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By Laurie Little, PsyD
Lindner Center of HOPE, psychologist

 

Depression can occur at any age. It does not discriminate. However, recent research suggests that young adults are experiencing symptoms of depression at higher rates than ever. There are many theories about why this is so, including the proliferation of social media, consequences of the Pandemic, escalating costs of living and even global issues.

Major Depressive Disorder is a result of a complex interplay of biological, psychological, and environmental factors. One’s family history, genetics, brain chemistry, life experiences, and stressors all contribute to its onset and severity.

However, there are unique challenges that young adults face that make them potentially at higher risk for experiencing depression. Young adults are trying to make their transition from dependency on parental figures and family support systems, to relative independence. There are new pressures that they are trying to manage that can be new and often confusing. There are academic, occupational, social, and financial pressures that can lead to feelings of inadequacy. Some young adults are woefully unprepared for the new responsibilities in their lives. They are also faced with transitions in their identity and being required to ask themselves questions about their life goals, meaning and purpose. These questions and challenges can all lead to anxiety, overwhelm and hopelessness when things are not going as they had expected.

Recognizing the signs of severe depression in young adults is crucial for early intervention and support. Symptoms often manifest as sadness, however some young adults experience more irritability and an overall moodiness. There may be changes in appetite or sleep patterns, withdrawal from social activities, and even reckless or impulsive behaviors. A comprehensive assessment from a licensed health professional is required to make sure that depression is the only issue. Oftentimes, depression can co-occur with other mental health concerns such as anxiety.

Navigating conversations about depression with young adults requires empathy, patience, and understanding. Here are some helpful tips to facilitate meaningful dialogue and support:
Create a Safe Space: Establish an environment free of judgment where young adults feel comfortable expressing their thoughts and emotions. Avoid dismissing their experiences or offering unsolicited advice. Instead, listen actively and validate their feelings. (Example: “Of course you would feel upset about that, that sounds really difficult.”)

Normalize Mental Health: Foster open and non-judgmental discussions about mental health and addiction within your social circles and communities. By reducing the stigma surrounding depression, you empower young adults to seek help without fear of judgment or discrimination. Remember, everyone knows someone who struggles with a mental health issue or addiction.

Educate Yourself: Stay informed about depression and its symptoms in young adults. Empower yourself with knowledge about available resources, treatment options, and support networks.

Encourage Professional Help: While offering emotional and practical support is essential, it’s equally important to encourage young adults to seek professional assistance from mental health professionals. Provide information about treatment options such as psychotherapy and medication management, emphasizing that seeking help is a sign of strength, not weakness. Research is clear that the “Gold Standard” of treatment for depression is a combination of both therapy and medications.

Be Patient and Persistent: Healing from depression is a journey marked by ups and downs. Be patient with young adults as they navigate their emotions and experiences. Offer consistent support and encouragement, reminding them that they’re not alone in their struggles.

Psychotherapy for young adults is often a crucial step in recovery. Depression has been shown to be reduced by Cognitive-behavioral therapy (CBT) and mindfulness-based interventions. Family therapy may also be useful if the young adult is still living at home. Pharmacotherapy may also be required. For some young adults with treatment resistant depression (has not responded to traditional talk therapy or antidepressant trials) they may need to explore other treatment modalities, such as transcranial magnetic stimulation (TMS) and ketamine assisted therapy. These treatments offer new hope for individuals resistant to traditional treatments.

In addition to professional interventions, lifestyle modifications play a crucial role in managing depression. Encourage young adults to prioritize self-care activities, such as regular exercise, healthy eating, adequate sleep, and stress management techniques. Engaging in hobbies, creative outlets, and social interactions can also foster a sense of purpose and belonging. Be a healthy role model for the young adult in your life by trying to do the same.
Lastly, peer support groups and online communities provide valuable opportunities for young adults to connect with others who share similar experiences. These platforms offer a sense of solidarity and validation, reinforcing the message that recovery from depression is possible with the right support and resources.

Severe depression in young adults is a multifaceted challenge that demands a holistic approach to understanding, intervention, and support. In order to combat these rising rates, it is essential that we all work together to reduce the stigma of seeking help for depression and all mental illnesses and addiction. We must be vigilant about mental health symptoms in ourselves and our loved ones. Lastly, it is imperative that we provide empathy, support and resources when needed.

If you or someone you love is in need of mental health assessment or treatment, call the Lindner Center of HOPE at 513-536-HOPE or visit lindnercenterofhope.org for more information.

 

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by Dawn Anderson LPCCS

Sexual Orientation and Gender Identity (SOGI) is the medical format for incorporating what we commonly refer to as LGBTQ information about those we serve in the medical community. The acronym LGBTQ stands for lesbian, gay, bisexual, transgender, and questioning or queer. Sexual orientation describes the attraction a person experiences to others, whereas gender identity is that person’s internal sense of who they are. Best said by a dear friend of mine, Tristan Vaught owner of Transform Cincy, “Sexuality is who you go to bed with, gender is who I go to bed as.”

In healthcare, collecting this information is an important sector of understanding a person, the same way that we ask about their early life experiences, support system, or educational history. For some people, each of those questions would give more insights into how to best support and work with them more than other questions. By collecting data on gender and sexual identity as well as relationships, we can better understand their lives and the of value those sectors of personhood.

A second reason that we collect SOGI data is to provide respectful care. Knowing the proper title and pronouns to use when addressing someone is a way to demonstrate respect and honor them as an individual. Some ways you can incorporate this into your daily life might be introducing yourself first with your name and pronouns, or by using gender neutral pronouns if you are unsure of someone’s pronouns. We use this model more than we commonly think of, such as if I find a lost phone, I would say “someone left their phone here,” and that is the same for “this guest is here for their appointment.” By demonstrating this level of knowledge with those we serve as well as colleagues, we can create a safer work community for everyone with inclusion.

Sexuality is also valuable context in the way we actively show up against heteronormativity in our world. If I ask about my patient’s relationship, I want to make sure I am respecting them by referring to the important people in the lives appropriately. If a coworker tells me they have a child, I wouldn’t likely assume it’s a son. Similarly, if a coworker refers to their spouse, I shouldn’t assume their gender either. It helps to use the same words other use to refer to their significant others. (ex. Husband, wife, partner, son, daughter, child).

When it comes to asking questions, it’s important to consider if I would ask this question to any general person, if not, am I asking for the benefit of the person I’m talking to or my curiosity? If the latter, there are ways to do research and learn more that are more respectful than asking someone I don’t know well. Some resources to learn more include https://pflag.org/ or https://www.cdc.gov/healthcommunication/Preferred_Terms.html.

 

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by Jessica Kraft, MSN, PMHNP-BC

 

 

 

 

Anxiety and mood disorders are amongst the most commonly diagnosed mental health conditions in the United States. While many find successful treatment through various psychotherapies or medications targeted at managing anxiety and depression, no medication will magically take away all anxiety or life stressors and it is not uncommon to experience breakthrough anxiety or symptoms of depression even while under the care of mental health professionals.  In today’s hectic world it can be challenging to juggle daily responsibilities and find ways and time to take a step back and practice mindfulness or focus on self-care. This article explores different mindfulness activities and alternative therapies, some of the benefits they illustrate, and how to include them in our day-to-day routines.

Meditation: Meditation has been practiced for thousands of years and is considered one of the oldest spiritual practices in ancient India and China. While it can be challenging to find an agreed upon definition for meditation, in general it is agreed upon that meditation is a practice and form of mental training with the goal of calming the mind (Wang et al., 2022). Meditation can look different to different people and can be practiced in as little as a few minutes every day.

Yoga: Yoga is an ancient spiritual practice with roots in Indian culture and is an alternative therapy often combined with meditation that focuses on breathwork and the adoption of physical postures.  There are multiple style of yoga that differ in intensity and length of time, but multiple individual studies and systematic reviews have concluded that yoga can benefit those struggling with depression with symptom reduction seen with 60-minute sessions per week (Saeed et al., 2019).

Exercise: There are numerous studies and clinical trials showing the benefits of exercise related to mental health, particularly for those who struggle with anxiety and depression. A meta-review examining the relationship between anxiety disorders and physical activity (especially aerobic and resistance exercises) with over 69,000 participants showed that on average participants reported significantly reduced anxiety over a 3-year period when engaging in physical activity on a regular basis. Analysis examining sedentary behavior showed an increased risk of depression over time compared to those who engaged in more physical lifestyle activities (Firth et al., 2020). While there can be limitations in studies related to exercise types, additional therapies, and other variables there is one thing that remains consistent: no trials have shown that physical activity worsens anxiety or depression (Saeed et al., 2019).

While mindfulness activities and alternative therapies sound great on paper, they can be challenging to practice regularly. Below are some tips for squeezing in mindfulness activities into a hectic schedule:

  • Utilizing meditation apps. Most popular meditation apps (Calm, Headspace, Healthy Minds Program) have lengthy daily meditations, but they also include quick 1-3 minute meditations/deep breathing exercises that can easily be practiced before going to bed, before starting the work day, or to take a time out when feeling overwhelmed
  • Find exercise you enjoy doing. Motivation to exercise can be challenging enough, but when it is for an activity you don’t even enjoy this can be even more challenging. Find an activity or sport that you actually enjoy or look forward to doing and this will help with consistency, especially if you are able to engage in the activity with friends or family and turn it into a social or group event
  • Make slow, incremental changes to routine. It’s not uncommon to make a self-care plan including things like exercising daily, meditating daily, and making dietary changes. When we try to make multiple changes like this overnight it is easy to get discouraged if we miss a day and sometimes, we don’t even get back to it. Focusing on one change at a time and incorporating it into your routine more slowly helps with habit changing
  • In short, set yourself up for success with the four laws of behavior change. 1) make it obvious – if you want to go to the gym after work every day pack your bag the night before, 2) make it attractive – get yourself a new pair of shoes or a new workout outfit, 3) make it easy – start with a few minutes per day, and 4) make it satisfying – set up incentives to motivate yourself and keep it going (Clear, 2022)

Sources:

Clear, J. (2022). Atomic habits: An easy & proven way to build Good Habits & Break Bad Ones: Tiny Changes, remarkable results. Cornerstone Press.

Firth, J., Solmi, M., Wootton, R.E., Vancampfort, D., Schuch, F.B., Hoare, E., Gilbody, S., Torous, J., Teasdale, S.B., Jackson, S.E., Smith, L., Eaton, M., Jacka, F.N., Veronese, N., Marx, W., Ashdown-Franks, G., Siskind, D., Sarris, J., Rosenbaum, S., Carvalho, A.F. and Stubbs, B. (2020), A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry, 19: 360-380. https://doi.org/10.1002/wps.20773

Saeed SA, Cunningham K, Bloch RM. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 2019 May 15;99(10):620-627. PMID: 31083878.

Wang, Zanyi1,; Rawat, Vikas1; Yu, Xinli2; Panda, Ramesh Chandra3. Meditation and its practice in Vedic scriptures and early Taoism scriptures. Yoga Mimamsa 54(1):p 41-46, Jan–Jun 2022. | DOI: 10.4103/ym.ym_48_22 (https://journals.lww.com/yomi/fulltext/2022/54010/Meditation_and_its_practice_in_Vedic_scriptures.8.aspx)

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By: Elisabeth Renner LPCC-S, Lindner Center of HOPE Outpatient Therapist

 

 

 

In the journey of mental health and personal growth, two concepts stand out as essential: authenticity and vulnerability. These are not just buzzwords; they represent profound paths to healing and self-discovery. Drawing insights from the writings of physician and author Gabor Maté, let’s delve into the transformative power of authenticity and vulnerability.

Authenticity is the courage to be true to oneself, to honor one’s feelings, thoughts, and experiences without pretense. Authenticity begins with self-awareness and acceptance. It requires a deep dive into our inner world, acknowledging our strengths, weaknesses, fears, and desires. Authenticity invites us to embrace our imperfections and vulnerabilities, recognizing them as integral parts of our humanity.

 

Vulnerability is often misconstrued as weakness, when in fact, it is a profound strength. It is the willingness to expose our true selves, to open up and genuinely connect with others. Gabor Maté asserts that vulnerability is the gateway to intimacy and healing. When we allow ourselves to be vulnerable, we invite empathy, understanding, and support into our lives. It is through vulnerability that we break down walls of isolation and shame, forging authentic connections with others.

In our society, authenticity and vulnerability are often suppressed by societal norms and expectations. We are conditioned to wear masks, to hide our true selves. True liberation comes from shedding these masks, from embracing our authenticity and vulnerability unabashedly.

Practicing authenticity and vulnerability requires courage and resilience. It means stepping into discomfort, confronting our inner demons, and facing the judgment of others. Maté illuminates, it is only through embracing our shadows that we can bask in the light of self-acceptance and inner peace.

How can we cultivate authenticity and vulnerability in our lives? It begins with self-reflection and introspection. Take time to explore your inner landscape, to identify your values, passions, and fears. Embrace your vulnerabilities as valuable aspects of your humanity, rather than weaknesses to be hidden. Practice self-compassion, treating yourself with kindness and understanding as you navigate the ups and downs of life. Cultivate authentic connections with others by sharing your truth openly and honestly. Engage in deep, meaningful conversations that go beyond surface-level interactions. Create spaces where vulnerability is welcomed and celebrated, where individuals can show up as their authentic selves without fear of judgment.

In conclusion, authenticity and vulnerability are not just ideals to strive for; they are essential ingredients for mental and emotional well-being. The path to healing and self-discovery begins with embracing our authenticity and vulnerability wholeheartedly. Dare to be authentic, to be vulnerable, and to embark on a journey of self-discovery and growth with courage and grace

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Drug and alcohol detoxification, commonly referred to as detox, is the process by which an individual’s body clears itself of substances such as drugs and alcohol. It involves the physiological or medicinal removal of toxic substances from the body, typically under the supervision of medical professionals. The primary goal of detoxification is to manage the acute and potentially dangerous effects of withdrawal that occur when a person stops using substances to which they have become dependent.

Detoxification can occur in various settings, including medical facilities, detox centers, or even at home under medical supervision, depending on the severity of the addiction and the individual’s overall health status. The process may involve medications to alleviate withdrawal symptoms, as well as supportive care to address any medical or psychological complications that may arise during withdrawal.

It’s important to note that detoxification is just the first step in the journey to recovery from drug and alcohol addiction. While detox addresses the physical aspects of addiction by removing the substances from the body, it does not address the underlying psychological, emotional, and behavioral issues that contribute to addiction. For example, according to SAMHSA (Substance Abuse Mental Health Services Administration), 83% of individuals with a substance abuse issue, also have a co-occurring mental health issue (i.e., depression, anxiety, trauma). Therefore, detox is typically followed by ongoing treatment and support, such as counseling, therapy, and participation in support groups, to address these deeper issues and help individuals maintain long-term sobriety.

Certain substances are associated with more severe withdrawal symptoms and potential complications during detoxification. Here are a few examples:

Alcohol withdrawal can be particularly dangerous and even life-threatening in severe cases. Symptoms may include tremors, hallucinations, seizures, delirium tremens (DTs), and in extreme cases, cardiovascular collapse. Medically supervised detox is often necessary for individuals with alcohol dependence to manage these symptoms safely.

Benzodiazepines, such as Xanax, Valium, and Ativan, are central nervous system depressants that can lead to physical dependence with prolonged use. Withdrawal from benzodiazepines can be severe and potentially life-threatening, with symptoms including anxiety, insomnia, seizures, and in rare cases, delirium, or psychosis. Medically supervised tapering is usually recommended to minimize the risk of severe withdrawal symptoms. Always consult your prescriber prior to making any medication changes.

Opioids, including prescription painkillers like oxycodone and illicit drugs like heroin, can cause significant physical dependence. Withdrawal symptoms from opioids can be highly uncomfortable and include flu-like symptoms, nausea, vomiting, diarrhea, muscle aches, anxiety, and insomnia. While opioid withdrawal is typically not life-threatening, it can be challenging to manage without medical assistance, and medications such as methadone or buprenorphine may be used to ease withdrawal symptoms and support recovery.

Barbiturates, though less commonly prescribed today, are another class of central nervous system depressants that can lead to physical dependence. Withdrawal from barbiturates can be similar to benzodiazepine withdrawal and may include symptoms such as anxiety, insomnia, seizures, and in severe cases, delirium, or cardiovascular collapse. Medically supervised detox is necessary to manage withdrawal safely.

In addition, the advancement in technology, has resulted in the rise of behavioral or process addictions (i.e., gambling, social media, gaming, compulsive buying). These new forms of addiction can emulate drugs and alcohol withdrawal and increased tolerance symptoms as well. Individuals who become addicted to these behaviors can exhibit depression, anxiety, irritability, and agitation when discontinuing the behavior.

It’s important to emphasize that detoxification from any substance should be approached with caution and under the guidance of medical professionals, as withdrawal can be unpredictable and potentially dangerous, especially in cases of severe dependence. Seeking professional help from healthcare providers or addiction specialists is crucial for ensuring a safe and successful detoxification process.

In the journey of detoxification from alcohol and drugs, remember: the path to recovery may be challenging, but the destination of freedom and a healthier, happier life is worth every step. Embrace the support around you, stay resilient in the face of obstacles, and know that every day sober is a victory worth celebrating. Your courage to embark on this journey is the first step towards a brighter tomorrow.

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

 

 

 

 

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An Untapped Resource in the Treatment Journey

 According to a February 2024 article in the Journal of American Child and Adolescent Psychiatry, the prevalence of mental health conditions in adolescents has been increasing worldwide, outpacing the availability of effective mental health care. More adolescents require acute inpatient psychiatric hospitalization, but do not have resources for sub-acute care after discharge. Step-down programs, often known as partial hospitalization or day treatment programs, are helpful in decreasing re-admissions but are often underutilized. These programs can also serve as a step-up from outpatient care if severity is escalating. Partial hospitalization is designed to offer this intermediate level of care between inpatient and outpatient services.

Given that adolescence is a dynamic stage of life full of transitions and a common time for symptoms of mental illness to first present, teens may have difficulty managing home, school, and social activities without therapeutic intervention. Adolescent partial hospitalization offers day treatment during weekdays, so evenings and weekends can be used for patients to test skills learned during treatment hours.

Though partial hospitalization programs primarily occur in group settings, programs should be designed in a way that meet the unique needs of each patient participating in the program.  Ideally, programing includes elements such as psychoeducation, individualized treatment planning and goal setting, a variety of psychotherapeutic experiences, psychiatric evaluation, educational support, and family involvement.

The most effective adolescent partial hospitalization programs are staffed by multidisciplinary treatment teams including a board-certified child and adolescent psychiatrist and psychiatric nurse practitioner, mental health specialist, specialized therapists, licensed social worker, psychiatric registered nurse, licensed teacher, and a dietitian.

Patients and families participating in adolescent partial hospitalization should benefit from tangible insights and skills that will foster resilience, improve communication, bolster coping skills and functioning. These tools are intended to help better navigate daily life and maximize a teen’s chances for success.

 

Lindner Center of HOPE in Mason, Ohio offers an adolescent partial hospitalization program for mental health. Learn more about the program at:  https://lindnercenterofhope.org/adolescent-partial-hospitalization-program/.

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Elisha Eveleigh Clipson, Ph.D.
Child Psychologist, Lindner Center of HOPE
Assistant Professor – Clinical, University of Cincinnati College of Medicine
Department of Psychiatry and Behavioral Neuroscience

 

 

Parents bring their children for psychological testing to answer the same question: How do I best help my child navigate through life? Increased autism awareness has led to a greater sense of identity and connectedness among many members of the autism community. There have been opportunities to highlight the strengths of individuals with autism spectrum disorder (ASD) and their families. With increased autism awareness, more parents notice symptoms and wonder if the diagnosis applies to their child.

I spend much of my professional time determining whether a child meets the criteria for autism. Part of the process is ruling out other explanations, and possibly ruling out autism. Sometimes families are upset when their child does not meet the criteria for autism.

Recently, a teen without ASD symptoms reported she was upset I did not “give her the diagnosis of autism” because she knew she had it. I deeply wanted this teen to better understand her experience, but she was not sufficiently trained to provide an accurate diagnosis.

Psychologists aim for accurate diagnosis. This informs the answer to the question of how to best help a child navigate through life. It is worth educating parents on what other issues have overlapping symptoms with autism.

When it is Autism

Individuals with ASD have differences in social communication and social interaction. Part two of the diagnosis has to do with restricted, repetitive patterns of behavior, interests, or activities.

On the communication side, we see significant difficulty in the following areas:

  1. Social-emotional reciprocity.
    1. This may include trouble with back-and-forth conversations or failure to initiate or respond to social interactions.
  2. Nonverbal communication used for social interaction.
    1. For example, trouble understanding or using nonverbal gestures, lack of facial expressions or avoiding eye contact.
  3. Developing, maintaining, and understanding relationships.
    1. For instance, trouble sharing in imaginative play, making friends or a seeming absence of interest in peers.

Restricted, repetitive patterns of behavior might include:

  1. Repetitive motor movements or speech. Classic examples include repetitive phrases and unusually repetitive lining up of toys.
  2. Some children with autism have inflexible routines, unusual greeting rituals, or distress with small changes.
  3. The experience of abnormally restricted, fixated interests or preoccupations may be present.
  4. Many children with autism have differences in sensitivity to sensory input. This may include indifference to pain, excessive smelling of objects or visual fascination with the movement of an object.

 

What else could it be?

Social (Pragmatic) Communication Disorder

This involves persistent trouble with the social use of verbal and nonverbal communication. Symptoms include difficulty with:

  • Greeting others and sharing information.
  • Changing communication to match the context, e.g. communicating differently with a teacher than a peer.
  • Knowing how to use nonverbal signals to regulate social interactions.

Attention Deficit/Hyperactivity Disorder

  • Children with ADHD experience more sensory processing issues than other children. They may be more sensitive to sounds or smell.
  • They may have difficulty taking turns or picking up on social cues.
  • May become distracted and disengage in the middle of a conversation.
  • Some children with ADHD can become, “hyper-focused” on an interesting task.

Anxiety Disorders and OCD

  • Individuals with anxiety disorders may avoid social situations.
  • Anxiety can make a person feel less comfortable with eye contact.
  • Some children refuse to talk outside of the home.
  • Rigid patterns of behavior and thinking are possible.

Sensory processing difficulty

Individuals with a range of developmental and psychological experiences have sensory processing difficulty. This is more commonly experienced with mood disorders, anxiety or ADHD. It is also more prevalent in children with Intellectual Disability or Global Developmental Delay.

Behavioral concerns

  • Not all children with autism have behavior problems. In fact, many do not.
  • Children with behavioral concerns may have trouble understanding and regulating their emotions.
  • Some children with speech and communication delays exhibit behavior problems when unable to express themselves.

Depression

  • The range of facial expression or tone of voice may be more neutral.
  • A person may become socially withdrawn.

“Overcontrolled” personal traits

Some of my colleagues at LCOH provide Radically Open DBT. This is for people who experience a spectrum of problems that result in being “overcontrolled.”

  • May exhibit less emotional expression, saying, “I’m fine” when they are not.
  • Show a limited range of facial expressions.
  • Their lives may be rigid, and rule governed.
  • May seem aloof or distant in relationships. For instance, they might avoid sharing personal information.

 

Having Autism does not exclude a person from also experiencing the conditions described above. Yet, meeting the criteria for one or more of these conditions does not mean a person has autism. Providing an accurate diagnosis honors the experience of people with ASD and other conditions. It empowers families to best support their children throughout the lifespan.

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By: Dr. Nicole Bosse, PsyD, Lindner Center of HOPE

 

OCD is a disorder that responds very well to a form of Cognitive Behavioral Therapy called Exposure and Response Prevention. Brain imaging studies found that people with OCD have excessive levels of activity in the orbital cortex, the caudate nucleus, the cingulate gyrus, and the thalamus. Differences are unrelated to intelligence and most other cognitive abilities. These studies also show that the brain changes in response to Exposure and Response Prevention. The overactive parts of the brain become less active and similar to others without OCD after engaging in Exposure and Response Prevention.

Exposure and Response Prevention consists of confronting what you are afraid and abstaining from the related compulsions. Specifically, exposures are purposeful and gradual confronting and maintaining contact with feared objects, thoughts, or images to allow the anxiety to rise, peak, and subside. Response Prevention is the halting of neutralizing actions and/or thoughts (i.e., compulsions) to allow habituation to a feared stimulus (e.g., not washing after touching a doorknob). This is done with the help of a trained therapist. It is a form of therapy that is collaborative and the individual works with the therapist to brainstorm various exposure ideas to start forming a hierarchy.

A hierarchy ranges from items that bring about low to high distress/anxiety. An example hierarchy for someone that has a fear of snakes could look like: reading about snakes, looking at pictures of snakes, watching videos of snakes, looking at snakes behind glass, being in the room with someone holding a Gardner snake, being in the room with someone holding a boa constrictor, touching a Gardner snake while someone else is holding it, touching a boa constrictor that someone else is holding, holding a Gardner snake, and being in a bathtub with boa constrictor snakes. The last item can be something that wouldn’t necessarily be done for exposures, it is just used as a something to help scale other exposures.

There are two types of exposures I usually talk about with patients, planned vs. spontaneous. Planned exposures can take various forms, from in vivo to imaginal. In vivo exposures are exposures that are completed in person, for example touching things that could be contaminated with germs or breaking down avoidance of certain people for fear of harming them. Imaginal exposures are usually implemented when it is impossible/unethical to do in person exposures. For example, the individual can be instructed to write sentences about hurting someone or write an imaginal script detailing their worst fear. These exposures can be done over and over in one sitting until it starts to get boring.

Spontaneous exposures are things that happen throughout the day that are unplanned and typically cause significant anxiety. For instance, if someone is afraid of germs and someone sneezes on food etc. With spontaneous exposures, I usually instruct individual to do one of two things, either abstain from the compulsion or do something called ritual weakening. Ritual weakening is completing the compulsion but doing it differently than the OCD desires. For example, postponing washing hands or writing down that you are giving into a compulsion in order to be able to do the compulsion. The idea is it makes it slightly less convenient to do the compulsion, which over time weakens OCD.

In sum, Exposure and Response Prevention is a very successful form of treatment for OCD. To be effective, the individual must be willing and motivated. An individual is never made to do something they are uncomfortable with. It is best to go slow in order for the individual to learn their anxiety will decrease over time.

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By Jennifer B. Wilcox Berman, PsyD, Lindner Center of HOPE

 

OCD and OCPD are often mistaken for one another or used interchangeably. Although there is some overlap between the two disorders, it’s important to distinguish between them because they are quite different in many ways. It is important to note that although there are differences, some people may have symptoms of both OCD and OCPD. The two disorders are differentiated below.

Obsessive-Compulsive Disorder (OCD) is a debilitating psychiatric disorder that presents in many forms. OCD is comprised of obsessions, which are persistent and unwanted intrusive thoughts, images, or urges. To reduce or eliminate this distress or discomfort, OCD sufferers begin to engage in compulsive behavior, which is ritualized behavior or mental acts, that serve to reduce their discomfort and anxiety. It should be noted that not all compulsions are outwardly observable and may include avoidance of triggers or engaging in mental compulsions. Unfortunately, engaging in compulsions or avoidance of triggers reinforces obsessive thinking. Therefore, the goal of treatment is to reduce compulsions while learning how to tolerate the distress that comes from intrusive thoughts. Some subtypes of OCD include fears related to contamination, scrupulosity (religious-based fears)/morality, fear of harming others (aggressive or sexual), ordering and arranging, repeating, and checking. There are several other subtypes of OCD not noted here. In OCD, these intrusive thoughts are considered ego-dystonic, meaning they are inconsistent with someone’s self-image, beliefs, and values. Therefore, these obsessions cause significant distress, anxiety, and worry and can greatly interfere with one’s life. People with OCD tend to seek help when these thoughts and behaviors cause problems in their life.

According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), Obsessive-Compulsive Personality Disorder (OCPD) is “a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control.” Due to this, people with OCPD struggle with flexibility, openness to new ideas, and are often inefficient at completing tasks due to perfectionism. Their rigidity and inflexibility can lead to preoccupation with details, rules, lists, order, organization, and schedules. They can hold themselves to perfectionistic standards that interfere with their ability to complete tasks. They are often overly devoted to work and productivity at the expense of leisure activities and interpersonal relationships, leading to a poor work-life balance. People with OCPD can be overly conscientious, very scrupulous, and are often inflexible about matters of ethics, morality, and personal values. Some people with OCPD tend to be miserly, may hoard money for the future, and may have difficulty discarding worn-out or useless items. They may appear to be stubborn or rigid, and may struggle to delegate tasks or work with others because they don’t believe others will do things to their high standards. OCPD is considered ego-syntonic, meaning that it is consistent with someone’s self-image, beliefs, and values. People with OCPD tend to feel validated in their patterns of rigidity and perfectionistic rules and schedules. Therefore, people with OCPD are less likely to seek treatment, unless their behavior begins to negatively impact those around them.

While Exposure and Response Prevention (ERP) is considered the “gold standard” treatment for OCD, there is no such definitive standard intervention for OCD. Exposure and Response Prevention (ERP) is a type of Cognitive-Behavior Therapy (CBT). Cognitive-Behavior Therapy varies from other types of talk therapy in that it is focused on changing thinking patterns and behaviors. It tends to be directed at the present, rather than the past and is goal-oriented and solution-focused. ERP aims to change behavioral patterns, allowing someone to confront their fears and therefore, reduce their OCD symptoms. Exposure refers to the direct confrontation of one’s fear through voluntarily taking steps towards their fears and triggers. Response Prevention refers to someone voluntarily agreeing to reduce their usual rituals and compulsions. It is very important for someone who is working on doing exposures to simultaneously refrain from engaging in compulsions. Without reducing or refraining from the related compulsions, the person cannot learn that they can tolerate the exposure or that the compulsion is unnecessary.

Treatment for OCPD tends to focus on the identification of rigid rules and lifestyle and how these things may be negatively impacting one’s life. Therapeutic intervention includes working on flexibility, willingness to make changes, and focusing on one’s values as motivation for change.

For those suffering from symptoms of OCD or OCPD, therapeutic intervention can be helpful. It is important to seek a specialized provider that can accurately diagnose and treat these disorders.

 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Grant, J. E., Pinto, A., & Chamberlain, S. R., (Eds.) (2020). Obsessive compulsive personality disorder.    American Psychiatric Association Publishing.

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Kaila Busken, Lindner Center of HOPE, Licensed Independent Social Worker

One moment you are bursting at the seams with overwhelming joy. Every fiber of your being is filled with love for this tiny human being in your arms. Looking in your baby’s eyes, you feel like you have found your life’s purpose. And still, motherhood is really hard. New motherhood is sitting in the messy middle of seemingly opposite feelings. You can feel a mixed bag of emotions: sad and happy, overwhelmed, and peaceful, grief and joy, lost and found.

The transition to motherhood and its ambivalence has its own name: matrescence (pronounced like adolescence). The term was first developed by medical anthropologist Dana Raphael in 1973. This term is used to describe the bio-psycho-social- spiritual change that occurs when a woman makes the transition to motherhood. Like in adolescence, matrescence is a physical, hormonal, and emotional change all happening at the same time. Matrescence recognizes the large shift in identity that occurs when a woman becomes a mother and helps to normalize what it feels like to be in the middle of a whirlwind of emotions. Motherhood is a magical metamorphosis, because once you have a baby, nothing will ever be the same. And that is both beautiful and sad.

Around 15-20% of women who birth a child will experience postpartum mood disorders such as depression and anxiety. But matrescence is a normal part of motherhood and it is normal to feel ambivalence in this season of life.

Here are some helpful tips for coping in this new season of life:

1. Let go of expectations.
From the time a woman decides she is going to have children she hears an influx of information about what it means to be a mom and how to care for her baby. One of the biggest things a mom may hear is “you don’t have time for yourself anymore.” An important thing to remember is that you are a person worth caring for. You deserve to eat. You deserve a hot shower. You deserve to hydrate yourself. And you deserve love. You may even have a “Pinterest” perfect image in your head of what motherhood would be like. You may have pictured a blissful bubble in which you only feel complete happiness, but it is important to allow yourself to embrace the messiness and imperfection that is motherhood.

2.  Build your support system.
Just as a baby was born, you as a mother were born too. It is okay to ask for help and it is important to find a group of people who will help care for you. Look for people who will help support you emotionally while you adapt to your new role. Also look for people who will provide practical support like doing that pile of dirty dishes in your sink or the endless pile of laundry that babies create. Babies are tiny but they certainly require a village.

3.  Practice self-compassion.
Being a new mother is difficult. Suddenly this new little life is depending on you day and night and it can be exhausting.  It can be easy in this new vulnerable state to be harsh and self-critical. During this time, it is especially important to practice self-compassion and remind ourselves of our own worth. It can be easy to believe that you are a “bad” mother and that you are not providing what your baby needs. An important self-compassionate reminder is that “you are the best mother for your baby”. The goal is not for you to be a perfect mother but rather to be a “good enough” mother and embrace all the imperfection that comes with raising a baby. Perfection in motherhood is not possible and practicing self-compassion can help in remaining resilient in the face of this new role.

4.  Embrace the ambivalence.
Motherhood is embracing so much of the messy middle between seemingly opposing emotions. It can be uncomfortable to be in this place, where you want to spend every moment with your precious newborn and to crave the independence and space you had prior to having a baby. Motherhood is about the “both/and”, knowing that good and bad can exist in the same place. It is possible for you to embrace them both at the same time. You can love your baby with every fiber of your being and miss a time when you were able to sleep through the night or drink a hot cup of coffee.

5.  Allow yourself to grieve.
It is okay to grieve in this new phase of life. We tend to believe that grief is only reserved for death, but we can grieve many things in this new phase of motherhood. You may grieve your old life, previous relationship dynamics, your body and how it may have worked before, your time, your envisioned birth plan, your envisioned feeding plan, or your expectation of what you thought motherhood would be like. Allowing yourself to feel the sadness in some of these losses will help you to move on and embrace your new role as a mother.