Author: pricilagran

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by: Elizabeth Mariutto, PsyD, Lindner Center of HOPE, Psychologist and Clinical Director of Partial Hospitalization/Intensive Outpatient Adult Eating Disorder Services

With all of the news and changing regulations in our current times, it can be very hard to manage anxiety and mood related to coronavirus. Below are 10 tips on how to manage your mental health.

1. Limit your access to the news and social media. With everything changing minute by minute, it is easy to find yourself constantly scrolling various sources. Possibly set a certain number of times per day or a set amount of time that you are “allowed” to check one news source that you trust. Some find it helpful to set an appointment with themselves to do so and limit their checking to this appointment. Some phones allow to you track or limit your screen time, which can be a beneficial tool. It can also be helpful to physically put your phone or computer in a separate place, or to go in a separate room from your TV.

2. Practice mindfulness. Try to take it day by day and remember that all of this is temporary. Use of apps such as Headspace and Calm can help promote mindfulness.

3. Use gratitude. Identify 1-3 things each day that you are grateful for. Don’t neglect things that we take for granted, such as our physical health, the ability to use technology to keep us connected, and all of those working at those grocery stores to keep the shelves stocked as much as possible.

4. Focus on what matters in the big picture. Taking steps to practice social distancing is to help our healthcare system avoid being overwhelmed and to help healthcare workers save lives. These could be those that you love, or loved ones of your loved ones.

5. Stay active. Exercise releases endorphins and can help us stay both physically and emotionally happy when done in moderation.

6. Go outside. Vitamin D can positively impact our mood and energy level, and a great source is from the sun.

7. Stay connected with others. This is key when practicing social distancing. Facetime is a great way to be present with those you love without increasing anyone’s risk.

8. Perform acts of service. Volunteering can lead to improvements in mental health, so offering to bring groceries to an elderly neighbor or donating to a local food pantry can both help others as well as boost our mood.

9. Engage in hobbies. One of the best ways to fight depression is to engage in behavioral activation, or do things that are fun for you. This may be a great time to try a new recipe if you enjoy cooking, or to take that online course on photography.

10. Get connected with resources if needed. Many therapists are switching to use of different technologies for therapy to help with social distancing, and you can find self-help resources online to help cope with stress

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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.

 

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

Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

Not all children and teens respond to stress in the same way. Some common changes to watch for include

  • Excessive crying or irritation in younger children
  • Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
  • Excessive worry or sadness
  • Unhealthy eating or sleeping habits
  • Irritability and “acting out” behaviors in teens
  • Poor school performance or avoiding school
  • Difficulty with attention and concentration
  • Avoidance of activities enjoyed in the past
  • Unexplained headaches or body pain
  • Use of alcohol, tobacco, or other drugs

There are many things you can do to support your child

  • Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand.
  • Reassure your child or teen that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
  • Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
  • Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
  • Be a role model.  Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.

The emotional impact of an emergency on a child depends on a child’s characteristics and experiences, the social and economic circumstances of the family and community, and the availability of local resources. Not all children respond in the same ways. Some might have more severe, longer-lasting reactions. The following specific factors may affect a child’s emotional response:

  • Direct involvement with the emergency
  • Previous traumatic or stressful event
  • Belief that the child or a loved one may die
  • Loss of a family member, close friend, or pet
  • Separation from caregivers
  • Physical injury
  • How parents and caregivers respond
  • Family resources
  • Relationships and communication among family members
  • Repeated exposure to mass media coverage of the emergency and aftermath
  • Ongoing stress due to the change in familiar routines and living conditions
  • Cultural differences
  • Community resilience
For 7 to 10 year olds

Older children may feel sad, mad, or afraid that the event will happen again. Peers may share false information; however, parents or caregivers can correct the misinformation. Older children may focus on details of the event and want to talk about it all the time or not want to talk about it at all. They may have trouble concentrating.

For preteens and teenagers

Some preteens and teenagers respond to trauma by acting out. This could include reckless driving, and alcohol or drug use. Others may become afraid to leave the home. They may cut back on how much time they spend with their friends. They can feel overwhelmed by their intense emotions and feel unable to talk about them. Their emotions may lead to increased arguing and even fighting with siblings, parents/caregivers or other adults.

More on taking care of your family

Disasters and other crisis events have the potential to cause short- and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. It’s important that pediatricians, and all adults in a position to support children, are prepared to help children understand what has happened and to promote effective coping strategies. This will help to reduce the impact of the disaster as well as any associated bereavement and secondary stressors.

Stress is intrinsic to many major life events that children and families face, including the experience of significant illness and its treatment. The information provided about how to help children cope after disaster and crisis is therefore relevant for many encounters that pediatricians will have with children, even outside the context of a disaster.

Talk about the event with your child. To not talk about it makes the event even more threatening in your child’s mind. Silence suggests that what has occurred is too horrible to even speak of. Silence may also imply to your child that you don’t think their reactions are important or appropriate.

  • Start by asking what your child has already heard about the events and what understanding he or she has reached. As your child explains, listen for misinformation, misconceptions, and underlying fears or concerns, and then address these.
  • Explain – as simply and directly as possible – the events that occurred. The amount of information that will be helpful to a child depends on his or her age. For example, older children generally want and will benefit from more detailed information than younger children. Because every child is different, take cues from your own child as to how much information to provide.
  • Encourage your child to ask questions, and answer those questions directly. Like adults, children are better able to cope with a crisis if they feel they understand it. Question-and-answer exchanges help to ensure ongoing support as your child begins to understand the crisis and the response to it.
  • Limit television viewing of disasters and other crisis events, especially for younger children. Consider coverage on all media, including the internet and social media. When older children watch television, try to watch with them and use the opportunity to discuss what is being seen and how it makes you and your child feel.

Healthy Children. Org provides additional insights

  • Recognize that your child may appear disinterested. In the aftermath of a crisis, younger children may not know or understand what has happened or its implications. Older children and adolescents, who are used to turning to their peers for advice, may initially resist invitations from parents and other caregivers to discuss events and their personal reactions. Or, they may simply not feel ready to discuss their concerns.
  • Reassure children of the steps that are being taken to keep them safe. Terrorist attacks and other disasters remind us that we are never completely safe from harm. Now more than ever it is important to reassure children that, in reality, they should feel safe in their schools, homes, and communities.
  • Consider sharing your feelings about the event or crisis with your child. This is an opportunity for you to role model how to cope and how to plan for the future. Before you reach out, however, be sure that you are able to express a positive or hopeful plan.
  • Help your child to identify concrete actions he or she can take to help those affected by recent events. Rather than focus on what could have been done to prevent a terrorist attack or other disaster, concentrate on what can be done now to help those affected by the event.

AACAP Recommendations for talking to children about COVID-19 :

Talking to Children About Coronavirus (COVID19)

  • Remember that children tend to personalize situations. For example, they may worryabout their own safety and the safety of immediate family members. They may alsoworry about friends or relatives who travel or who live far away.
  • Be reassuring, but don’t make unrealistic promises. It’s fine to let children know that they are safe in their house or in their school. But you can’t promise that there will be no cases of coronavirus in your state or community.
  • Let children know that there are lots of people helping the people affected by the coronavirus outbreak. It’s a good opportunity to show children that when something scary or bad happens, there are people to help.
  • Children learn from watching their parents and teachers. They will be very interested in how you respond to news about the coronavirus outbreak. They also learn from listening to your conversations with other adults.
  • Don’t let children watch too much television with frightening images. The repetition of such scenes can be disturbing and confusing.
  • Children who have experienced serious illness or losses in th
  • Although parents and teachers may follow the news and the daily updates with interest and attention, most children just want to be children. They may not want to think about what’s happening across the country or elsewhere in the world. They’d rather play ball, go sledding, climb trees or ride bikes.

 

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

The best way to prevent illness is to avoid being exposed to this virus.

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).
  • Through respiratory droplets produced when an infected person coughs or sneezes.

Clean your hands often

  • Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid close contact

 Take steps to protect others

Stay home if you’re sick

  • Stay home if you are sick, except to get medical care

Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.

Based upon available information to date, those most at risk include:

  • People 65 years and older
  • People who live in a nursing home or long-term care facility
  • People of any age with the following underlying medical conditions, particularly those that are not well controlled
    • Chronic lung disease or asthma
    • Congestive heart failure or coronary artery disease
    • Diabetes
    • Neurologic conditions that weaken ability to cough
    • Weakened immune system
    • Chemotherapy or radiation for cancer (currently or in recent past)
    • Sickle cell anemia
    • Chronic kidney disease requiring dialysis
    • Cirrhosis of the liver
    • Lack of spleen or a spleen that doesn’t function correctly
    • Extreme obesity (body mass index [BMI] >40)
  • People who are pregnant
  • Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19.
  • There is no evidence that children are more susceptible to COVID-19. In fact, most confirmed cases of COVID-19 reported from China have occurred in adults. Infections in children have been reported, including in very young children. There is an ongoing investigation to determine more about this outbreak. This is a rapidly evolving situation and information will be updated as it becomes available.

The symptoms of COVID-19 are similar in children and adults. However, children with confirmed COVID-19 have generally presented with mild symptoms. Reported symptoms in children include cold-like symptoms, such as fever, runny nose, and cough. Vomiting and diarrhea have also been reported. It’s not known yet whether some children may be at higher risk for severe illness, for example, children with underlying medical conditions and special healthcare needs. There is much more to be learned about how the disease impacts children.

 

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Margot Brandi, MD
Staff Psychiatrist
Sibcy House, Medical Director
Lindner Center of HOPE

-“ Y hasta cuándo cree usted que podemos seguir en este ir y venir del carajo? – pregunto.

Florentino Ariza tenia la respuesta preparada desde hacia cincuenta y tres anos, siete meses y once días con sus noches.

 -Toda la vida – dijo.”
Gabriel Garcia Marquez en El amor en los tiempos del cólera.

En este mes de febrero, en el que querámoslo o no el asunto del amor se convierte en protagonista ,pienso en esta frase del final de El amor en los tiempos del cólera, que tal vez no sólo habla de una relación (Fermina y Florentino), sino también del arraigo  a un pueblo, de las rutinas pesadas del proceso de inmigración.Siempre la he pensando como una propuesta irreverente ante la eternidad del amor, la idea de un vinculo que perdura para siempre como el vinculo con el lugar de nuestro origen.  Pero, de qué amor estamos hablando…?

En el más reciente  juego de super bowl, justo entre el primer y segundo cuartos, me quede hipnotizada frente al comercial de una compañía de seguros que en 60 segundos paseaba al espectador a través de los 4 tipos de amor según el lenguaje de los antiguos griegos. EL comercial comenzaba explicando cómo los griegos tenían cuatro palabras para referirse al amor. La primera es PHILIA, que se refiere al afecto que crece desde la amistad. La segunda es STORGE que tiene que ver con el tipo de amor que se desarrolla hacia los padres o hacia los hermanos. El tercero es EROS que alude a la incontrolable urgencia de decir “te amo”. EL cuarto se llama AGAPE y es el más admirable, el amor como una acción, implica coraje, sacrificio y fuerza. Es aquello que nos inspira a poner las necesidades del otro primero que las nuestras. Es la búsqueda por convertirnos en la mejor version de nosotros mismos. El intento por construir un mejor futuro para aquellos que amamos.  El comercial es un reconocimiento a las acciones que tomamos todos los días para proteger a nuestros seres queridos. La emigración puede tomar esa forma. Lo que me pareció genial no fue tanto el comercial sino el “timing” del mismo. Me refiero a presentar estas ideas cuando nuestra mente esta básicamente atrapada por un sentimiento de rivalidad entre dos equipos, y el foco principal apuntando a  un consumismo descarado. Lograr una pausa para capturar nuestra atención y recordarnos nuestras prioridades. ( claro, y también vender muchos seguros) como si alguien hubiese cambiado el canal del televisor sin darnos cuenta.

Mi reflexion de este mes es la de tomarnos el mes de febrero como una pausa que nos permita recordarnos el poder del amor como acción, bien sea a través del mas pequeño de los gestos o la mas difícil de las decisiones como lo puede ser emigrar. Recordar de qué se alimenta la tan llamada fuerza de voluntad de un emigrante que empaca sus sueños en una maleta en busca de construir un mejor futuro para si mismo y sobretodo para nuestros seres queridos. Se trata de levantarnos todos los días y “seguir en este ir y venir “de nuestro diario vivir como inmigrantes, así como lo hizo Florentino, el protagonista de El amor en los tiempos del cólera. Poder mirar atrás con un amor melancólico, en mi caso por un país perdido irremisiblemente, o hacia adelante con la esperanza de que “en este ir y venir” nos construyamos un porvenir que trascienda nuestra geografía y nuestra generación.

 

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Mason, OH –Lindner Center of HOPE’s eleventh annual Touchdown for HOPE Super Bowl Sunday event at the Great American Ballpark Champions Club raised $195,000 for patient assistance. Approximately 250 people attended the event. This year Jim Breech, former Bengals star kicker, and his wife, Denise, were honorary hosts.

Proceeds from Touchdown for HOPE sponsorships and ticket sales will be used to fund a mental health services financial assistance program at Lindner Center of HOPE, benefitting our community’s first responders.

Community first responders (brave individuals who have specialized life-saving training) are among the first to arrive and provide assistance at the scene of an emergency, such as an accident, natural disaster, or terrorist attack.  These incidents are unfortunately all too frequent.  Fire fighters, paramedics, emergency medical technicians, law enforcement officials and other first responders experience incredible stress, while witnessing tragedies on a nearly unimaginable basis. When these heroes encounter traumatic experiences such as these, it often leaves them feeling as if no one else could possibly understand what they are going through besides their peers. They often don’t turn to experts to help them deal with mental health issues.

Touchdown for HOPE is a classy and fun Super Bowl party with big screen televisions, plush seating, and signature Cincinnati food favorites and other upscale tailgate-style treats. All taking place in a sports fan’s dream location –overlooking the baseball field.

A generous list of sponsors makes this event possible.

Photos:

– (l-r) Mary Alexander, Lindner Center of HOPE, Director of Development and Touchdown for HOPE organizer; Jim Breech, former Bengals kicker and Touchdown for HOPE honorary host; Paul Keck, MD, Lindner Center of HOPE President and CEO and Tracey Skale, MD, Medical Director, Greater Cincinnati Behavioral Health Services

 

 

– Jack Geiger and Kay Geiger

 

– Jean Crawford and Alvin Crawford, MD

– Craig Lindner, Lindner Center of HOPE Board Chair; Greg Joseph and Bill Butler, Lindner Center of HOPE Board Member

 

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This free movie night is intended to honor Eating Disorders Awareness Week

Lindner Center of HOPE’s Harold C. Schott Foundation Eating Disorders Program is hosting An Evening of Self-Compassion and Vulnerability in honor of Eating Disorders Awareness Week through a free movie night. The movie night will take place Thursday, February 27, 2020 from 6 to 8pm in Lindner Center of HOPE’s gymnasium/conference center.

This is the fourth annual movie night hosted at Lindner Center of HOPE in honor of Eating Disorders Awareness Week (February 24-March 1, 2020). Attendees will watch two TED Talks by well-respected and inspiring professionals in the mental health field, Kristin Neff, PhD, and Brené Brown, Ph.D., LMSW. Lindner Center of HOPE clinical staff will follow each video leading reflection and discussion on transforming lives to include more courage and self-compassion.

Doors open at 6pm, with the first video beginning at 6:30pm. A light dinner will be served. Seating is limited so RSVP is required online at tinyurl.com/lcohfreemovienight. Registration closes on February 20th.

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, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders 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.

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Anna I. Guerdjikova, PhD, LISW, CCRC

Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program

Currently over 50% of the world’s population is living in urban areas with limited opportunity to engage with nature. In North America most adults spend ∼90% of their time indoors. Ecotherapy, also known as nature therapy or green therapy, is the applied practice of the rapidly evolving field of ecopsychology, a term coined by Theodore Roszak in 1992. Ecotherapy builds on the biophilia hypothesis proposed by E. O. Wilson which suggests that human beings are genetically hardwired to “affiliate with other forms of life”. He proposed that the connection humans seek and have with other life forms and nature is deeply rooted in our biology. If prevented from sufficient contact with nature, we are at risk for developing a “nature-deficit disorder” which can lead to negative consequences for our mental and physical health.

It is established through research from all over the world that people with good access to natural environments are more likely to experience wellness. For example, green space has been associated with improvements in cognitive functioning and self-esteem and reductions of depression, stress and anxiety. Blue spaces, defined as environments predominately consisting of water, lower levels of anxiety and mood lability, and are positively associated with self-reported mental and general health. Physical activities in natural settings are associated with less anger, fatigue, and sadness and might reduce the blood flow to the part of the brain responsible for despondency. Mere exposure to nature can be healing, it has been consistently shown that simply looking at environments dominated by greenery or water is significantly more effective in promoting recovery and restoration as compared to milieus lacking nature.

Nature based interventions (NBIs ) include programs and activities engaging people in nature-based experiences to enhance general health through promotion of wellness and prevention of illness. NBIs include interventions that alter the environments where people live and interventions designed to change individual’s behavior (such as promoting walks outside or gardening).

Prescription: A Dose of Nature

Some examples of NBIs as listed below. Of note, nature based interventions can be a helpful adjunct in the treatment of mental illness along with pharmacotherapy and psychotherapy.

  • Physical exercise outdoors: walking, jogging, biking, doing yoga or other exercises in a park fosters increased awareness of the natural world and can be recommended for reducing stress, anxiety, depression, and anger. Walk-and-talk therapy is a gaining popularity treatment model, encouraging patients to be more physically active for mental and physical reasons and helping them move forward, literally and metaphorically speaking, when facing challenging problems
  • Nature meditation: using nature as focus point and incorporating it in meditation and mindfulness experiences. Forest bathing, for example, is a well stablished practice in Japan since the 1980s. It requires that one just sits in the presence of trees, without engaging in any physical activity. It has been shown that in the week after the forest visit, the activity of human natural killer cells (implicated in cancer prevention and immunity) increases and those positive effects can last up to a month following each weekend in the woods. Furthermore, forest environments might help decrease contisol, pulse rate, and blood pressure as compared to city environments.1
  • Horticultural therapy: Various forms of gardening and landscaping are known to improve community connectedness, create a sense of purpose and can promote better eating habits.
  • Animal-assisted therapy: Extensive data supports the use of this complementary type of therapy, with canine and equine-assisted therapy being the most well researched, to improve the social, emotional, or cognitive functioning in various settings  (mental health centers, nursing homes, schools and prisons) and across diagnoses (dementia, ADHD, PTSD and autism to name a few).2
  • Indoor nature exposure- enriching indoor work and living spaces with nature elements (plotted plants, pictures and photos with view of nature, window view of grass or woods etc.) are known to improve attention, moods and productivity and  to reduce stress and heart rate. In one study, for example, sunlight and/or a nature view increased job satisfaction, reduced intention to quit and lowered feelings of being  worn out uptight.3

A study published in the summer of 2019 examined a representative sample of over 20000 people in England and concluded that a “two-hour “dose” of nature a week significantly boosts health, and life satisfaction”, including among those with long-term illness and disabilities.4  If spending only twenty minutes per day in natural environments can make a difference, it is certainly worth giving it  a try.

References :

  1. Environ Health Prev Med. 2010 Jan;15(1):18-26. The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y.
  2. Complement Ther Med. 2018 Dec;41:203-207.”We need them as much as they need us”: A systematic review of the qualitative evidence for possible mechanisms of effectiveness of animal-assisted intervention (AAI).Shen RZZ, Xiong P, Chou UI, Hall BJ.
  3. Health Promot Int. 2015 Mar;30(1):126-39  Indoor nature exposure (INE): a health-promotion framework. Mcsweeney J, Rainham D2, Johnson SA, Sherry SB, Singleton J.
  4. Sci Rep. 2019 Jun 13;9(1):7730.Spending at least 120 minutes a week in nature is associated with good health and wellbeing. White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, Bone A, Depledge MH, Fleming LE.

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William Hartmann, MD; Lindner Center of HOPE Psychiatrist, Medical Director, Willliams House

Navigating the realm of psychiatric medications can be challenging, often hindered by common misperceptions. Managing and understanding expectations can go a long way in ensuring treatment success. Seeking out help is often complicated by preconceived ideas. Preconceived notions about psychiatric medication often get in the way of successful treatment. Building a trusted relationship paves the way for educational opportunities, treatment adherence, and recovery.

5 Common Misperceptions of Psychiatric Medications

1 – “It’s just a chemical imbalance.” 

The advent of serotonin reuptake inhibitors (SSRIs), with their efficacy for depression and anxiety and reduced side effect risk compared to their predecessors, remains a major milestone in psychiatric care. It became increasingly commonplace to hear of the “chemical imbalance” of these illnesses. For as much as “chemical imbalance” helped spread the word that this is a brain disorder, not a moral failing, this wording unfortunately has promoted an overreliance on the power of the medication. The medications do alter brain chemistry and lead to a chain of biochemical events influencing symptom reduction and recovery. What the medication will not do is eliminate stressors, change one’s lifestyle, or cause satisfaction with an otherwise unhealthy situation. I find that those with the greatest success are those who recognize that medication helps facilitate deeper work in psychotherapy and making constructive changes to promote wellness. The medication may help substantially, but it will not do all of the work.

2 – “I don’t want to be a zombie.”

Many will fear that medication will change their personality substantially, or cause them to feel or appear sedated. The goal of treatment is to help a person function as their best self, not change who they are, or make them void of emotional response. While any effective medication has side effect potential, most patients can work with their prescriber to find the right fit for them to manage the illness with success.

3 – “I don’t want to take happy pills.”

Addressing the stigma associated with psychiatric medications, particularly antidepressants, is crucial. Depression is more than the usual sadness one inevitably encounters from time to time. Treatments for mood disorders are not instant “uppers” nor are they performance-enhancers. 

The effects of antidepressants are gradual and usually occur over about 4-6 weeks. Moreover, they will not make you “happy” so much as reduce and resolve symptoms of clinical depression. They aim to restore the capacity for contentment and joy. Treatment allows reduction of the “thought constriction” which limits one’s perspective to seeing few options. One may then see the broader opportunities to connect with core values in a rewarding way. It is about getting back to being your best self. Psychotherapy helps bring this together.

4 – “I don’t want to be dependent on a medication.”

The fear of dependency on medication is a valid concern for many. Taking medication may be a constant reminder of the illness, but the illness exists whether taking the medication or not. The majority of psychiatric medications, except benzodiazepines, do not produce true physical dependence. Turning the focus to the goals of recovery, and how the medication is part of the process, can help.

5 – “Don’t you put everyone on medication?”

There is not a one-size-fits-all approach. A common misconception is that every psychiatric patient is put on medication. Correct diagnosis is essential and, for some conditions, medication may not be the appropriate first line of treatment. A large portion of a psychiatrist’s work involves evaluating and managing the use of psychiatric medications. Most people will not come my way unless they have reached a point where medication appears necessary. A person may be experiencing sadness, grief, anxiety, milder depression, or an adjustment problem that is better suited for psychotherapy. A person might make gains in exposure response prevention for anxiety without the aid of medication. There may not be adequate or applicable evidence for medication helping a particular problem. Evidence is weaker for antidepressants in milder major depressive disorders, for example, but antidepressant treatment is recommended for moderate to severe depression. In some conditions, such as bipolar I disorder or schizophrenia, medication is crucial for the treatment and prevention of recurring episodes of illness. In opiate use disorders, prescription medications such as naltrexone and buprenorphine have emerged as a best practice, something that was not the case decades ago.

Ultimately, the decision regarding the role of medication for a given individual is between patient and prescribing clinician. Addressing attitudes and expectations early in the process can make a better experience for everyone. Empower yourself with knowledge to make the best choices for your mental health journey.

For more information and resources on psychiatric medications, contact us at Lindner Center of HOPE.