May 17– Manor House
Nicole Mori, RN, MSN, APRN-BC, Lindner Center of HOPE Psychiatric Nurse Practitioner
An Inside Look at Clinical Research
The presentation will cover:
REGISTER NOW! 1 CME/CEU OFFERED
Participants in the webcast will be able to:
Target Audience:
Psychiatrists, Primary Care Physicians, Non-psychiatric MDs, Nurse Practitioners, , Social Workers, Psychologists, Registered Nurses, and Mental Health Specialists and interested parties as well
ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing
Medical Education (ACCME) through the joint providership of the University of Cincinnati and the Lindner Center of HOPE. The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians.
The University of Cincinnati designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credits
commensurate with the extent of their participation in the activity.
The Ohio Psychological Association under approval number P099-311067501 (2010-2012) approves the University of Cincinnati College of Medicine
Department of Psychiatry for 1 mandatory continuing education credit for Ohio Licensed Psychologists.
The This activity has been approved for 1 clock hour of CEU by The State of Ohio Counselor, Social Work, Marriage and Family Therapist Board.
DISCLAIMER
The opinions expressed during the educational activity are those of the faculty and do not necessarily represent the views of the University of Cincinnati. The information is presented for the purpose of advancing the attendees’ professional development.
You are invited to attend an IN PERSON seminar presented by Hopewell and Lindner Center of HOPE, April 21st from 9:00 AM to Noon EST at the Linder Center of HOPE.
Information regarding the event can be found in the attached flyer.
The cost will be $30, there will be CEU’s available (for counselors, social workers, and psychologists), refreshments will be provided, and there are a limited number of spots available.
If you are interested, please head to the website below to register. This is going to be a wonderful way to end the series and meet the clinicians!
https://www.hopewellcommunity.org/events/hopewell-virtual-ocd-summit-4
By Thomas Schweinberg, PsyD, Staff Psychologist, Lindner Center of HOPE
Over the last few years, cannabis has clearly become much more prevalent and accepted in this country, both for medical and recreational purposes. This is in stark contrast to the demonization of cannabis that existed from the 1950’s through the 1970’s. The pendulum has swung radically in the opposite direction as cannabis is now viewed as not only benign, but also a panacea for a multitude of ills. In fact, in the state of Ohio, as of the end of 2022, marijuana has been approved to treat 25 medical conditions. I am not aware of any other medication that is approved to treat over two dozen conditions. It would appear that cannabis is a very powerful medication capable of relieving many symptoms and conditions. Accordingly, shouldn’t we be asking what side effects we might experience from such a powerful substance? Yet, this information is not freely offered up as it is during every pharmaceutical commercial that we see on television. Instead, cannabis is generally portrayed as a substance with considerable upside and very little, if any, downside. Of course, this cannot accurately reflect reality.
Cannabis does have a number of benefits to its users, and I am actually in favor of its legalization. However, a great deal more needs to be done to inform and caution users about the potential side effects, some of which can be extremely disruptive, even life altering. Obviously, cannabis directly impacts the central nervous system when actively using, but what about over the long term? The National Institute of Health reported that chronic cannabis exposure, particularly during the period of brain development (up to 26 years old), “can cause long-term or possibly permanent adverse changes in the brain.” To begin with, animal studies have shown that exposure to cannabis is associated with structural and functional changes in the hippocampus, the brain structure responsible for consolidating and recalling new information, i.e., memory. Memory difficulties are likely experienced by the majority of those who use cannabis regularly, which is typically accompanied by poorer attention and slowed response time. What is less clear is how persistent these memory problems are after an individual stops using.
In addition to this, there is the potential for cannabis to globally impact a developing brain. As young brains develop, the connections between our brain cells, or neurons (via branch-like structures called “dendrites”) are either strengthened (because that connection is often used or adaptive), or they are pruned away (because that connection is seldom used or is maladaptive). Animal studies have revealed that exposure to cannabis during adolescence can provoke premature pruning of dendrites in the developing brain. The “before and after” images that come from these studies are very clear and compelling. While some of these neuronal connections may have eventually been pruned away anyway, it seems clear that some of these connections that are lost could have been strengthened and put to functional use during adulthood. This neurological impact may help to explain research findings which indicate that those who use cannabis chronically, particularly during adolescent brain development, are less likely to complete high school or obtain a college degree, have a lower income, experience greater unemployment, and report diminished life satisfaction. Certainly, this is not true for all who use, but those are the statistics.
Perhaps one of the most life-altering risks of using cannabis is the increased risk of experiencing psychosis that can become prolonged, or even life-long. There is considerable controversy about whether cannabis simply provokes psychotic symptoms in those who were already genetically predisposed to schizophrenia, or whether cannabis could cause a prolonged psychotic state which resembles schizophrenia. While the majority of users will not encounter psychotic symptoms, it does appear to be a sizeable minority, perhaps 10-15% of chronic users. Clinically, my colleagues and I have repeatedly seen the connection between cannabis misuse and psychotic disorders, enough that it is difficult to believe that it is merely coincidental. The association between cannabis and the onset of psychosis is great enough that the Canadian government has attached a warning label to its medicinal marijuana which reads, “Warning: Regular use of cannabis can increase the risk of psychosis and schizophrenia.” They added, “Young people are especially at risk.” Unfortunately, you will not find a comparable warning label in the United States.
While this article appears to generally denounce the use of cannabis, I should state again that I am in favor of its legalization as there are a number of potential benefits for those attempting to manage certain physical or emotional disorders. However, if cannabis is legalized without clearly reporting the potential side effects and adverse outcomes, we are being reckless and irresponsible. Those who produce and distribute legal cannabis should be held to the same standard as pharmaceutical companies who are compelled to advertise the potential risks of their products. While many or most who use cannabis can do so safely, there are those for whom cannabis presents a substantial risk for a number of cognitive and psychological difficulties. These potential risks should be clearly and responsibly communicated to the public as cannabis use becomes much more widely available. Otherwise, cannabis users could be misled into believing that its use is entirely safe and benign, unwittingly opening themselves up to possible long-term cognitive, psychological and functioning difficulties.
Continue to explore the relationship between cannabis and mental health
by: Ronald Freudenberg, Jr., MA, LPCC-S
Outpatient Therapist, Lindner Center of HOPE
Anxiety can take many forms. Anxiety is also one of the most common reasons one might seek out mental health treatment. In this blog, we will explore some of the most frequently occurring anxiety disorders, as well as panic attacks, which can be part of a Panic Disorder (but do not have to be, as will be discussed later). We will also look at effective strategies for preventing, treating, and managing anxiety disorders and symptoms of anxiety.
Regardless of how anxiety may present for one person, the various anxiety disorders all have at least one thing in common…fear. Whether it is described as worry, nervousness, feeling “on edge,” or something else, the basic emotion of anxiety is fear. We all experience some anxiety sometimes, and in fact, you may have heard that a little bit of anxiety can be a good thing from time to time. It serves a protective purpose when it tells us to avoid people, things, or situations which could be dangerous. Anxiety can also help us by keeping us on our toes and motivating us to perform well under pressure, such as when pulling an all-nighter before an exam, giving a big presentation at work, or playing in the championship game. Yet, as with any negative emotion, anxiety can become problematic when it becomes too frequent, too intense, lasts for too long, or interferes with our lives and our ability to function well, as can happen in the context of the following types of anxiety disorders.
Sometimes, one may feel excessively stressed or anxious about a certain thing or things in one’s life. People often describe this as “situational”, and the clinical term is an Adjustment Disorder with Anxiety. (It can also present with depression, or other emotional/behavioral responses.) An example might be if one would experience something stressful like the loss of a job. Of course, most people would likely feel some anxiety about this. However, an adjustment disorder is thought of as when one’s response is out of proportion with what may be typically expected. With this type of anxiety, once the stressor has resolved, so will the anxiety. So, when that same individual lands a new job, he/she/they will feel better, simply put.
Generalized Anxiety Disorder is very much like it sounds. This is when a person feels generally anxious, worried, and nervous much of the time (more than half of their days) about any number of different subjects. In order to meet criteria for the diagnosis, one must experience this type of anxiety for at least six months, find it difficult to control the worry, and present with at least some of the following additional symptoms: restlessness, trouble concentrating, irritability, muscle tension, sleep difficulties, and/or trouble concentrating. Although every person is unique, classically, a person with GAD may tend toward long-term anxiousness, worry excessively about many things (such as finances, family, work, health, world events, etc.), and lay awake in bed at night doing so.
Specific Phobias are another type of anxiety disorder in which a person experiences strong fear and anxiety about a specific thing (object or situation), and actively avoids that thing or endures exposure to it with intense discomfort. In this writer’s experience it is relatively rare for this to be a person’s main reason for seeking treatment, at least in outpatient settings. Perhaps that may be because many anxiety-provoking subjects can be pretty easy to avoid. (When was the last time you unexpectedly came across a snake?)
An exception to anxiety that is easily avoided, is Social Phobia, also known as Social Anxiety Disorder. Social Phobia exists when the source of a person’s fear is social or performance situations in which one may feel subject to scrutiny or judgment by others. Social anxiety may arise when one feels uncomfortable mingling with new people at a party, walking through halls of (seemingly) glaring eyes at school, or giving a speech. From an evolutionary perspective, if anxiety helps us to avoid dangerous things which threaten our survival, being ostracized from one’s tribe and forced to try to survive alone in the wilderness is near the top of that list. With this in mind, it is little wonder that public speaking is often cited as people’s number one fear.
Finally, let us explore the issue of panic. So, what is a panic attack? Panic Attacks, according to the DSM-5, occur when a person experiences an “abrupt surge” of anxiety which reaches a peak within minutes and includes (at least four of) the following symptoms.
When one develops a fear of having additional panic attacks and exhibits maladaptive behaviors designed to avoid or limit the likelihood of them, this is called a Panic Disorder. Further, if one’s fear and avoidance includes public situations away from home, open or enclosed crowded spaces from which it would be difficult to escape should panic-like symptoms arise, that is called Agoraphobia (which may, but does not have to, co-occur with Panic Disorder). Also, according to the most recent edition of the DSM, panic attacks are now thought to be a feature which may occur in the context of a spectrum of other mental health disorders, substance use disorders, and some medical conditions.
When it comes to treatment of anxiety, it is unrealistic for one to expect to live out the rest of their days, anxiety-free. One can no more be “cured” from anxiety, than from happiness, sadness, or anger. These are basic human emotions, and there are reasons why we have them. However, the good news is that anxiety symptoms, whether mild or debilitating, can be effectively prevented, treated and managed, usually by a multi-faceted approach.
Medications can often be a very helpful part of a person’s treatment plan. Antidepressants, such as SSRIs, and some SNRIs, are commonly used to treat ongoing symptoms of anxiety, while benzodiazepines (such as Xanax, Klonopin, Valium, or Ativan) are sometimes used on a shorter-term or as-needed basis to alleviate acute anxiety or panic. (Caution is usually advised with the latter due to their addictive potential.) Some antihistamines, beta-blockers, and anticonvulsants have been shown to be helpful for anxiety as well.
Various forms of talk therapy can be beneficial by providing a safe, supportive experience in which a person can process fears and learn to implement rational coping thoughts to overcome them. Therapy can also assist one to form new behaviors to mitigate symptoms of anxiety. Regardless of the specific therapy used, a common element is learning to approach, rather than avoid, that which causes one’s anxiety. Anxiety and fear lead to avoidance by definition, while summoning the courage to face and overcome our fears cuts them down to size (this is commonly referred to as “exposure”). Cognitive-Behavioral Therapies (CBT), Dialectical Behavioral Therapy (DBT, as well as Radically Open DBT), and mindfulness-based psychotherapies are common effective treatment approaches. Mindfulness can help one learn to be in and accept the present, increasing one’s capacity to tolerate feelings of discomfort while reducing anxious thoughts about the future.
In the case of panic attacks, it is advised to first rule-out any medical causes of the symptoms which can mimic other medical issues, specifically heart disease. If another person is present during a panic attack, they provide support and reassurance, helping the person to talk through it or asking what they need that may be helpful. In addition to medication, there are other helpful strategies for panic symptoms.
Therapy can also help a person develop effective coping skills for preventing and managing anxiety. These may vary depending on personal preferences, but can include increasing social supports, problem-solving for stressors, journaling, exploring spirituality, exercise/movement, etc. Practicing healthy self-care habits (such as getting regular exercise and restful sleep, managing health conditions, and minimizing/avoiding alcohol, caffeine and other drugs) and generally trying to live a balanced lifestyle can simultaneously help to reduce the stress one may experience in life, while increasing one’s ability to effectively cope with anxiety.
Summary: Anxiety is a common human experience, but persistent and debilitating anxiety, is often what causes people to seek treatment. There are a variety of types of anxiety. Panic or Panic Attacks are among the types of anxiety. Learn what are panic attacks, symptoms and causes and treatments for panic attacks and other anxiety disorders.
Wednesday, May 1o, 2023
PRESENTED BY:
THE HIGH HOPES AUXILIARY FOR THE LINDNER CENTER OF HOPE
Become inspired as Michele Henning Folan, Host of Asking for a Friend Podcast conducts a live podcast with Laurie Little, PsyD, Lindner Center of HOPE Staff Psychologist
Mason, OH, March 21, 2023 – Lindner Center of HOPE has named Jan Marhefka, MSN, RN, to the position of Chief Nursing Officer. Marhefka has been serving as Associate Chief Nursing Officer since November 2021.
As Chief Nursing Officer at the Lindner Center of HOPE, Marhefka has oversight of the Access Referral Center, the Welcome Center, Neuromodulation Center, social work, spiritual care, recreation therapy, House Supervisors, Utilization Review, Educators, Staffing Coordinator and direct oversight of both adult inpatient units.
Prior to joining the Lindner Center of HOPE, she worked in an acute medical hospital and served as Director of Nursing with oversight of the inpatient psychiatric unit, outpatient partial hospitalization program, ICU, Emergency Department and progressive care unit. Marhefka has been in management for 24 years and an RN for 31 years. She also teaches as an ad hoc professor for Miami University’s nursing program. Marhefka was named Employee of the Year at Lindner Center of HOPE in 2020.
Marhefka joined the Center in 2015 initially serving in the Manager of Quality and Compliance role. In 2018, she accepted the Manager of Inpatient Units and was promoted to Director of Nursing in 2019.
Marilyn Schwemberger, MBA, MSN, RN, retired from the role of Chief Nursing Officer at Lindner Center of HOPE earlier this month.
Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults and adolescents, outpatient services and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.
Radically Open Dialectical Behavioral Therapy (RO DBT) is a treatment developed by Thomas Lynch for those who develop disorders associated with an overcontrolled (OC) personality. OC individuals are often described as reserved and cautious, not very expressive with their emotions, and great at delaying gratification. OC individuals tend to be strong rule followers and feel a high sense of obligation in their lives (i.e., go to a birthday party because they feel they have to rather than wanting to do so). However, at times, they may experience “emotional leakage,” or emotionally breaking down once they are in private after holding it all together all day in public. An OC personality can be really helpful in some ways. These are the people that get their work done no matter what, show up to work on time every day, work through all the nitty, gritty details of a project, and follow through on their word. They can be very organized and methodical, and they are great at planning for long-term gains (i.e., saving to buy a house). However, they can be rigid and inflexible at time (i.e., get very upset if a restaurant lost a dinner reservation and struggle with figuring out where else to go to eat) and may have difficulty receiving feedback. Patients that may benefit from this treatment include those with chronic depression and anxiety, autism spectrum disorders, Obsessive-Compulsive Personality Disorder, and Anorexia Nervosa.
The biosocial theory behind RO DBT explains that OC individuals have brains that zoom in on the negative or threatening aspects of a situation before seeing the positives. This predisposition interacts with being raised in an environment that encourages or praises high levels of self-control in one’s life (i.e., doing homework without one’s parents needing to remind them to do so), performing at a high level (i.e., getting good grades, doing well in sports, receiving accolades), and avoiding making errors. These individuals end up avoiding uncertain situations, hold back their emotions out of fear that others may see them as being out of control, and become guarded in social situations, appearing to others as withdrawn. Their lack of vulnerability and difficulty expressing what they are really feeling leads others to struggle to relate to them, so they end up feeling lonely and isolated. Thus, RO DBT operates under the assumption that increasing connectedness to others can improve psychological functioning, thus targeting emotional expression. Additionally, RO DBT encourages being open to hearing other points of view so that one can learn as well as learning to be flexible in responding to varying situations.
Thomas Lynch describes that the five main behavioral targets of RO DBT include 1) being socially distant or reserved, 2) inflexible, rule-governed behaviors, 3) focusing on the details rather than the big picture of a situation and being overly cautious, 4) demonstrating emotional expressions that are inconsistent with how one is really feeling, and 5) comparing oneself to others, leading to resentment and envy. In RO DBT, patients work with their therapists on identifying personal goals consistent with these behavioral targets, connecting these goals to the problems that brought them into treatment. For instance, a patient may bring up that he/she would like to deepen relationships with others, be more flexible when things don’t go according to plan, or let go of past grudges to help fight depression and anxiety.
Many incorrectly assume that RO DBT and Dialectical Behavior Therapy (DBT) are the same thing. While RO DBT has some similarities with DBT, these are two very different treatments. DBT primarily benefits those who have an undercontrolled (UC) personality. UC traits include being impulsive, sensation-seeking, wearing one’s heart on one’s sleeve, and acting in the here and now. Thus, DBT can be helpful for those that have impulsive control problems, such as those with borderline personality disorder, bulimia nervosa, binge eating disorder, and substance abuse disorders. Both RO DBT and DBT combine individual therapy with skills training classes, involve tracking emotions and behaviors via diary cards, allow for telephone consultation with the individual therapist, and involve consultation teams for the group and individual therapists. However, DBT has a stronger focus on self-regulation to target emotion dysregulation whereas RO DBT is much more focused on helping individuals address social signaling and connectedness with others.
For more information see our Comprehensive Guide to RO-DBT.
References:
Lynch, T. R. (2018). Radically Open Dialectical Behavior Therapy. New Harbinger Publications.
Lynch, T. R. (2018). The Skills Training Manual for Radically Open Dialectical Behavior Therapy. New Harbinger Publications.
Lindner Center of HOPE, Psychologist and Clinical Director of Partial Hospitalization/Intensive Outpatient Adult Eating Disorder Services
April 19– Countryside YMCA – Lebanon
Chris Tuell, EdD, LPCC-S, LICDC-CS, Lindner Center of HOPE, Clinical Director of Addiction Services
Addicted to Numbing Mental Illness
The presentation will cover: