Conversacion con la incertidumbre
En esta oportunidad quiero compartir con ustedes el articulo que escribimos en mi Grupo de estudio Psicoanalisis de Cara a lo Social integrado por Manuel Llorens, Alicia Leisse, Carmen Elena Dos Reis, Claudia Alvarez, Yone Alvarez y esta servidora. Nos reunimos de forma “virtual” cada 15 dias para discutir trabajos y temas de corte psicoanalitico y tambien social. Somos todos venezolanos conectados desde el exilio o desde la emigracion elegida. Espero que les resulte de utilidad en estos tiempos de incertidumbre…
UNA CONVERSACION CON LA INCERTIDUMBRE
Una de las anécdotas que ha circulado ampliamente en medio de la pandemia es de la antropóloga Margaret Mead cuando un estudiante le preguntó que cuál era, a su juicio, el hallazgo que evidenciaba el comienzo de la cultura. Esperando escuchar algo como potes de arcilla o cabezas de flechas, el estudiante se sorprendió al escuchar “un fémur roto que fue curado”.
La pandemia ha servido para subrayar la íntima conexión de la humanidad entera. La manera en que los hábitos alimenticios, los sistemas de gobierno, los medios cada vez más veloces de transporte, y hasta nuestra manera de saludarnos, influyen en el curso de un virus que ha detenido todo el planeta. El coronavirus ha puesto de rodillas el poderío humano: paralizó el comercio, las olimpiadas, los aeropuertos, las protestas públicas y más.
Sumado a las consecuencias de la salud de los contagiados, los sistemas sanitarios, la economía mundial y las adaptaciones a la vida cotidiana que ha exigido la pandemia, ha habido un repunte a nivel mundial de trastornos de ansiedad. Por ende se les pregunta a los profesionales de la salud mental: ¿cómo se lidia con las angustias que todo esto despierta?
Circulan muchas recomendaciones, ideas, gestos salvadores, actos creativos que dan cuenta de que, en lugares geográficos con mayor piso de respuesta social, los daños ciertamente están, pero el músculo creativo se reinventa al servicio del otro y de uno con el otro y del sí mismo. Muchas de las recomendaciones, útiles sin duda, se anclan en el terreno de las acciones concretas y conscientes que podemos incluir en nuestras rutinas para sobrellevar la angustia, el tedio, la pérdida o el conflicto que desata las medidas de protección que han alterado nuestras vidas.
Creemos, sin embargo, que puede ser útil tomar un paso al costado y escucharnos desde otro lugar. Hay por lo menos dos elementos fuera de las prescripciones más concretas que valen la pena considerar. El primero, es que la pandemia nos ha colocado de manera dramática frente a la vulnerabilidad humana. Ante esto, algunos han querido continuar como si nada, como los presidentes de Brasil y México, besucones desafiantes, que parecerían estar en negación de los riesgos que implica el COVID-19. Lo cierto, es que desde el Príncipe Carlos hasta los plebeyos estamos expuestos. La omnipotencia no está resultando buena consejera.
A la vulnerabilidad se le suma una gran cuota de incertidumbre. Nuestros parámetros de control han sido trastocados. Hay recomendaciones que nos pueden ayudar a sobrellevar el día a día, pero inevitablemente necesitamos escuchar y articular el temor que surge. El miedo, lo sabemos, pero se nos olvida, es una alerta que necesita ser atendida, para poder prepararnos para lidiar con una amenaza. Lidiar con el miedo sin negarlo, pero sin quedar sobrepasado por el desespero, es parte de la tarea.
La escucha y el esfuerzo por darle palabra a nuestro mundo interno, es parte de una solución que lidia con la incertidumbre sin pretender tener las respuestas de antemano. Una de las maneras en que la psicoterapia psicoanalítica ha sido descrita es como una “conversación con la incertidumbre”. La gran verdad, es que ni los expertos tienen la respuesta completa de las dimensiones del problema ni de su solución. Lo más probable es que tengamos que hablar y escucharnos para descifrarlo en conjunto.
Lo que estamos diciendo, y que lleva al segundo elemento, es que el problema tiene que ver con la interdependencia humana, y su solución, probablemente también. Una de las medidas preventivas curiosamente se ha llamado “distanciamiento social”, cuando lo que necesitamos es distanciamiento físico, pero no social. Tanto por el proceso de concebir soluciones a un problema de dimensión sistémica, como por el funcionamiento biológico individual: la conexión humana es esencial. Sabemos que el sistema de defensa inmunológico está íntimamente relacionado con la vinculación interpersonal, la soledad nos hace más propensos a enfermar.
Nos estamos quedando en casa, aunque parezca paradójico, como gesto de profundo reconocimiento del otro. Nos quedamos en casa, para cuidar a los demás tanto como a nosotros mismos. Nos quedamos en casa, porque el bienestar del otro es indispensable para el bienestar nuestro. Visto así, nuestro encierro no es aislamiento. Las redes de solidaridad, para estar atentos a las personas de nuestro vecindario que no se pueden valer por sí mismas, el comunicar nuestra preocupación por el otro, el pedir ayuda, la música en los balcones o los aplausos a los operarios de salud, son gestos indispensables de conexión humana, necesarios para mantenernos sanos y cuerdos.
No olvidemos finalmente que los riesgos y las desventajas tienden a multiplicarse, por lo que, aquellos que vienen arrastrando desventajas, están ahora en una situación multiplicada de riesgo. Los que tienen alguna situación previa de vulnerabilidad, por edad, por salud, por pobreza, por red de apoyo limitada, están mucho más expuestos y haremos bien en pensar en el problema priorizando las necesidades de aquéllos que la van a sufrir más.
La cuarentena es un alto obligatorio que puede ayudar a hacer un parado en una vida que no deja de exigir apresuramiento, un llamado a abrir espacios para la reflexión, para recalibrar nuestras prioridades y para hacernos más conscientes de nuestra interdependencia, nuestra necesidad del otro, fomentar nuestra capacidad de construir la cultura en los términos que propuso Margaret Mead.
Margot Brandi, MD,
Sibcy House, Medical Director
Keeping Your Family Functional in the Wake of COVID 19
Tracy S. Cummings, MD Psychiatrist, Lindner Center of HOPE Chief of Child and Adolescent Psychiatry Medical Director of CCHMC Services at LCOH
On a large scale, our world continues to adjust to the new normal enacted for our safety in the wake of COVID19. And while we may be interested in global responses and big picture outcomes, this tends to pale in comparison to the level of concern a family holds for its members and home. Our definitions of “family” may vary, and our abilities to handle stress can be wide-ranging, but we all likely share our desire to see the system succeed. Having tangible options to put into action in our households right now can give us a sense of purpose and accomplishment while keeping those that mean the most to us moving forward in positive directions through this uncertain time. Consider the following acronym, HELP, to help keep your family functional:
H– Heed the advice of our trusted medical and community leaders.
- Staying up to date on current safety recommendations from the CDC, WHO and governmental leaders is important.
- Understanding what local resources may be needed and taking the time to consider your home’s personal emergency plan is worthwhile.
- Creating a sense of control over those things that are within your grasp will feel rewarding, even if there is some anxiety around the situation.
- Once you have the general information you need to proceed with helping your family, limit exposure to crisis-related media.
E– Enact the recommendations of the leaders and your personal plan.
- In order for this to be successful for families, there will need to be good communication about its importance. Talking about the virus in a way everyone can understand (particularly if there are young children in the home) will pose a worthwhile challenge. Consider this as an opportunity to demonstrate empathy and compassion for each other when our particular ways of acknowledging, responding to, and addressing stress becomes apparent.
- Take the universal precautions immediately: good hand hygiene, covering coughs/sneezes, frequently clean/disinfect, maintain social distancing, wear a mask if in a public setting, stay home as much as possible and absolutely if sick.
- Remember that younger members in the home will be watching those around them for cues on how to handle this situation, so reinforce the recommendations through modeling the appropriate behaviors as much as possible. If the adults in the home are struggling with how they are personally managing the stress of today, seeking assistance for mental health strength should not be delayed.
L– Listen to the needs of your individual household and make room for those in the necessary changes.
- Label priorities for your family: academics, virtual lessons, family meals, general chores, and what needs to be done on a given day.
- The use of a broad-strokes calendar may be helpful here, so as to set some daily standards and routines. With so much changing around us (ie. schools closed, remote working requirements, conveniences disrupted), having some predictability to the day can provide security to adults and children alike. Do you have to set up a strict schedule for every hour of the day and follow it militantly? No, but knowing there is some allotted time for a few essential activities a day is reasonable, and IT CAN CHANGE as needed.
- Emphasize flexibility over perfection these days.
P– Protect your unity.
- Emotions can run high during this time of collective crisis. Accepting how difficult these changes are for us all can be freeing.
- It is ok to grieve the loss of all the special moments and events that have been postponed or canceled due to COVID19. Whenever possible, consider ways to creatively experience those moments in an alternative fashion. Can’t go to Disney? How about making a Disney movie night and riding some virtual rides that are posted for the park?
- Keep in contact with those who are important to your family as much as possible. Use the technology available to your advantage. Virtual birthday parties and gatherings, like many current classrooms, are being readily utilized with success. Phone calls with or without video, texts, and even sending letters/cards are simple ways to avoid isolation while maintaining social distancing.
- Staying connected doesn’t mean you have to spend every moment together, though. It might be nice, and likely necessary, for family members in the same home to have some time to themselves. Use these moments to recharge and encourage young ones in the home to appreciate this personal time as well.
These are uncharted waters for our families, our communities, our planet. We cannot expect to know how to handle our current circumstances flawlessly, but we can keep trying. All we need is a little HELP.
Mental Health Remains Critical During Pandemic
Lindner Center of HOPE, Chief Clinical and Operating Officer, Psychiatrist
4075 Old Western Row Rd.
Mason, OH 45040
Most of us are weeks into the significant life changes caused by the novel coronavirus. Even as we work to adjust to our new normal, there continues to be changing instructions and sometimes confusing and frightening information to process. Daily, we are being asked to make sacrifices and critically important decisions for the safety and welfare of our family and our communities. It is important during this crisis to remember to monitor and maintain our own mental wellness.
Some tips to manage the stress of today’s circumstances include avoiding excess exposure to media, including social media, taking care of yourself through exercise, eating healthy foods, getting enough sleep, and talking to friends and family. Cultivating a practice of mindfulness and gratitude is another evidence-based way of improving wellness and alleviating stress-related mental health symptoms. For people new to the idea of meditation and to those with more experience, there are many apps, such as Headspace www.headspace.com, to guide the process. Also, even though social distancing is necessary during these times, seek out safe ways to stay connected with others. The American Psychological Association, The National Alliance on Mental Illness, and Mental Health America are advocacy organizations that have a wealth of information about supporting your mental wellbeing during this crisis. www.apa.org www.nami.org www.mhanational.org
With most students out of school and engaged in some combination of home-based and online learning, the situation is understandably stressful for both children and parents. It can be hard to know where to start; but, try and establish a regular routine. Children (and most adults) are reassured by structure and predictability. Try to keep in mind that children learn from watching and listening to the adults around them. They will be very interested in how you respond to news about the coronavirus outbreak. Let children know that there are lots of people helping the people affected by the coronavirus outbreak. This is a good opportunity to show children that when something scary or bad happens, there are people to help. Try to create an open and supportive environment where children know they can ask questions. It is also important to remember that most children may be more interested in playing games, reading books, and other physical and recreational activities than discussing current events or following the news about what is happening across the country or elsewhere in the world. The American Academy of Child and Adolescent Psychiatry’s website is an excellent resource with advice to help families help the children in their lives through the pandemic. www.aacap.org
When there are many changes and uncertainties that are beyond our control, heightened stress and anxiety are normal feelings. A time of crisis can also be a trigger for the onset or reoccurrence of mental health symptoms. If anxiety and/or stress related feelings are causing you significant discomfort or are interfering with relationships, work, or other areas of your life, it may be time to seek help from a mental health professional. Other symptoms to look for include:
- Behaving, thinking, or feeling in ways that are out of character
- Withdrawing from social contacts
- Lack of interest in things that would normally bring joy
- Becoming consistently irritable
- A change in sleep patterns
- Changes in eating habits and/or weight
- Increased use of intoxicating substances
It is essential to remember that mental health services are still available during the COVID-19 crisis. For individuals already receiving mental health and/or substance use disorder treatment services, it is important to continue with these services during this difficult time. To follow social distancing guidelines, outpatient services for mental health assessment and treatment are being offered virtually via a simple phone call or one of several easy-to-use, secure video conferencing apps. When needed, in-person services are still being offered with added health and safety measures to keep patients and staff safe throughout their treatment.
Similar to adults, children who become overly preoccupied with concerns about the coronavirus outbreak should be evaluated by a trained and qualified mental health professional. Other signs that a child is struggling and may need additional help include ongoing sleep disturbances, intrusive thoughts or worries, recurring fears about illness or death. If you notice similar symptoms or other behaviors, thoughts, or feelings that seem out of character for your child, seek a consultation with a pediatric mental health professional. For help finding such a provider, your child’s pediatrician, family physician, or school counselor are good places to seek a referral.
Unfortunately, stigma about mental illness remains the key reason that people do not access care. It is important to know that more than 50 percent of the population will suffer from a diagnosable mental illness at some point in their life and about 20 percent every year. Only a small fraction of these individuals ever seek treatment. One way to start breaking the stigma is to start talking about mental illnesses as a part of normal conversation, similar to how we may discuss illnesses like diabetes or high blood pressure. Mental illnesses are common, biological illnesses that tend to respond very well to treatments that are typically very safe. The goal of mental health treatment is to get back to feeling completely like yourself again. In most cases, treatment is highly effective and allows individuals to function to their full potential.
When it comes to mental health, we need to start treating ourselves more gently. We also need to extend that compassion to those around us. We may be social-distancing but we are all in this together. As, together, we work to fight off this pandemic and take up the challenge of recovering from it, kindness to ourselves and others has never been more important.
If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call:
- Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)
- The National Suicide Prevention Line: 800-273-8255
Look into my eyes … You’re getting very sleepy.
You can’t affect the cards that are dealt, but you can determine how you play them.
Milton Erickson, MD
The father of modern hypnotherapy
When we think of hypnosis, we typically think of a stage performance in which the subject is crowing like a rooster or engaged in some outlandish behavior designed to entertain. Many view hypnosis as a “party trick” or an “act” for amusement. However, the practice of medical hypnosis can be traced back thousands of years in cultures around the world. It was once used for pain management during surgery until doctors started using ether. Today, physicians, licensed psychotherapists and psychologists commonly use it as a tool for change. Hypnosis or hypnotherapy, has been known to help patients with everything from depression, anxiety and phobias to smoking cessation, weight loss, stress management and irritable bowel syndrome. Some hospitals even use it as a tool to reduce pain in individuals before, during and after surgery, as well as in patients with chronic conditions or diseases. Hypnosis is a human condition involving focused attention, reduced peripheral awareness, and an enhanced capacity to respond to suggestion.
One major myth regarding hypnosis is that the individual is unconscious – and powerless. Most people have a clear memory of what happens during hypnosis, while another’s recollection might be not as clear. Some might be able to move their head or lift a finger if they’re prompted, whereas others will remain impassive. Everyone’s experience with hypnosis can differ. While “under” hypnosis, you are not rendered unconscious; you are simply in a deeply relaxed state. In fact, we enter “trance” states all the time. Most of us are familiar with highway hypnosis, the phenomenon in which the person can drive a vehicle great distances, responding to external events in the expected, safe and correct manner with no recollection of having consciously done so. Another example of a common trance state is watching a movie. When we watch a movie, we know actors are up on the screen. We know that this story is not happening in real life. But for those few hours, we can experience emotions and a connection to the story. A movie can create an experience of happiness, sadness, suspense, fear or joy.
Hypnosis is a deeply relaxed state in which suggestions can be given to assist the individual in changing a maladaptive behavior. Do you remember when you were playing as a child and fell down, and your parent kissed your “boo boo,” and you instantly went back to play? Suggestion can change our behaviors.
One of the major problems within the field of research is when clinical trials are conducted and a medication or placebo is given to a subject, the placebo (a sugar pill) turns out to work too well. Researchers don’t like this. Unaware subjects who receive the placebo should not report a difference from the sugar pill, but sometimes they do. The subject’s belief or the “suggestion” that the “pill” is going to improve how one feels, in fact, improves how he or she feels. Recent studies have also found that even a physician’s own presentation of the effectiveness of a new medication to the patient, can result in a patient’s higher perception that the medication is going to be effective, resulting in a more positive result for the patient.
Even though hypnosis has faced many misconceptions through the years, it remains an effective technique in making behavioral changes and improving the lives of many individuals. Not everyone may respond to hypnotherapy in the same way, but this can also be said about other treatment approaches. In searching for a hypnotherapist, find a licensed professional within the mental health or medical fields, and who has been certified to conduct this clinical hypnosis. The American Society of Clinical Hypnosis is a resource, which can assist in locating a certified hypnotherapist in your area. Like meditation, guided imagery, acupuncture, and music therapy, Hypnotherapy can be a valuable tool in providing a healing science to facilitate the body’s innate healing response.
10 Tips on How to Manage Your Mental Health
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
Coping With Stress During This Difficult Time
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
- 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.
Mindfulness During the Holidays
Jennifer Farley, PsyD
Lindner Center of HOPE, Staff Psychologist
The holiday season can be an enjoyable and peaceful time for many of us. We adults know that this can also be a busy, tense, overstimulating, overindulgent, and overwhelming time. Any of these experiences can be triggered, for example, by holiday memories of the past, our current experiences, or worries about the future. We also may have expectations for how our holidays “should” be, which can bring about even more stress in planning them or sadness or anger if our experiences fall short of what we wanted.
Using mindfulness, or focused attention on the “here and now,” can be helpful in making the holiday season more tolerable and, hopefully, more enjoyable. Mindfulness involves being self-aware of one’s thoughts or feelings or behaviors in the current moment and without judgment. Why the current moment? Because thinking about the past can bring about sadness (and depression) and thinking about the future can bring about worry (and anxiety). Being mindful without judgment is also important – it helps prevent an emotion from being experienced more intensely. For example, telling oneself, “I’m a horrible friend for not giving them a gift,” is far different than, “I have the thought that I am a horrible friend for not giving them a gift.” Similarly, reflecting, “I’m sad that my family member isn’t here,” is experienced differently than “I have the feeling of sadness about my family member not being here.” The without judgment part also comes from not judging oneself or anyone else for having a particular thought, feeling, or behavior. Telling oneself, for example, that they’re “bad” for thinking or feeling a certain way is a judgment – having a thought or feeling simply makes one human. What we do with a thought or feeling is what matters more.
Thoughts about how the holidays “should be” can intensify people’s emotional experiences further. Many people, for instance, experience “shoulds” surrounding holiday traditions. While these can bring comfort to our holidays, “shoulds” can also weigh people down with guilt, burden, or anxiety. Family traditions are important, but so is the consideration of how a specific tradition might be unreasonable to expect – for oneself or others. Letting go of the word “should” allows more flexibility and adaptability to an experience, and as such, can bring about more joy and a lot less tension. Do you really “need” to host Christmas dinner? Or is it that you prefer it but can adapt to having someone else host?
Mindfulness can be practiced by observing and describing one’s current thought(s) or feeling(s). Mindfulness can also involve doing something with intention. Consider how you might – with focused intention – wrap a present, look at Christmas lights, drink your cup of coffee or hot chocolate, hug a loved one, sing a Christmas carol, hang ornaments on your tree, watch a favorite holiday movie, or study the fire in the fireplace. Doing something with intention helps you remain in the present moment. Be aware of how your phone or other distractions prevent you from being fully present with others. If you find yourself diving deeper into a holiday memory, try to catch yourself first, and mindfully reflect if it’s a happy or heartwarming memory or one that could bring about sadness or hurt or anger.
One classic holiday movie (A Christmas Story) features Ralphie and his myriad of Christmas-related incidents. There are two scenes that highlight mindfulness practice: 1) when Ralphie looks with amazement at the snow-covered scene outside his bedroom window on Christmas morning, and 2) when Ralphie’s parents sit together in the dark and gaze at their Christmas tree. Another movie (Elf) depicts a father making a choice to fully participate in singing a carol with his family. These pop culture references may help highlight ways you might practice mindfulness in your own ways this holiday season. As a result, may your next month or so be experienced with mindful moments that bring self-awareness, peace, and joy.
Identifying and Treating Panic Disorder
By Nicole Bosse, PsyD
What is panic disorder? Panic disorder consists of recurrent unexpected panic attacks, specifically a spike of intense anxiety
When treating panic disorder, it is treated mostly from a cognitive behavioral approach. The cognitive piece targets the person’s misappraisals about the panic. Individuals with panic disorder tend to overestimate the likelihood of panic occurrence, underestimate one’s ability to cope with panic, and exaggerate the negative consequences of panic attacks.
By helping the individual to identify the misappraisals and working on challenging them, individuals are less fused with their thoughts and can start to think differently about things rather than buy into their thoughts as facts.
The behavioral piece of the approach involves exposure therapy, specifically exposure to what situations they avoid, but also interoceptive exposures. Interoceptive exposures involve gradually exposing oneself to the physical sensations of the panic attack that are feared. Working with a therapist to identify the exposures that rank from low to high is important. Once this is identified, the patient and therapist work from the least distressing to the most distressing. The following are some examples of possible interoceptive exposures:
* Running in Place
* Holding breath
* Head shaking (side to side)
* Spinning in a chair
* Mirror staring
* All over muscle tensing
* Straw breathing
* Over breathing
* Head between legs
The therapist and the individual work to complete just one of these exposures, five times during the day for about 30-60 seconds. This is done repeatedly every day until the person habituates to that sensation before moving on to the next exercise.
Another exposure idea that is sometimes used is pretending to actually have a panic attack in a public area. This strategy is brought in when the person’s fear centers around the social consequences of having a panic attack, such as not wanting others to crowd around them or being embarrassed. For example, I have suggested that individual’s go to a store and practice sitting down somewhere to pretend they are dizzy or cannot catch their breath. This is a great strategy for teaching the person that what they typically fear in that situation is not as bad as they make it out in their mind. It actually usually ends up being pretty uneventful.
Exposures for the avoidance of situations is a little more specific for the person and their unique avoidances. Some common examples of avoidance that I have come across are the following: avoiding caffeine, avoiding intense exercise that increases their heart rate, avoiding being in a car, avoiding driving, avoiding going into stores, avoiding traveling far distances from one’s house, avoiding going places alone, avoiding going places without safety items (i.e., water, benzodiazepine, food, etc.), and avoiding places where the amount of time being there is uncertain (i.e., waiting in lines, sitting down at a restaurant, etc.)
Once the individual’s unique avoidances are identified, the therapist and individual work to create another hierarchy, ranking from low to high distress. For example, if someone avoids going certain distances from their house, some exposures could consist of walking down the street and gradually increasing the distance. A similar strategy could also be used for driving, gradually increasing the distance of driving from a person’s house. Similarly, for line waiting, the individual could practice waiting in lines and gradually increase the amount of time they wait in line, working up to actually waiting in the entire line and being uncertain of when it when it will end.
As you can see by the above described therapy, the main component is facing what the individual fears and letting the body learn that their anxiety will decrease without having to escape the situation. Panic disorder is a very treatable disorder, especially when engaging the correct therapy for it and when combined with the appropriate medication.
“In the News” – Dr. Cummings and patient discuss youth mental illness warning signs with Local 12’s Liz Bonis.
Trevor Steinhauser’s struggle with mental illness began at an early age, but thanks to receiving early help and support for his symptoms, Trevor is feeling better and is now four years sober.
Trevor and Tracy Cummings, MD, Medical Director of Inpatient and Partial Hospital Program Services at Lindner Center of HOPE, spoke with Local 12’s Liz Bonis about mental illness warning signs to watch for in children, such as anxiety and panic attacks.
Trevor credits the Lindner Center of HOPE for helping him overcome his own issues with mental illness and substance abuse. By employing a team approach and giving him a voice in his own treatment, Trevor says the Center was the first to help him learn coping skills for lifelong problems, such as depression and anxiety.
According to Dr. Cummings, behaviors that lead to addiction often present in a person’s youth.
“The reality is that, in any given year, one in five of us are experiencing mental illness. About half of those cases started before age 14, so a lot of people have been having symptoms for a long time. They’ve just figured out ways to either adapt to those or not talk about those,” Dr. Cummings said.
Lindner Center of HOPE has a comprehensive program that treats both substance abuse and co-occurring mental health disorders. Learn more about our Intensive Outpatient program here.
Watch the full story from Trevor and Dr. Cummings’ sit down with Liz Bonis interview on local12.com
Trauma and Mental Health
Jennifer L. Farley, PsyD
Lindner Center of HOPE, Staff Psychologist
When horrible things happen, things that we didn’t want or expect, they can have a significant – and sometimes devastating – effect on our lives. This is especially the case when the horrible event was perceived as a risk to our life or the life of someone we care about. A traumatic event can be shocking, scary, and/or dangerous. It can affect the way we perceive our environment, it can lead us to do things we would not normally do, and it can affect the quality of our relationships. Hence, a trauma can negatively impact many aspects of our well-being.
When someone experiences a trauma, the effects of it can depend on a variety of factors such as the age when the trauma occurred, the duration of which the the trauma occurred, and the intensity of the negative effects of the trauma. These factors do not mean, for example, that one who experienced a one-time traumatic event “should” have a better mental health outcome than someone who experienced a repeated trauma; rather, it is helpful to understand the nature of the trauma and how individuals can be affected.
When a traumatic experience occurs, the limbic system in the brain is activated and initiates the “fight, flight, or freeze” response to protect the person from harm. Interested in touring Sometimes these responses are so strong that a person may do something they would not have imagined was possible. Imagine being able to move something very heavy to protect a child from harm’s way or to run fast away from danger. Other responses can lead one to experience “shock” to where one cannot process their environment in a way to elicit any response. During this “fight, flight, or freeze” response, the individual is not focused on problem-solving or rational thought process, which are functions elicited by the frontal lobe of the brain (the “executive” center, if you will). Instead, the person is focused on survival and protection.
Feeling afraid is natural during and after a traumatic experience. Also,most people recover from initial symptoms they may have after a trauma. However, there are some people who may experience anxiety long after the traumatic experience, even when they are no longer in danger. Some of these individuals may develop symptoms associated with Post Traumatic Stress Disorder (PTSD). People may experience flashbacks that triggers them to feeling the same intensity of fear they had during the trauma. People may develop a strong mistrust of others.
They may also develop feelings of guilt, as if they were responsible for the traumatic event. Some people may avoid certain places or things associated with the trauma. Nightmares may be common. People may also develop very unhealthy ways to cope with their symptoms of PTSD, for example, by “numbing” their feelings with alcohol and/or drugs or with self-harm behaviors. It is estimated that 7 or 8 out of every 100 people will experience PTSD at some point in their lives. When a traumatic event is experienced in a child, the negative effects upon that child’s social and emotional development can be even more profound. The attachment that child has to his or her loved ones can be severely impacted. They struggle to form healthy relationships with others. Their academic performances can be hindered, especially if they become focused on their worries instead of their school work.
For these reasons, seeking psychological treatment as soon after a traumatic is experienced is highly recommended. Psychotherapy can help a person become more empowered over their fears through cognitive and behavioral strategies. Medication also can be indicated for people with PTSD, especially to help regulate sleep, reduce anxiety, and minimize depression. The goal for treatment would be to help the individual function better in several ways (e.g., socially, emotionally, and behaviorally) and to reduce the long-term impact that a trauma might have.
People may experience a traumatic event, but the symptoms associated with experiencing the trauma can be overcome.