The finalists for Cincy Magazine’s “Cincy Best Docs 2020” have been announced, and the final voting phase is open now through Friday, Nov. 20, 2020. Congratulations to Lindner Center of HOPE’s 4 finalists! See complete list below.
Please take this opportunity to vote for finalists by Nov. 20. Voting is open to the public. Anyone can vote once per week through Nov. 20. Winners from each category will receive the “Cincy Best Doc 2020” Award. All winners and finalists will be recognized in the winter issue of Cincy Magazine later this year.
Lindner Center of HOPE is pleased to announce that three medical staff members have been recognized as members of the Class of 2020 Rising Star Medical Leaders by Venue Magazine.
Nicole Bosse, PsyD, staff psychologist; Jen Milau, APRN, PMHNP-BC, psychiatric mental health nurse practitioner; and Zachary Pettibone, MD, inpatient adult psychiatrist, were recognized among a class of 15 medical professionals practicing within the tri-state region, Greater Cincinnati.
Tuning into the news can be a stressful and anxiety provoking experience, even in the best of times. During a pandemic, it can be downright frightening. If all of this negativity is wreaking havoc on your emotions, maybe it’s time to put your energy into building a Gratitude Practice.
Gratitude is the conscious decision to focus attention on the positive aspects of a situation and to notice feelings of joy, appreciation and thankfulness. It is a mindset that celebrates all of the wonderful, special, and unique gifts that life has to offer every day, no matter how simple.
When the world pressures us to pay attention to things that are hurtful, dangerous or missing in our lives, it can be especially challenging to maintain a mindset of gratitude and appreciation. This year especially has brought many unforeseen challenges to us all. Cultivating a mindset of gratitude can be accomplished even in these difficult times.
Why Gratitude?
Over the last several decades there have been numerous studies that have shown countless positive effects of practicing gratitude on our emotional, social and physical health. Practicing gratitude has been shown to improve mood, and help reduce depression, anxiety and irritability. Regular practitioners of gratitude are likely to feel happier, more peaceful and do kinder things for others.
Those who practice gratitude may have stronger social relationships. Couples who regularly express gratitude to each other feel their partners are more responsive to their needs and are overall more satisfied with their relationship. This extends to the workplace as well. When gratitude is expressed at work, employees improve their felt sense of self-worth and confidence, leading to an increase in trust between colleagues and more initiative to help one another out.
Physically, people who practice gratitude regularly have a host of positive effects including improved sleep, stronger immune systems, more consistent exercise habits, fewer physical symptoms and better progress towards achieving personal goals. This is especially important in the current climate.
The act of being grateful creates a chain reaction: the more positive things you notice and give thanks for, the better you feel. As you feel better, you are likely to seek out more positive experiences for which to be thankful.
Building a Gratitude Practice
There are many ways that you can begin to incorporate more gratitude into your life. Remember that when making any change in behavior, it is best to start small and gradually build over time.
If you are just starting out, try choosing one or two times per day that you devote to being grateful. You might consider as you are falling asleep each night to think of three things that happened during that day that you are thankful for. You could also try to think of the one thing you are most grateful for. Try to be as specific as possible. Instead of saying to yourself “I am grateful for my family” think …“I am grateful my husband cleaned up the kitchen after dinner.” Or “I am grateful that my son gave me a hug before bed.”
Once you have practiced that, you might want to upgrade to a Gratitude Journal. You can spend 5-10 minutes each night or first thing in the morning, reflecting on all of the things in your life you appreciate. The act of writing it down helps to solidify in your mind the memories and experiences.
Consider incorporating your family into the practice. When sitting down to meals, ask your family members one thing that happened today that they each feel grateful for. We tend to do this before Thanksgiving dinner, but we can also do this as we sit down with our take-out pizza. Before falling asleep, tell your partner something about him or her that you value and appreciate.
Lastly, find opportunities in your day to express your appreciation for others. Consider sending an email to a colleague when you overhear a positive comment or compliment about them. A text with a thank you or heart emoji only takes five seconds but can brighten someone’s morning.
Remember that gratitude is not the same as denial or wearing rose colored glasses. It does not dismiss or deny the very real things that are not ‘ok’ in our society. Instead, gratitude helps us to collectively notice and appreciate the beauty, the kindness, the love that surrounds us every day. Sharing our gratitude allows us to work together to find solutions and to maintain hope in the face of adversity.
Practicing a grateful mindset can be challenging at first, especially when there are so many messages of negativity around us. Over time and with intention, building your gratitude practice can bring just a little more peace and joy to your world.
By Laurie Little, PsyD, Director of Therapeutic Services, Residential, Lindner Center of HOPE
Fort Mitchell, KY – One of the NKY Chamber Women’s Initiative’s most anticipated professional development events – the Women’s Initiative Regional Summit, sponsored by PNC – is returning this October and will expand to a two-day virtual event for the first time in its five-year history. Dr. Danielle Johnson, MD, FAPA, Chief Medical Officer, Lindner Center of HOPE, will present a breakout session.
Taking place Tuesday, Oct. 13, 2020 and Wednesday, Oct. 14, 2020 from 8:30 a.m. to 12:30 p.m., the 5th Annual Women’s Initiative Regional Summit, sponsored by PNC will feature a variety of speakers and timely topics designed to support professional women in all stages of their careers, including young professionals, mid-career and senior-level professionals, and entrepreneurs.
Each day will kick off with a morning welcome and general session, after which attendees will have the opportunity to attend two rounds of breakout presentations from a selection of six presenters, and a networking session. Each day will wrap with closing comments and a debriefing providing attendees the opportunity to discuss and share insights and learnings gained during the day.
On Tuesday, Oct. 13 the morning welcome and general session will feature Catrena Bowman-Thomas, Executive Director at the Northern Kentucky Community Action Commission and Priya Klocek, President/CEO at Consultant On The Go, LLC who will present All Talk Little Change: Diversity, Equity and Inclusion in Action. This informative session will create a constructive dialogue around workplace diversity, equity and inclusion. This will be followed up on Wednesday, Oct. 14 by Angel Beets of Gilman Partners whose topic, Elevate Your Leadership Influence, will dive into how to communicate vision, add value to your organization, articulate your goals purposefully and more.
The complete schedule for this year’s 5th Annual Women’s Initiative Regional Summit, sponsored by PNC, is as follows (events are subject to change):
Tuesday, October 13 Morning General Session:
All Talk Little Change: Diversity, Equity and Inclusion in Action
Lindner Center of HOPE Announces Leadership Transitions
September 23, 2020 – Mason, Ohio – Paul Keck, MD, current President and Chief Executive Officer of The Frances and Craig Lindner Center of HOPE is pleased to announce: Paul R. Crosby, MD, has transitioned to the role of President and Chief Operating Officer of the comprehensive mental health center of excellence, which opened in 2008.
Dr. Crosby, Associate Professor and Vice Chair of Psychiatry and Behavioral Neuroscience at the University of Cincinnati (UC) College of Medicine and summa cum laude graduate of The Ohio State University, was recruited to join the Lindner Center of HOPE medical staff for the Center’s opening in 2008. As a people-first physician leader with expertise in healthcare operations and policy, Dr. Crosby is guided by the values of empathy and excellence. He drives results by combining his clinical experience with sound business principles. He played significant, strategic roles in the growth and development of Lindner Center of HOPE, taking on more responsibility over time and serving in progressively more complex roles: Chief of Child and Adolescent Psychiatry, Medical Director of Lindner Center of HOPE Professional Associates, Chief Medical Officer, Chief Clinical Officer, Chief Operating Officer (COO) and now President and COO. As President, Dr. Crosby will assume leadership of all of the Center’s strategic and operational activities.
Dr. Crosby’s leadership has brought achievements in clinician recruitment and retention, multiple surveys by regulatory and accrediting bodies, and restructuring of LCOH’s nationally-renowned residential services resulting in increased referrals, increased census, and increased patient and referrer satisfaction. He led LCOH’s pandemic response including coordination of communications, establishment of safety best practices rapid conversion to telehealth of most outpatient services, and rapid transitioning to working-from-home for many staff. Notably, throughout the pandemic, the Center has not instituted layoffs or furloughs, pay reductions, or capacity reductions. He is a recipient of The Healthcare Leadership Award, Venue and LEAD Magazine, Cincinnati.
Dr. Crosby is board certified in Adult, Child and Adolescent Psychiatry and has provided care in many of the Center’s service lines, including residential services, inpatient adolescent services, and partial hospital programs. He will continue to provide outpatient psychiatric consultation to children and families referred from around the country.
Founding President and CEO since 2005, Dr. Keck, is continuing to serve in the role of Chief Executive Officer of Lindner Center of HOPE, while also serving patients as part of the Center’s outpatient practice.
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 services for all ages and short-term residential services for adults, 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.
Paul Keck, MD, Chief Executive OfficerPaul Crosby, MD, President and Chief Operating Officer
Danielle Johnson, MD, Lindner Center of HOPE Chief Medical Officer, has been named Exemplary Psychiatrist by National Alliance on Mental Illness (NAMI) Southwest Ohio as part of the 2020 Award Winners for Excellence in Mental Health Care. The awards recognize individuals who have demonstrated extraordinary work and advocacy on behalf of people with mental illness and their families. Dr. Johnson is very deserving of this honor.
Many think that psychosis cannot be targeted with cognitive behavioral therapy, but that is not the case. There is a specific form of therapy that was developed for psychosis called CBTp. One important point to mention is that the symptoms are only targeted when they are distressing to the client and they interfere with their functioning or safety, not because one believes them to be untrue or abnormal. The main tenet is to join with the client and build rapport while not directly challenging their psychosis, which is referred to as working within their belief system. Once this is established, gradually helping them think differently about some of their experiences or beliefs is possible, but not in all cases. In some cases, the cognitive therapy is used to help them live their life and meet their goals in spite of their experiences or beliefs.
Combatting Stigmatization
One useful technique with this therapy is to help them feel less stigmatized and normalize some of their experiences. There are specific websites out there that detail stories and list famous people out there who have struggled with psychosis, which can be very helpful for the client to read about. One such website is intervoiceonline.org.
Effective Coping Strategies
Another very practical technique is helping them set smart and realistic goals. This can be done by asking what their goals are and developing a shared goal that can be accomplished. For example instead of “wanting the voices to stop” a smart goal could be “by the fourth session I will have learned and used two different coping strategies that reduce how much distress the voices cause from 100% to 75%”.
Other strategies that CBTp utilizes are coping strategy enhancement. First you figure out what they already are using to cope and figure out if they need to be refined or improved. Helping them figure out the time of day to use these strategies is important. They are likely to be most helpful when their voices are triggered, such as certain times of the day, a specific place, a certain smell, or certain feeling. Some strategies that can be useful to use before their voices are triggered include progressive muscle relaxation, deep breathing, and practicing mindfulness of the present moment such as identifying things in the room. Strategies that can be helpful once the voices are already triggered include: using an ipod and listening to a feel good songs playlist; playing the look, point and name; using sub vocal speech or singing under one’s breath which can interrupt the voices; focusing on voices (hearing out in order to change relationship with voice); entering into dialogue with them, and setting specific times for listening to voices.
CBTp Objectives and Techniques
When targeting voices in sessions, there are several main goals. One is to help the client understand how their beliefs and thoughts relate to the voices and influence their feelings, mood, and coping. Another is to help them identify their beliefs about their voices. Helping them explore evidence for and against their distressing beliefs is important. One can also develop behavioral experiments to test out the reality of their belief. Helping them generate alternative explanations and thoughts about their voices is also helpful. Providing behavioral interventions to reduce distress associated with their voices is key as well. Lastly, helping them change their relationship to their voices is important.
As you can see, there are many strategies that can be useful in psychosis treatment for this presenting problem.
The key it to present it in a way that is collaborative with the client and doing so in a trusting professional relationship. Meeting the client where they are at is important. It is also helpful to keep in mind that these techniques take some time to work and for the client to be able to use them, so patience is key as well.
Nicole Bosse, PsyD
Staff Psychologist, Lindner Center of HOPE
Established in 2008, Lindner Center of HOPE has stood as a beacon of support for countless individuals grappling with mental health issues or addiction. Contact the Lindner Center of HOPE today to learn more about our comprehensive suite of mental health treatments and services, our environment fosters enduring recovery. Powered by our dedicated psychologists, the Lindner Center of HOPE is wholly devoted to instilling hope and guiding you on your personal journey to wellness.
Screen time recommendations vary by the child’s age. Presently, the American Academy of Pediatrics (AAP) recommends that for children younger than 18 months of age, the use of screen media other than video-chatting should mostly be discouraged. For children 2 to 5 years of age screens are acceptable for no more than one hour per day thus allowing them ample time to engage in other activities promoting growth. For older children, current guidelines encourage proactive development of an individualized Family Media Use Plan (www.healthychildren.org/MediaUsePlan) that takes in consideration the particular child’s maturation and needs. This article will focus on a few recent neurobiological findings addressing the effects of excessive screen time exposure on the growing brain in youth to help us be better informed as parents, educators and healthcare workers.
Preschoolers – if the content is educational, that’s all that matters, not how it is presented, right? Wrong!
In a 2019 study by Cincinnati Children’s Hospital researchers documented associations between higher screen use and lower measures of brain structure and skills in preschool-aged children. The team examined the screen time habits and cognitive skills of 47 children, 3 to 5 years of age and conducted brain scans on each child. Prior to the scans, the kids took a cognitive test and the parents filled out a questionnaire regarding their child’s screen time habits. The final score, called the ScreenQ score, was based on a number of criteria focusing on AAP recommendations, including whether the child was exposed to screens before 18 months of age, if they had a television in their room, and how much time they spend in front of screens. Scores ranged from zero to 26 and the higher scores represented less of an adherence to general screen time recommendations from the AAP. It was observed that higher ScreenQ scores were associated with lower brain white matter integrity, poorer expressive language and poorer cognitive skills suggesting that excessive time in front of a screen, even if the content is considered educational, might decrease cognitive skills in preschoolers. (1)
Elementary School Age and tweens -Reading is all good, right? Wrong!
A 2018 study from Cincinnati Children’s Hospital explored the time spent using screen-based media versus reading an actual book on the functional connectivity of the reading-related brain regions in children aged 8-12. Time spent on screens might be linked to impaired shifts in brain connectivity, while reading a book is linked to more beneficial neurobiological changes. The researchers had families rate how much time their children spent on various screens and how much time they spent reading actual books. The children’s brains were scanned, to assess how regions involved in language were connected, and it turned out that screen time was linked to poorer connectivity in areas that govern language and cognitive control. Reading a physical book, on the other hand, was linked to better connectivity in these regions. These findings underscore the importance of children reading real books to support healthy brain development and literacy and to consider limiting excessive screen time, even if some of the content presented through screens might be related to reading and considered educational. (2)
Tweens- screens are all bad, right? Wrong!
A 2019 study published in NeuroImage explored the effect of screen media activity on structural brain changes and how this might affect specific behaviors in 9-11 year olds. Structural scans of the brains of 4277 participants were correlated to screen activity like watching television, playing video games, or using social media. Some finding were expected, like individuals with significant exposure to activities engaging the visual system (watching TV or video) showing structural patterns suggestive of greater maturation in the visual system (i.e., thinner cortex). Some structural brain changes related to increased screen exposure were associated with more psychological issues and poorer performance on cognitive tests, while other latent variables did not show such relationship. The authors summarized that it remains difficult to conclude that brain structural characteristics related to screen media activity have uniformly negative consequences. Moreover, while some media activity associated brain structural changes were related to poorer cognitive performance, others were related to better cognitive performance suggesting that screen media activity can not be simplified as overarchingly “bad for the brain or for brain related functioning”.
Regardless of the age group discussed, one strategy to mitigate the potential risks associated with excessive exposure to screens is to ensure that the child has an overall well balanced and healthy lifestyle. This includes reinforcing proper eating and sleeping habits adequate for the age of the child, sufficient and diverse physical activity and providing plenty of opportunities for not screen related social interactions. Establishing a flexible family matrix of screen rated “rules” which dynamically adapts to the growing child would ensure that parents and educators factor in screen time exposure as one of the determinants when raising a healthy kid.
John S. Hutton, Jonathan Dudley, Tzipi Horowitz-Kraus, Tom DeWitt, Scott K. Holland.
Associations Between Screen-Based Media Use and Brain White Matter Integrity in
Preschool-Aged Children. JAMA Pediatrics, 2019.
Horowitz-Kraus T, Hutton JS. Brain connectivity in children is increased by the time they spend reading books and decreased by the length of exposure to screen-based media. Acta Paediatr. 2018;107(4):685-693.
Paulus MP, Squeglia LM, Bagot K, et al. Screen media activity and brain structure in youth:
Evidence for diverse structural correlation networks from the ABCD study. Neuroimage. 2019;
185:140-153.
Anna Guerdjikova, PHD, LISW, CCRC Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program, Lindner Center of HOPE, University of Cincinnati, Department of Psychiatry, Research Assistant Professor
Binge eating disorder (BED) is the most common eating disorder, with an estimated prevalence of 3% in the US population. It is also the most common eating disorder among men. BED is characterized by regularly recurrent episodes of eating unusual amounts of food within a discrete time frame (usually <2hrs), which are associated with loss of control and significant psychological distress. Unlike people with Bulimia nervosa, those with BED do not engage in purging behaviors (such as fasting, driven exercise or self-induced vomiting). Untreated BED is a risk factor for obesity, metabolic disorders, mental health problems and poor quality of life. Although psychotherapy and medications have demonstrated effectiveness in treating BED symptoms, the vast majority of patients with BED remain undiagnosed and untreated.
Patients with BED face significant barriers to evaluation and treatment. First, there are patient-related barriers such as lack of awareness of BED as a medical condition, where the patient may attribute their loss of control to having no willpower. Moreover, patients may be reluctant to discuss their eating behavior and weight out of shame or fear of being judged. Finally, past experience may lead patients to assume that their primary care provider is unwilling or unable to address their disordered eating. Providers also face challenges in identifying BED in the primary care setting: Some patients with BED may have a normal BMI, which makes providers assume that they do not have an eating disorder. In addition, BED often co-occurs with psychiatric disorders such as depression and anxiety, which can lead to attributing the BED symptoms to the patient’s mental health diagnosis or the effects of psychotropic medications. Finally, lack of knowledge about treatment options and underestimation of the impact of BED on medical conditions, leads many primary care providers to overlook BED as a target for evaluation and treatment.
The reality is that primary care providers have much to offer patients with BED. Screening, education, self-management tools and in some cases, referrals to specialty care or medication. Screening for and treating BED can be advantageous when managing patients with diabetes, where decreasing the frequency of binges can lead to significant improvement in metabolic parameters. A BED diagnosis is useful when selecting psychotropic medications with lesser potential to aggravate binge eating. Finally, diagnosing a patient with BED can alleviate the patient’s distress and stigma. Patients who struggle with BED are often relieved and thankful that they have a treatable medical condition rather than attributing their bingeing to a character flaw and feel empowered and thankful for any help in managing their disorder. Since untreated BED poses a challenge in treating conditions such as diabetes and dyslipidemia, diagnosing and managing BED can benefit all areas of patient health.
Although there are still significant barriers to screening, diagnosis and treatment, primary care providers have the means to improve health outcomes among their patients with binge eating. Primary care is the ideal setting for raising awareness of the problem of binge eating among the general population, to address patient’s disorder eating concerns and start patients on their journey to recovery. First of all, routine procedures such as weighing patients, offer opportunities to ask patients whether they have any concerns about their weight or eating patterns. These questions can also be added to the medical history updates hat patients complete prior to office visits. Routine screening of special populations such as patients with diabetes, those attempting weight loss or receiving psychotropic medication is of great help in managing those comorbidities. The SCOFF questionnaire is a brief screen for eating disorders suitable for primary care*. Providers interested in providing medication management for BED should also screen for psychiatric comorbidities and substance use disorders to guide their medication choices.
In summary, patients with BED are largely undiagnosed and untreated, which complicates the management of their medical and mental health issues. Although access to specialty continues to be a challenge, primary care providers have the means to start patients on their road to recovery and improve overall health outcomes and quality of life.
The Research Institute at the Lindner Center of HOPE is a world leader in Binge eating disorder research. For more information about our current studies, call 513-536-0710.
Javaras KN, Pope HG, Lalonde JK, et al. Co-occurrence of binge eating disorder with psychiatric and medical disorders. J Clin Psychiatry. 2008;69(2):266-273. doi:10.4088/jcp.v69n021
Nicole Mori RN, MSN, APRN-BC
Nurse Practitioner, Lindner Center of HOPE Disorder Services
On June 5, 2020, Lindner Center of HOPE, along with Greater Cincinnati Hospitals, joined medical professionals across the country to protest against racial injustice and work to eliminate racial bias in healthcare. Racism threatens our opportunity to create a Greater Cincinnati that is healthy by design #WhiteCoatsForBlackLives
Lindner Center of HOPE representatives paused and prayed for peace and justice.
