you have been avoiding, soak up the springtime outdoors.

Practice Gratitude. Lastly, practice gratitude every day. Spend some time thinking about what you have that you are grateful for rather than hyper-focusing on what you don’t have or what has been taken away, which tends to just create more stress. Be specific, instead of just saying you are grateful for your family, say “I am grateful that today my kids helped clean the kitchen and cuddled with me on the couch.”

We as humans are under an incredible amount of stress right now, but remember, as humans we are also incredibly strong and resilient.  Importantly, please know you do not have to struggle with this alone. Sometimes the strongest thing we can do is ask for help. If your anxiety is persistent and intense and/or is significantly interfering with your life, please reach out to a mental health therapist. Telehealth services are being offered across the region, including at the Lindner Center of HOPE, who has a whole team of providers eager to help guide you through this.

By Allison Mecca, PsyD
Lindner Center of HOPE, Staff Psychologist, Harold C. Schott Foundation Eating Disorders Program

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Quarantine.Isolation . Lockdown.

Who could have ever predicted that these words – so often associated with scary movies or rare, brief safety emergencies – would become so commonplace in our social language? The terms, themselves, being so casually thrown around that we’ve nearly become numb to their actual magnitude? The concept of loneliness is a broad one: certainly, this can describe distance or literal, geographical separation from others; however, it is also quite possible to experience loneliness while physically surrounded by people. This often arises in response to feeling misunderstood or “different” from those around us, or through a belief that we are truly alone in our struggles and suffering.

 

When in this state of mind, it’s easy to inadvertently fall into self-destructive patterns and habits that further worsen the depth of isolation we experience. This tends to be easier to “catch” in the “normal” world – someone is missing days at work or school, not showing up to family events, skipping appointments. However, in the midst of the COVID19 pandemic, this has become more difficult to identify, both in ourselves and in family members or friends. In this strange new reality, maladaptive coping might present through symptoms of depression:

– Withdrawing from others by declining phone calls or choosing not to respond to text messages
– Staying in bed during times when you’re not sleeping or physically in need of rest
– Deferring school assignments or work deadlines in favor of binging on Netflix series for extended periods of time
– Not leaving the house for fresh air when weather permits
– Declining hygiene practices and decreased attention to nutritional needs and physical activity
– Self-medicating through alcohol or drug use

In contrast, some individuals experience severe levels of anxiety when facing loneliness or isolation. Those with pre-existing obsessive-compulsive disorder, anxiety or impulse-control disorders, eating disorders, or traits of perfectionism may attempt to cope with isolation by trying to gain a sense of control over specific aspects of their lives. This could present as:

– Excessive cleaning, organizing, list-making in the home without clear need to do so
– Catastrophic thought processes with over-indulgence in news reports and social media
– Difficulty sleeping or resting due to racing thoughts
– Flare-ups of previous OCD rituals or disordered eating patterns
– Difficulty concentrating on school assignments or work due to preoccupation with above concerns

One of my favorite, go-to methods for combating these negative impulses is an emotion regulation technique called “opposite action,” a concept originating from the skill sets taught in dialectical behavioral therapy (DBT). This technique forces us to identify our emotion and the urges or impulses that go along with it, and to assess their degree of helpfulness or harmfulness by challenging them with facts. If found to be irrational or maladaptive, then we aim to implement the opposite of our emotion-driven impulse. We actually implement opposite action frequently through our lives without necessarily naming it as such. By identifying the technique, though, we
can consciously choose to use this skill when our level of motivation to change is low. Consider this example
(modified content courtesy of PsychPoint.com):

STEP ONE: Identify the emotion you’re looking to change. You’re really anxious about leaving home to go
on vacation.
STEP TWO: Identify the urges/impulses associated with the emotion. You actively avoid booking the
vacation by burying yourself in work and household tasks to subconsciously convince yourself that you simply
do not have the time to take a vacation.
STEP THREE: Assess whether the urge or behavior fits the facts of the situation. You have plenty of unused
vacation time and recognize that your year-end productivity will not be negatively impacted by taking the break.
You’ve taken vacations before and your family has benefited from the escape each time.
STEP FOUR: If the emotion and behavior does not fit the situation, then apply the opposite action.
Create a manageable schedule / timetable to take the steps necessary to search for and secure the logistics
required for booking the trip.
STEP FIVE: Experience the opposite emotion. Experience the excitement involved with planning activities
and excursions or buying a new outfit for the occasion. Go on the trip and enjoy the time with your family while
allowing others at work to keep things running smoothly until you return.

Used consistently, opposite action can help us to change our emotional response to stressors over time. It’s
important, though, to commit to the technique so that you can experience the full benefits of taking control of
your mood and behaviors rather than allowing them to be in control of you.

For a quick video explanation of opposite action, view the following:

If you’re experiencing the above symptoms associated with loneliness and have tried methods for self-help
without benefit, or if you’ve been previously diagnosed with a psychiatric illness or substance use disorder
that has begun to flare up in the midst of these extraordinary times, please know that psychiatric treatment
providers are still open, available, and ready to help you through this – at all levels of care.

Clinicians at the Lindner Center of HOPE are seeing patients every day through Telehealth, with options for
telephone or video sessions for both therapy and medication management. Additionally, our services are open
for emergency intake assessments and inpatient hospitalization, partial hospitalization, intensive outpatient,
residential, and treatment for substance use disorders.

If you or a loved one could benefit from professional help, call the Lindner Center of HOPE at 513-536-
4673 to start the conversation and take the next steps toward healing.

Jen Milau, APRN, PMHNP-BC
Lindner Center of HOPE , Psychiatric Mental-Health Nurse Practitioner

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“Take a rest.  A field that is rested give a beautiful crop”
– Ovid, Roman Poet, circa 20 BC

 

Pockets of Rest
By Valerie Martin, Spiritual Care Team

It is not news that poor rest and sleep can have a negative effect on health.  But look at this: On the public safety side, besides falling asleep at the wheel of your car, it can cause disasters.  According to the Div. of Sleep Medicine at Harvard Medical School & WGBH Educational Foundation, it was found that sleep deprivation was a significant factor in the 1979 nuclear accident at Three Mile Island, as well as the 1986 nuclear meltdown at Chernobyl.

Then there are the personal nuclear meltdowns that can happen when we are weary.  They may present themselves in various forms: frustration, anger, being short with people, fits of crying, wanting to hit a wall (choose something softer please), withdrawing, even giving up.

We have allowed lack of rest to happen, you know.  We have allowed schedules and other people’s priorities to direct our lives, even if we do not realize it.  We do not question the flow or the huge pressure we feel to “keep up”.  We CAN and SHOULD take more control over our schedules and what we put on them.  Don’t go quitting everything!  Just be the director of your own story.  Take back a measure of control.

We have listed for you a few things that have worked for others.  Find what works for you.  Be intentional about this.  Look for pockets in your day to take a control of your need for rest.  You just might avoid going nuclear!

Finding pockets of rest in 4 main areas of your life

  • The Car
    • Turn off radio in your car
    • Turn off talk-radio in your car
    • Aromatherapy
  • At Work
    • Take your breaks
    • No work talk on your lunch hour
    • Change your position at your desk or get up and work the hall.  It’s recommended you do this every hour
    • If you are overloaded, have an honest conversation with your boss and team & call Spiritual Care Team
  • At Home
    • Stick to a bed time for the kids that is earlier than yours and stop with the to do list a couple of hours before bed.  The dust will be there tomorrow.
    • Dance while making dinner
    • Have a family dinner time ritual
      • “What’s your biggest up/down for the day”
      • Prayer
      • Tell me something funny
  • Don’t turn on your TV as soon as you get home
  • Take a hard look at all the activities your family is involved with
  • In Your Ear
    • The information we expose ourselves to daily impacts our thoughts, our stress levels, our view of life.  Be thoughtful about what these things are.
    • Classical music – especially baroque – has been proven to have calming effect on your heart rate
    • Take news breaks. TMI (Too much information) is everywhere!  It can over load us, make us feel powerless and gives us a skewed view of the world.
    • Take technology fasts – anything with a screen
    • Try silence.  A time to pray, meditate or simply be.

 

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Many who struggle with OCD are probably noticing a spike in their symptoms during these unprecedented times. Stress and uncertainty can often make OCD symptoms flare. Those who struggle with specific types of OCD may be having an even harder time: specifically those with contamination concerns and those concerned with harming others. Another symptom of OCD that may be particularly hard currently are perfectionism tendencies. While it may be harder to fight back against OCD with everything going on right now, it is more important than ever to not give in to compulsions and let them take over your life. One simple step you can take is to stay connected to your therapist, likely via telehealth at the moment. Having regular sessions during this time is key, especially as symptoms flare. Staying connected to others online or through social media options is also important, as the more you are connected to others the less stress you will notice. Another key piece is to continue to do things you enjoy and that bring you pleasure, as this will help lessen stress as well. Keeping a structured routine can be helpful and can help make things to continue to feel more normal. It can be important to try to continue with whatever routine you had going before that you are still able to do, for instance still getting at the same time in the morning and getting ready for work even if you are working from home. Adding consistent exercise into that routine will also be helpful, as this helps create endorphins and naturally lessens anxiety. Lastly, avoid reading the news all day, which will only lead to more stress and anxiety. It is important to limit access to only a couple of trusted sites and not get carried away with reading up on everything all day long.

Some specific OCD related steps you can take will vary depending on the type of OCD you have. For those who struggle with contamination concerns, get familiar with the CDC guidelines for the current pandemic and do not add other steps that are not recommended. For instance, they are recommending only washing hands for 20 seconds after being outside or in public, before eating, after going to the bathroom, and after you’ve coughed/sneezed/blown your nose. If soap and water are not available, they recommend you use hand sanitizer that contains at least 60% alcohol. They also only recommend disinfecting surfaces once per day. This should only take a few minutes per day and they suggest only focusing on the surfaces in your home that are frequently touched. It is also important to think about whether this is truly needed (for example, if you stayed home all day and had no visitors, do you really need to disinfect that doorknob?). It is also important to avoid some news sources that might not offer expert recommendations but rather their own opinions.

For those who struggle with fears of harming others, these symptoms might tackle the current pandemic and cause you to obsess about whether or not you might have infected someone or whether or not you might infect someone in the future. This might be a similar theme to past fears of contamination concerns, but it will still be helpful to alert your therapist to the new content so that new exposures can developed.

For those who struggle with perfectionism tendencies, this might be an especially trying time. The perfectionism could target all of the changes going on and adaptations people are having to make to conduct
their jobs, manage their families etc. It is important to give yourself a break and realize that it is impossible to be perfect in anything we do, but especially now during all of this change and uncertainty. Practice doing one or two things imperfectly on purpose as an exposure.

One important exercise I make sure to encourage all of my patients to do is to keep track of their victories against OCD, whether the victories are big or small. Keeping track of successes and not dwelling on everything that is going wrong is a helpful way to stay on track and to realize everything that you are doing to fight OCD, which is likely a lot. It can sometimes be hard to pick out the successes and often others only notice the failures or slips, but there are victories in there as well that deserve your attention and that can help give you confidence to fight back even harder next time

Nicole Bosse, PsyD
Lindner Center of HOPE, Staff Psychologist

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Chris Tuell Ed.D., LPCC-S, LICDC-CS, Clinical Director of Addiction Services

As feelings of anxiety, depression, or sheer boredom mount due to the growing pandemic of the coronavirus, the desire to turn to drugs and alcohol as a coping mechanism could become more problematic. Experts warn against self-medicating during these stressful times for a multitude of reasons. For many people who struggle with mental illness and/or substance use disorders, there is an unfortunate tendency to withdraw or isolate from others. So when we are told to practice social distancing, remain in our homes, isolate from one another, this can feed into a further deepening of an individual’s struggles and isolation with depression, anxiety, trauma or loss.

According to SAMHSA, (Substance Abuse Mental Health Services Administration), 84% of individuals who experience a substance use disorder, also experience a co-occurring mental health issue as well. During times of stress, many of us seek relief, in any way we can find it. The use of substances is not a healthy way of coping. Substance use is frequently used as a means to escape or numb-out from life’s problems. Substance use will often exacerbate a previous existing problem, making it worse.

In cities across the country, people are increasingly living under “shelter-in-place” or lockdown mandates that have closed businesses, limited social gatherings, and urged self-quarantine. These added stressors have resulted in increased levels of alcohol consumption. According to the Republic National Distributing Company, a wine and spirits distribution company, sales of spirits jumped by 50% for the week ending March 21, 2020. Nationally, the overall increase for the week according to Nielsen data, saw a 55% spike in alcohol sales.

Each of us experiences stress from time to time. However, recent events of the past few months have been unprecedented. Stress can feel overwhelming. There are different types of stress – all of which carry physical and mental health risks. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Some people may cope with stress more effectively and recover from stressful events more quickly than others. Unfortunately for some, substance use becomes an unhealthy way to self-medicate one’s stress, mood and/or anxiety.

Coping with the impact of chronic stress can be challenging. Because the source of long-term stress is more constant than acute stress, the body never receives a clear signal to return to normal functioning. With chronic stress, those same lifesaving reactions in the body can disturb the immune, digestive, cardiovascular, sleep, and reproductive systems. Some people may experience mainly digestive symptoms, while others may have headaches, sleeplessness, sadness, anger, or irritability. Over time, continued strain on the body from stress may contribute to serious health problems, such as heart disease, high blood pressure, diabetes, and other illnesses, including mental health issues such as depression or anxiety. For some, substance abuse only adds insult to injury.

When does one’s consumption of a substance (i.e., alcohol, drugs, gambling, Internet, gaming) become
problematic? Addictive behaviors consists of the following three behavioral questions (The Three C’s).
• Is there a loss of Control? (I am unable to manage the behavior.)
• Is the behavior Compulsive? (I cannot stop doing the behavior.)
• Do I continue to engage in the behavior, despite the negative Consequences?

Coping with life stressors by the use of alcohol or any other substance, is a bad idea. If you take practical
steps to manage your stress, you may reduce the risk of negative mental and physical health effects. Rather
than reaching for that adult beverage, below are tips that may be helpful in coping with stress:

Be observant. Recognize the signs of your body’s response to stress, such as increased alcohol and other
substance use, difficulty sleeping, , being easily angered, feeling depressed, and having low energy.

Talk to a health professional. Don’t wait for your health care provider to ask about your stress. Start the
conversation and get proper health care for existing or new health problems. Effective treatments can help
if your stress is affecting your relationships or ability to work.

Get regular exercise. Just 30 minutes per day of walking can help boost your mood and improve your
health.

Pursue calming activities. Explore relaxation or wellness programs which may incorporate meditation,
imagery, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy and
relaxing activities.

Set goals and priorities. Decide what must get done now and what can wait. Learn to say “no” to new
tasks if you start to feel like you are taking on too much. Try to be mindful of what you have accomplished at
the end of the day, not what you have been unable to do.

Stay connected. Even though this may be a challenge, given our current social distancing, we need to remain
connected with one another. You are not alone. Keep in touch with people who can provide emotional
support and practical help. To reduce stress, ask for help from friends, family, and community or religious
organizations. Many community support groups (AA, NA, GA, SMART Recovery) are available online. Stay
healthy, stay connected.

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En esta oportunidad quiero compartir con ustedes el articulo que escribimos en mi Grupo de estudio Psicoanalisis de Cara a lo Social integrado por Manuel Llorens, Alicia Leisse, Carmen Elena Dos Reis, Claudia Alvarez, Yone Alvarez y esta servidora.  Nos reunimos de forma “virtual” cada 15 dias para discutir trabajos y temas de corte psicoanalitico y tambien social. Somos todos venezolanos conectados desde el exilio o desde la emigracion elegida.  Espero que les resulte de utilidad en estos tiempos de incertidumbre…

UNA CONVERSACION CON LA INCERTIDUMBRE

Una de las anécdotas que ha circulado ampliamente en medio de la pandemia es de la antropóloga Margaret Mead cuando un estudiante le preguntó que cuál era, a su juicio, el hallazgo que evidenciaba el comienzo de la cultura. Esperando escuchar algo como potes de arcilla o cabezas de flechas, el estudiante se sorprendió al escuchar “un fémur roto que fue curado”.

La pandemia ha servido para subrayar la íntima conexión de la humanidad entera. La manera en que los hábitos alimenticios, los sistemas de gobierno, los medios cada vez más veloces de transporte, y hasta nuestra manera de saludarnos, influyen en el curso de un virus que ha detenido todo el planeta. El coronavirus ha puesto de rodillas el poderío humano: paralizó el comercio, las olimpiadas, los aeropuertos, las protestas públicas y más.

Sumado a las consecuencias de la salud de los contagiados, los sistemas sanitarios, la economía mundial y las adaptaciones a la vida cotidiana que ha exigido la pandemia, ha habido un repunte a nivel mundial de trastornos de ansiedad. Por ende se les pregunta a los profesionales de la salud mental: ¿cómo se lidia con las angustias que todo esto despierta?

Circulan muchas recomendaciones, ideas, gestos salvadores, actos creativos que dan cuenta de que, en lugares geográficos con mayor piso de respuesta social, los daños ciertamente están, pero el músculo creativo se reinventa al servicio del otro y de uno con el otro y del sí mismo. Muchas de las recomendaciones, útiles  sin duda, se anclan en el terreno de las acciones concretas y conscientes que podemos incluir en nuestras rutinas para sobrellevar la angustia, el tedio, la pérdida o el conflicto que desata las medidas de protección que han alterado nuestras vidas.

Creemos, sin embargo, que puede ser útil tomar un paso al costado y escucharnos desde otro lugar. Hay por lo menos dos elementos fuera de las prescripciones más concretas que valen la pena considerar. El primero, es que la pandemia nos ha colocado de manera dramática frente a la vulnerabilidad humana. Ante esto, algunos han querido continuar como si nada, como los presidentes de Brasil y México, besucones desafiantes, que parecerían estar en negación de los riesgos que implica el COVID-19. Lo cierto, es que desde el Príncipe Carlos hasta los plebeyos estamos expuestos. La omnipotencia no está resultando buena consejera.

A la vulnerabilidad se le suma una gran cuota de incertidumbre. Nuestros parámetros de control han sido trastocados. Hay recomendaciones que nos pueden ayudar a sobrellevar el día a día, pero inevitablemente necesitamos escuchar y articular el temor que surge. El miedo, lo sabemos, pero se nos olvida, es una alerta que necesita ser atendida, para poder prepararnos para lidiar con una amenaza. Lidiar con el miedo sin negarlo, pero sin quedar sobrepasado por el desespero, es parte de la tarea.

La escucha y el esfuerzo por darle palabra a nuestro mundo interno, es parte de una solución que lidia con la incertidumbre sin pretender tener las respuestas de antemano. Una de las maneras en que la psicoterapia psicoanalítica ha sido descrita es como una “conversación con la incertidumbre”. La gran verdad, es que ni los expertos tienen la respuesta completa de las dimensiones del problema ni de su solución. Lo más probable es que tengamos que hablar y escucharnos para descifrarlo en conjunto.

Lo que estamos diciendo, y que lleva al segundo elemento, es que el problema tiene que ver con la interdependencia humana, y su solución, probablemente también. Una de las medidas preventivas curiosamente se ha llamado “distanciamiento social”, cuando lo que necesitamos es distanciamiento físico, pero no social. Tanto por el proceso de concebir soluciones a un problema de dimensión sistémica, como por el funcionamiento biológico individual: la conexión humana es esencial. Sabemos que el sistema de defensa inmunológico está íntimamente relacionado con la vinculación interpersonal, la soledad nos hace más propensos a enfermar.

Nos estamos quedando en casa, aunque parezca paradójico, como gesto de profundo reconocimiento del otro. Nos quedamos en casa, para cuidar a los demás tanto como a nosotros mismos. Nos quedamos en casa, porque el bienestar del otro es indispensable para el bienestar nuestro. Visto así, nuestro encierro no es aislamiento. Las redes de solidaridad, para estar atentos a las personas de nuestro vecindario que no se pueden valer por sí mismas, el comunicar nuestra preocupación por el otro, el pedir ayuda, la música en los balcones o los aplausos a los operarios de salud, son gestos indispensables de conexión humana, necesarios para mantenernos sanos y cuerdos.

No olvidemos finalmente que los riesgos y las desventajas tienden a multiplicarse, por lo que, aquellos que vienen arrastrando desventajas, están ahora en una situación multiplicada de riesgo. Los que tienen alguna situación previa de vulnerabilidad, por edad, por salud, por pobreza, por red de apoyo limitada, están mucho más expuestos y haremos bien en pensar en el problema priorizando las necesidades de aquéllos que la van a sufrir más.

La cuarentena es un alto obligatorio que puede ayudar a hacer un parado en una vida que no deja de exigir apresuramiento, un llamado a abrir espacios para la reflexión, para recalibrar nuestras prioridades y para hacernos más conscientes de nuestra interdependencia, nuestra necesidad del otro, fomentar nuestra capacidad de construir la cultura en los términos que propuso Margaret Mead.

 

 

Margot Brandi, MD,
Sibcy House, Medical Director

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Tracy S. Cummings, MD Psychiatrist, Lindner Center of HOPE Chief of Child and Adolescent Psychiatry Medical Director of CCHMC Services at LCOH

On a large scale, our world continues to adjust to the new normal enacted for our safety in the wake of COVID19. And while we may be interested in global responses and big picture outcomes, this tends to pale in comparison to the level of concern a family holds for its members and home. Our definitions of “family” may vary, and our abilities to handle stress can be wide-ranging, but we all likely share our desire to see the system succeed. Having tangible options to put into action in our households right now can give us a sense of purpose and accomplishment while keeping those that mean the most to us moving forward in positive directions through this uncertain time. Consider the following acronym, HELP, to help keep your family functional:

H– Heed the advice of our trusted medical and community leaders.

  • Staying up to date on current safety recommendations from the CDC, WHO and governmental leaders is important.
  • Understanding what local resources may be needed and taking the time to consider your home’s personal emergency plan is worthwhile.
  • Creating a sense of control over those things that are within your grasp will feel rewarding, even if there is some anxiety around the situation.
  • Once you have the general information you need to proceed with helping your family, limit exposure to crisis-related media.

E– Enact the recommendations of the leaders and your personal plan.

  • In order for this to be successful for families, there will need to be good communication about its importance. Talking about the virus in a way everyone can understand (particularly if there are young children in the home) will pose a worthwhile challenge. Consider this as an opportunity to demonstrate empathy and compassion for each other when our particular ways of acknowledging, responding to, and addressing stress becomes apparent.
  • Take the universal precautions immediately: good hand hygiene, covering coughs/sneezes, frequently clean/disinfect, maintain social distancing, wear a mask if in a public setting, stay home as much as possible and absolutely if sick.
  • Remember that younger members in the home will be watching those around them for cues on how to handle this situation, so reinforce the recommendations through modeling the appropriate behaviors as much as possible. If the adults in the home are struggling with how they are personally managing the stress of today, seeking assistance for mental health strength should not be delayed.

L– Listen to the needs of your individual household and make room for those in the necessary changes.

  • Label priorities for your family: academics, virtual lessons, family meals, general chores, and what needs to be done on a given day.
  • The use of a broad-strokes calendar may be helpful here, so as to set some daily standards and routines. With so much changing around us (ie. schools closed, remote working requirements, conveniences disrupted), having some predictability to the day can provide security to adults and children alike. Do you have to set up a strict schedule for every hour of the day and follow it militantly?  No, but knowing there is some allotted time for a few essential activities a day is reasonable, and IT CAN CHANGE as needed.
  • Emphasize flexibility over perfection these days.

P– Protect your unity.

  • Emotions can run high during this time of collective crisis. Accepting how difficult these changes are for us all can be freeing.
  • It is ok to grieve the loss of all the special moments and events that have been postponed or canceled due to COVID19. Whenever possible, consider ways to creatively experience those moments in an alternative fashion. Can’t go to Disney?  How about making a Disney movie night and riding some virtual rides that are posted for the park?
  • Keep in contact with those who are important to your family as much as possible. Use the technology available to your advantage. Virtual birthday parties and gatherings, like many current classrooms, are being readily utilized with success. Phone calls with or without video, texts, and even sending letters/cards are simple ways to avoid isolation while maintaining social distancing.
  • Staying connected doesn’t mean you have to spend every moment together, though. It might be nice, and likely necessary, for family members in the same home to have some time to themselves. Use these moments to recharge and encourage young ones in the home to appreciate this personal time as well.

These are uncharted waters for our families, our communities, our planet. We cannot expect to know how to handle our current circumstances flawlessly, but we can keep trying.  All we need is a little HELP.

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Paul R. Crosby, MD

Lindner Center of HOPE, Chief Clinical and Operating Officer, Psychiatrist

4075 Old Western Row Rd.

Mason, OH 45040

513-536-HOPE

Most of us are weeks into the significant life changes caused by the novel coronavirus.  Even as we work to adjust to our new normal, there continues to be changing instructions and sometimes confusing and frightening information to process.  Daily, we are being asked to make sacrifices and critically important decisions for the safety and welfare of our family and our communities.  It is important during this crisis to remember to monitor and maintain our own mental wellness.

Some tips to manage the stress of today’s circumstances include avoiding excess exposure to media, including social media, taking care of yourself through exercise, eating healthy foods, getting enough sleep, and talking to friends and family.  Cultivating a practice of mindfulness and gratitude is another evidence-based way of improving wellness and alleviating stress-related mental health symptoms.  For people new to the idea of meditation and to those with more experience, there are many apps, such as Headspace www.headspace.com, to guide the process.  Also, even though social distancing is necessary during these times, seek out safe ways to stay connected with others.  The American Psychological Association, The National Alliance on Mental Illness, and Mental Health America are advocacy organizations that have a wealth of information about supporting your mental wellbeing during this crisis. www.apa.org  www.nami.org www.mhanational.org

With most students out of school and engaged in some combination of home-based and online learning, the situation is understandably stressful for both children and parents.  It can be hard to know where to start; but, try and establish a regular routine.  Children (and most adults) are reassured by structure and predictability.  Try to keep in mind that children learn from watching and listening to the adults around them.  They will be very interested in how you respond to news about the coronavirus outbreak.  Let children know that there are lots of people helping the people affected by the coronavirus outbreak.  This is a good opportunity to show children that when something scary or bad happens, there are people to help. Try to create an open and supportive environment where children know they can ask questions.  It is also important to remember that most children may be more interested in playing games, reading books, and other physical and recreational activities than discussing current events or following the news about what is happening across the country or elsewhere in the world.  The American Academy of Child and Adolescent Psychiatry’s website is an excellent resource with advice to help families help the children in their lives through the pandemic.  www.aacap.org

When there are many changes and uncertainties that are beyond our control, heightened stress and anxiety are normal feelings.  A time of crisis can also be a trigger for the onset or reoccurrence of mental health symptoms.  If anxiety and/or stress related feelings are causing you significant discomfort or are interfering with relationships, work, or other areas of your life, it may be time to seek help from a mental health professional.  Other symptoms to look for include:

  • Behaving, thinking, or feeling in ways that are out of character
  • Withdrawing from social contacts
  • Lack of interest in things that would normally bring joy
  • Becoming consistently irritable
  • A change in sleep patterns
  • Changes in eating habits and/or weight
  • Increased use of intoxicating substances

It is essential to remember that mental health services are still available during the COVID-19 crisis.  For individuals already receiving mental health and/or substance use disorder treatment services, it is important to continue with these services during this difficult time.  To follow social distancing guidelines, outpatient services for mental health assessment and treatment are being offered virtually via a simple phone call or one of several easy-to-use, secure video conferencing apps.  When needed, in-person services are still being offered with added health and safety measures to keep patients and staff safe throughout their treatment.

Similar to adults, children who become overly preoccupied with concerns about the coronavirus outbreak should be evaluated by a trained and qualified mental health professional.  Other signs that a child is struggling and may need additional help include ongoing sleep disturbances, intrusive thoughts or worries, recurring fears about illness or death.  If you notice similar symptoms or other behaviors, thoughts, or feelings that seem out of character for your child, seek a consultation with a pediatric mental health professional.  For help finding such a provider, your child’s pediatrician, family physician, or school counselor are good places to seek a referral.

Unfortunately, stigma about mental illness remains the key reason that people do not access care.  It is important to know that more than 50 percent of the population will suffer from a diagnosable mental illness at some point in their life and about 20 percent every year.  Only a small fraction of these individuals ever seek treatment.  One way to start breaking the stigma is to start talking about mental illnesses as a part of normal conversation, similar to how we may discuss illnesses like diabetes or high blood pressure.  Mental illnesses are common, biological illnesses that tend to respond very well to treatments that are typically very safe.  The goal of mental health treatment is to get back to feeling completely like yourself again.  In most cases, treatment is highly effective and allows individuals to function to their full potential.

When it comes to mental health, we need to start treating ourselves more gently.  We also need to extend that compassion to those around us.  We may be social-distancing but we are all in this together.  As, together, we work to fight off this pandemic and take up the challenge of recovering from it, kindness to ourselves and others has never been more important.

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call:

  • 911
  • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)
  • The National Suicide Prevention Line: 800-273-8255

 

 

 

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“Cada persona debe vivir su vida como un modelo para otros.”

Rosa Park

Tenia muchas ideas para esta columna de marzo, fundamentalmente dedicarla al tema de la Mujer (a razón del día internacional de la mujer) y a las mujeres de mi vida y sus grandes hazañas pero para ello ya habra tiempo…

Creo que desde hace unas semanas todos estamos tratando de entender y explicar esta experiencia global sin precedentes que es la pandemia del coronavirus COVID-19 y por sobretodos las cosas intentado mantener la calma y la cordura.

Por norma, toda  situación de incertidumbre produce un desbordamiento de la angustia y debilita nuestras defensas habituales para manejarla.  Sin darnos cuenta, nuestros horarios, hábitos, rutinas y en general el orden del mundo exterior juegan un papel importante en nuestra propia organización interior y en nuestra identidad. Así, la incertidumbre y este quiebre en nuestra cotidianidad pueden dar origen a un cuadro emocional de confusión. Nosotros como inmigrantes estamos en una posición aún más vulnerable pues en nuestra identidad ya puesta a prueba, esta confusión puede reactivar la experiencia traumática vivida alrededor del proceso migratorio y enfrentarnos a fenómenos de “Deja Vu” y des-realizacion como manifestaciones de una angustia desbordada.

A continuación, algunos cambios a los que debemos estar atentos:

  • Dificultad para distinguir nuestras emociones  (impotencia, rabia, tristeza, frustración, euforia, angustia)
  • Distorsión de la realidad, bien sea minimizando o negando los hechos reales  o magnificándolos de una forma desproporcionada. (“No pasa nada vs el mundo se va a acabar”)
  • Cambios bruscos en nuestro estado de animo (cansancio e indiferencia  o hiperactividad )
  • Problemas para enfocarnos y concentrarnos en el trabajo o en el estudio.
  • Diversas y múltiples manifestaciones de la angustia: problemas para dormir o mantener el sueno, trastornos de la alimentación o de la vida sexual, malestares físicos, ataques de pánico, fobias o ansiedad generalizada.
  • Tendencia a la auto-medicacion  a través del incremento en el uso de tranquilizantes, alcohol, cigarrillos o drogas

Qué hacer ?

  • No intentar escapar de la realidad. No es posible. Mantenernos desinformados nos debilita aun mas.  Debemos mantener canales de percepción para estar informados de lo que acontece y acatar todas las medidas sanitarias recomendadas por el CDC (center for disease control ) mientras  también preservamos canales que nos protegen de la sobre-exposicion a la “noticia del día”. Con más razón aun, Mantengamonos nuestra mente y nuestro cuerpo activo a través del ejercicio y la meditación en cualquiera de sus formas.
  • Dale espacio a la creatividad. Muchos tendrán mas tiempo libre en sus manos si les corresponde quedarse en casa. Utilicen ese tiempo para darse permiso y hacer algo que siempre hubieran querido hacer y nunca encuentran el tiempo. Escriban esa canción que siempre sonaron con escribir.  Hagan música como los italianos en cuarentena desde sus balcones en Sicilia y otras ciudades. Comiencen por fin ese proyecto que tienen pendiente comenzar “algún día”. No permitan que el aburrimiento les gane esta partida.
  • Mantener la capacidad de disfrute-  lNo permitas que a rabia y la tristeza por lo que perdemos (planes de viaje de trabajo o vacaciones , carreras cortas, maratones para los que nos hemos estado entrenando, la visita tan esperada de familiares o amigos que nos impulsa a diario a no sentirnos tan lejos de nuestra tierra de origen) te impida disfrutar de lo que si conservamos.
  • Pensar en que nuestras acciones individuales afectan el colectivo – Mientras escribo este articulo, me tope con mensaje en twitter que decía lo siguiente: Han visto a muchísima gente correr a los mercados a comprar todo lo posible al mismo tiempo y en el mismo momento en lugar de limitarse a comprar lo que verdaderamente necesitan para la semana o la quincena. Ahora imagínense la misma dinámica en los hospitales. En lugar de papel higiénico serian camas y ventiladores en la terapia intensiva que no serian suficientes para cubrir la demanda.
  • Cuida tus relaciones familiares y de amistad más allá de la necesidad de “distanciamiento social”. Se nos ha pedido evitar el contacto social y sobretodo físico en todas las areas de nuestra vida para prevenir el contagio viral. Cuando estes en casa o en tu lugar de trabajo No uses a tus seres queridos como “basureros” de tu angustia. Más importante que nunca es importante conservar y no poner en riesgo nuestras relaciones mas significativas.   Usa el teléfono para textos y llamadas de video conferencia para mantenerte juntos “cercanamente lejos”.
  • Busca ayuda psicológica lo antes posible – Mientras más temprano busques ayuda especifica mas fácil sera poder empezar a sentirte mejor. El uso excesivo de tranquilizantes sin prescripción medica puede disminuir nuestra capacidad para pensar y reaccionar frente a las crisis.

La invitación este mes es a ser un modelo para otros, a cuidarnos todos, tanto del virus como de la “locura” que puede producir.

by: Margot Brandi, MD,Sibcy House, Medical Director

 

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by: Tracy S. Cummings, MD, Psychiatrist, Lindner Center of HOPE

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.

Everyone reacts differently to stressful situations.  How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.

People who may respond more strongly to the stress of a crisis include

  • Older people and people with chronic diseases who are at higher risk for COVID-19
  • Children and teens
  • People who are helping with the response to COVID-19, like doctors and other health care providers, or first responders
  • People who have mental health conditions including problems with substance use

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call

  • 911
  • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)

Stress during an infectious disease outbreak can include

  • Fear and worry about your own health and the health of your loved ones
  • Changes in sleep or eating patterns
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Increased use of alcohol, tobacco, or other drugs

People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms.

Things you can do to support yourself

  • Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
  • Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
  • Make time to unwind. Try to do some other activities you enjoy.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.