Category: Depression

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By Jennifer Farley, PsyD,
Lindner Center of HOPE, Staff Psychologist

There are a number of reasons someone may undergo a psychological evaluation or assessment. The type of testing that is done depends on the individual’s functioning and the setting in which testing may be pursued. This article will look at the different settings of mental health assessments.

Types of Mental Health Assessment Settings

  • Outpatient
  • Inpatient
  • Residential
  • Children’s Assessments

Psychological Assessment in an Outpatient Setting

Testing from a clinical psychologist in a clinical outpatient setting can be pursued on their own or they may be referred from another clinician (such as a primary care physician or psychiatrist). This type of assessment is for patients with non-immediate mental health concerns. In this case, testing is pursued with the referral question in mind (such as whether someone has Attention Deficit/Hyperactivity Disorder, depression, anxiety, a learning disorder, dementia, cognitive problems due to a medical condition, etc). The psychologist tailors the tests to help determine the person’s functioning in the areas that could be affected by a cognitive or emotional disorder. Tests can range from intellectual assessments to personality measures to behavioral questionnaires (which can be completed by the patient themselves, parents, and/or teachers) to academic achievement measures. Clinicians such as neuropsychologists and developmental psychologists can do all these tests and then add additional measures specific to their specialization (such as when documenting problems related to a head injury or when evaluating for Autism Spectrum Disorder). The psychologist can use this information to make a diagnosis and provide recommendations for treatment of the condition. Often, such as for school-age or college-age patients, recommendations for academic accommodations are also provided.

Psychological Assessment In An Acute Inpatient Unit

Sometimes, psychological testing is completed for patients during an acute inpatient psychiatric hospitalization (when the patient is in a mentally unstable condition). In these cases, testing is often used for diagnostic elucidation to help guide decisions about types of medication to use. Recommendations may also be made about additional assessments or resources to pursue following one’s discharge from the hospital. The clinical psychologist completes these evaluations within a short time, since these acute hospitalizations last (on average) about 7 days, and there are usually just a few measures that are administered. Tests are specific to the question about the individual’s diagnosis and may only include emotional/personality measures.

Psychological Assessment in a Residential Setting

Another setting in which psychological testing may occur is within a residential psychiatric setting. This setting is for patients who are experiencing psychological distress that is not severe enough to warrant an acute inpatient hospitalization. Length of stay in a residential setting can vary from 10 days to several months, depending on the purpose of the stay (i.e., evaluation and/or treatment). The purpose of testing in a residential setting is to help comprehensively understand – by way of several different measures – one’s personality functioning, cognitive functioning (which can include neurocognitive skills such as attention, memory, and executive functioning), and other factors (such as external stressors, substance use, medical conditions, etc.) that have contributed to the patient’s condition(s). The patient’s internal strengths and weaknesses are explored, with the intention of making recommendations for how treatment can be tailored to work with the patient’s strengths to compensate for their weaknesses. The clinical psychologist works closely with the other members of the treatment team (such as the psychiatrist, social worker, and the therapists) to understand the patient, develop a treatment plan, and (if a longer stay) to begin implementing the recommendations. The patient’s progress is then monitored and, if needed, further testing can be done to help assess changes in the patient’s functioning as a result of the treatment.

Psychological Assessment in Childhood

In childhood, early observations of potential problems may come from teachers. Teachers may observe struggles in behavior such as impulsivity, talking or interrupting others during times when there is an age-appropriate expectation of silence, and/or oppositional behaviors towards others. Teachers may also be the first to wonder if a child has an underlying learning or attention disorder. If the teacher’s attempts to help the child are unsuccessful, the teacher may recommend testing in the form of a Multi-Factored Evaluation (MFE). Psychological testing may be part of this evaluation and can include intellectual testing and academic achievement testing by a school psychologist. Parent and teacher questionnaires may also be included in the MFE. Depending on the nature of the child’s observed difficulties, others (such as speech and language therapists and physical therapists) may do their own screening. If findings reveal that the student experiences problems that would make learning difficult, accommodations are then recommended and interventions and/or accommodations are then put in place through a 504 Plan or an Individualized Education Plan. It is noteworthy that clinical diagnoses are NOT made from this type of evaluation and findings and recommendations are specific to helping the child learn better.

Prior to any psychological testing, the patient (and/or his/ her family) should understand the purpose of psychological assessment and how it can be useful for guiding treatment and other recommendations.

Find out more information on what psychological assessment is here and why it is a critical step of the process towards finding a diagnosis and treatment plan.

Finding Help and HOPE

If you, or someone you know, is experiencing a mental health crisis, there is help available. The first step would be to consult with a health care provider or mental health care specialist. To see how Lindner Center of HOPE can help you decide on the best mental health assessment setting, reach out to us today. We can help you take the next steps. 

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By: Sidney Hays, MSW, LISW, DARTT,

Lindner Center of HOPE Professional Associates, Outpatient Therapist

From wild parties in the massive frat houses to stories finding your soulmate in movies and television, many enter college with bright eyes and big dreams. There are expectations of melting into a friend group, dating, gaining experience, and finding your passion as soon as you get to college. All of this, stepping-stones to graduating with the dream job lined up, a group of best friends you’ll vacation with every summer, and that special someone you just might spend the rest of your life with. You’ve heard about the glory days and the football games and the spring break trips. But, what happens when you get to college and the classes are hard, friendships are complicated, partying comes with consequences, and heartbreak hits you?

Many young adults enter college with high hopes and expectations that seem reasonable Unfortunately, the movies and glory day memories from loved ones miss crucial struggles and obligations that come with college. This often leaves college students feeling like they’re “missing something” or failing, which contributes to poor mental health in an environment already rife with challenges. The struggles of large class sizes, living with strangers, easier access to drugs and alcohol, financial stress, being away from home, and lack of structure tend to tax the delicate wellbeing of young adults who have not been adequately equipped with needed skills and whose brains are not fully developed.

Most 18-year-olds step onto a college campus and it’s the first time they will be spending the majority of their time living away from home. Suddenly they are responsible for most every aspect of their life, with minimal adult supervision. Out from the safety net of coming home to parents and the guidance of coaches and teachers, college freshmen spend the majority of their time exclusively with others their same age, facing the same struggles. They navigate friendships, romantic relationships, and living with strangers as best they can, often struggling with codependency, lack of boundaries, and the pervasive anonymity and distance offered by the internet. This group tends to struggle with interpersonal skills and ability to regulate their own emotions, with little guidance on effective skills to use. Many find themselves feeling lonely and in cycles of unhealthy or unfulfilling relationships.

Accountability is a new concept for many college students. The looser structure of college settings requires more self-determination and discipline than high school. College is a place where students are generally free to make most of their decisions. While this can be liberating and a time of beautiful self-discovery, it can also lead to poor attendance, study habits, and moderation of substances and sleep. The negative physical, academic, and emotional effects of these choices tend to pile up, which is why so many college students begin to struggle with anxiety and depression.

What to tell a college student who isn’t having the best time of their life:

Know that you are not alone.

Mayo Health Clinic reported in July 22 that up to 44% of college students reported symptoms of depression and anxiety. The stressors faced by college students are underplayed and the good times overly glorified. It often takes time to make friends and friend groups naturally change; that’s okay. People are trying to understand what they want to do with the rest of their lives, becoming independent adults, and learning about the world. This will likely lead to many shifts in relationships as well.

Manage expectations.

You are in school to get a degree, learn about yourself, create relationships, and prepare yourself for the workforce. You may not find a group of friends during welcome week or even freshman year. The romantic relationships may not work out. You may not graduate with your dream job lined up. This is a step towards your goals and can still be part of a life worth living, even if you don’t get exactly what you want by graduation.

Get support and develop lasting relationship skills.

College is a great time to connect with a therapist to process the changes and have a support to help you identify your goals and live within your values. Learning skills to set boundaries, prioritize your time, communicate effectively, and regulate your emotions will make a world of difference in college and will carry on through your life.

A great option for learning these skills is Dialectical Behavior Therapy (DBT). DBT is a treatment that helps participants learn and practice skills to regulate emotions, tolerate distress, and effectively navigate interpersonal relationships.

If you are interested in learning more, for yourself or someone else, about DBT or individual therapy to help navigate this beautiful and challenging season, contact the Lindner Center of HOPE.

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The Difference Between CBT and DBT (Cognitive and Dialectical Behavioral Therapies)

Stacey L. Spencer, Ed.D.
Clinical Neuropsychologist, Lindner Center of HOPE
EMDR Trained therapist
Assistant Professor, Department of Psychiatry & Behavioral Neuroscience

 

There are many, many possible types of psychotherapy. Psychotherapy is an optimal treatment method for mental illnesses.  Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are among the most common psychotherapies.

CBT vs DBT

What is Cognitive Behavioral Therapy?

One that has been in the public sector for decades, and that you’ve likely heard of, is Cognitive Behavioral Therapy (CBT). If you’ve ever gone to therapy, it’s very likely that the therapist you saw practiced CBT. This therapy, also called talk therapy, helps people better understand how thoughts influence our feelings. The goal of CBT is to talk through problems and help frame thoughts differently. CBT is typically time-limited and there are specific goals and homework provided. You might start out with a situation that troubles you, or one you may find troubling. With the guidance of the therapist, you identify the thoughts around the situation and work on finding alternatives and ultimately changing the behaviors in order to feel better. So, it’s thought-feeling-action-focused. Some mental flexibility is involved given that most of these thoughts are automatic and can become engrained.

Cognitive Distortions are often discussed in CBT.  CBT helps us to break up negative thought patterns or “thought traps” that can lead to feelings of anxiety, depression and cause us to avoid. A technique to help one move away from this type of thinking and often employed in CBT is “cognitive shifting”. With the help of awareness in what a person focuses on (in this case, often the negative cognition/thought/belief) the idea is that this helps us learn to shift our focus to something more helpful or innovative. There are many Cognitive Distortions under this umbrella. Examples of catastrophizing could be magnifying or minimizing. I read a good description once of this being a “billowing cloud of everything can go wrong” and believing it inevitably will.  Or in Minimizing when we downplay our successes.

A CBT-oriented therapist might give someone who tends to catastrophize events in their lives, leading to anxiety, for instance, a worksheet and walk through the process with them. This is hypothesized to have evolved as a way to help us survive during the immediate crisis. Now that we have developed higher-level reasoning skills, this can turn against us, as these negative thoughts can turn sticky.

One way to start is to help the client identify what they are currently most worried/anxious about. The client might start by specifying what they imagine will occur without using “what if” statements. Instead, the focus is on the client’s own predictions, e.g., “ I will fail the exam and get kicked out of school.” You ask the client to rate how much they believe this to be true from 0-100%. Next, the client is asked to take a step back and consider the likelihood of the catastrophe to occur. By helping the client to take a step back and assess the fear from a different perspective and re-interpret their concerns, this is called “reframing”.

Working on ways to cope with and manage these fears/anxieties by not diving into them is a strategy that CBT therapists employ. It takes practice and yet studies have shown that finding more balanced ways of managing these types of thoughts can lead to better mental and physical health outcomes. By helping the client to explore the underlying thoughts, emotions and beliefs and problematic thinking, they can work towards a more balanced view of themselves. The hope is that by helping the client change their perception to support more positive thinking, they will reduce distress and suffering and lead a more fulfilling life.

To recap, CBT features the following:

  • Treats emotional response
  • Is time-limited
  • Works best with solid therapist-patient relationship
  • Relies on the application of logic and reason
  • Employs structure to guide tailored treatment

What is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy (DBT) comes from dialectical theory and is actually a type of CBT.  DBT posits balance; not leaning too hard in one direction or another. This modality was originally created by Dr. Marsha Linehan in her work with people with chronic life-interfering behaviors, like self-harm and chronic suicidal thoughts. It has expanded to help with many other issues. Dialectical Behavioral Therapy techniques utilize individual therapy, group skills class and coaching. Groups emphasize learning specific DBT coping skills and there is homework given in-between to reinforce what was learned.

DBT Coping Skills

The four pillars of DBT coping skills include:

Mindfulness

Emotion Regulation

Distress Tolerance

Interpersonal Effectiveness

Mindfulness is a DBT coping skill that involves living with intentional awareness of the present moment. This includes not trying to push away or reject the moment but to notice it and not attach ourselves to it. As Dr. Linehan describes, this is by “Attending to the experience of each new moment, rather than ignoring the present by clinging to the past or grabbing for the future.” This takes practice and patience and can take many forms. Some examples of mindfulness include meditation in the form of noticing by either opening or focusing the mind. Contemplative prayer (in any spiritual form) is another mindfulness practice along with mindful movement such as yoga, martial arts, hiking, tai chi.

Emotion Regulation involves understanding and naming one’s emotions. By helping to learn to identify emotions, one can hope to gain an understanding of what they do for us. Goals of this are to decrease the frequency of unwanted emotions, the vulnerability to them and decrease emotional suffering.

Distress Tolerance are DBT coping skills for when involved in a crisis situation and the goal is to not make the crisis worse. By utilizing skills of Radical Acceptance, one can achieve freedom from suffering and being “stuck”. This can help by reducing acting on intense emotions and tolerating painful events. These are only utilized in a crisis situation, where the event or experience is highly stressful and short-term.

Lastly, Interpersonal Effectiveness skills are to help assist with either strengthening current relationships or end destructive ones, to learn to say yes/no effectively, resolve conflicts before they get overwhelming and create and maintain balance in relationships.

The Difference Between CBT vs DBT in Treating Certain Illnesses

Not all mental illnesses respond to treatment in the same way.  The difference between CBT and DBT must be taken into consideration when determining the optimal treatment method for an individual. CBT has been shown to be effective when treating depression, anxiety, obsessive compulsive disorder (OCD), phobias, panic disorder and post-traumatic stress disorder. DBT was created to help people who might be easily dysregulated and tend benefit from learning ways to self-soothe, communicate more effectively with others and find ways to reduce significant distress.

The Difference Between CBT and DBT Treatment Methods

The difference between CBT and DBT are defined. CBT focuses on the connection between thoughts, feelings and behaviors and how they influence each other. DBT emphasizes regulating emotions, being mindful and tolerating the uncomfortable. CBT guides patients to recognize troubling thoughts and redirect them, while DBT helps patients accept themselves, feel safe and manage emotions to avoid harmful behaviors.

When comparing CBT vs DBT, both therapies have aspects of how our thinking influences our emotions and behaviors but are different in their approaches and structure of the therapeutic process. Both modalities are evidenced-based, that is, much research has gone into showing whether they are effective.  When choosing a therapist, as important as it is to find someone in-network or with openings, it’s equally so to know what treatments are most effective for the reasons you’re seeking therapy in the first place. Therefore, asking about CBT vs DBT and which one might work best for you, would be an important next step in this process.  This is the best way to determine if CBT vs DBT are right for you.

Knowing your diagnosis is key to determining what therapy will be most effective for you. However, many people have more than one diagnosis, and sometimes people use a blend of therapy elements to best manage symptoms.

It can be confusing to know what techniques will best help you. CBT and DBT are some of the more common therapy practices, and have been shown to help individuals suffering from a number of mental illnesses.

Choosing to take care of your mental health is just as important as your physical health and finding providers that utilize evidence-based practices will provide you with the best outcomes possible.

For more information about DBT skills group at Lindner Center of HOPE.

 

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By: Jessica Kraft, APRN, PMHNP-BC
Lindner Center of HOPE, Psychiatric Nurse Practitioner

Seasonal affective disorder (SAD) is a type of depression that is more isolated to the changing of the seasons. It can happen in the spring and summer but occurs most commonly in the fall and winter months. We know that everyone is going to have a bad day from time to time, and it’s not uncommon for some to face more challenges in the winter months when the weather is colder and the days are shorter. But when does this become a problem that requires intervention?

What are some of the common symptoms of SAD? 

  • Feeling down or depressed for most of the day, almost every day
  • Less interest in hobbies, social activities, or things that have brought you joy in the past
  • Decreased concentration at home and at work
  • Fatigue, sluggishness, or low energy
  • Sleeping too much or too little
  • Changes in appetite (increased craving for carbohydrates) or changes in weight
  • A general feeling of hopelessness
  • Low self-esteem
  • Thoughts of self-harm or suicide

It is hard to estimate the number of people who have SAD, as many do not know they have it. It’s also thought that the number in recent years has been higher due to the COVID-19 pandemic. Women can be at higher risk for developing SAD as well as those who live further north. SAD most commonly develops in young adulthood, it often runs in families, and can often be co-morbid with other mental health conditions including depression, bipolar, anxiety, ADHD, and eating disorders.

It is not entirely understood what causes SAD, but research indicates that people with SAD may have reduced activity of serotonin, too much melatonin production, or even vitamin D deficiency. Changes in these areas may impact the body’s daily rhythm that is tied to the seasonal night-day cycle. Negative thoughts and feelings about the winter and its associated limitations and stresses are common among people with SAD, as well as others. It is unclear whether these are “causes” or “effects” of the mood disorder, but they can be a useful focus of treatment especially when seeking therapy.

If the above symptoms start to interfere with day-to-day life, it may be beneficial to seek out care for SAD. For some it may be ideal to start with their primary care provider in order to rule out other medical conditions that could be responsible for symptoms of SAD including alterations in thyroid hormones, low blood sugar, anemia, or viral infections like mono. If there is not an identifiable medical cause, seeking psychiatric help may be beneficial.

What are some of the common symptoms of SAD?

  • Light therapy – a common approach to SAD since the 1980s. The thought is that exposure of bright light every day can supplement the lack of natural sunlight/sun exposure in the winter months. Sitting in front of a light box of 10,000 lux daily during the winter months in the morning can be a helpful intervention.
  • Talk therapy – the most common type of talk therapy for SAD is cognitive behavioral therapy (CBT).
  • Vitamin D supplementation – there is mixed research on how helpful supplementation of Vitamin D is for SAD but some find it helpful and a good option to try prior to trying a psychiatric medication.
  • Psychiatric medication – for those who haven’t seen much improvement with light therapy or CBT, psychiatric medication can be an option including SSRIs (Prozac, Zoloft, Lexapro, etc.) or Wellbutrin. It is important to keep in mind that treatment with one of these medications may take several weeks in order to be efficacious, for some up to 6-8 weeks.
  • When doing research on this topic I came across many anecdotal stories from those struggling with SAD and what interventions they tried and found helpful. Some examples included going outside more often, taking a trip, caring for something like a plant or a pet, finding a new hobby or interest, staying social, creating new rituals, consistent exercise, quality nutrition, good sleep, and maintaining a consistent schedule.

What are some of the common symptoms of SAD?

One of the helpful things about treating SAD is the predictability of when symptoms set in compared to other sub-types of depression that are much more variable. Unfortunately there is little research answering the question of whether or not this can be prevented or if there is a significant benefit to starting treatment early. Of the limited data available the medication Wellbutrin was found to be the most helpful intervention to start early.

Sources:

https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder/index.shtml 

https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder 

https://www.yalemedicine.org/news/covid-19-seasonal-affective-disorder-sad 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302868/ 

https://www.sciencedirect.com/science/article/pii/S2215036620303072 

https://forge.medium.com/advice-for-coping-with-seasonal-depression-from-9-people-who-have-it-a5c04fdfe996

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Nicole Jederlinic, DO
Lindner Center of HOPE Staff Psychiatrist and Medical Director for the Cincinnati Children’s Hospital Acute Unit at Lindner Center of HOPE

As an inpatient and outpatient child / adolescent psychiatrist, I see children and teens, and, consequently, their families facing a wide range of mental health conditions. In the wake of the extensive remote learning related to the COVID-19 pandemic, these challenges have become increasingly common, and can range from social impairments to academic hardship to overt refusal to attend school.

According to the National Alliance on Mental Health, one in six children ages 6-17 experience a mental health disorder each year. Nearly half of all mental health conditions begin by age 14. While schools play a critical role in helping to identify concerns in children, schools are often tremendously (and increasingly) overwhelmed and can only do so much. As such, parents and guardians can play an active role in helping to identify their children’s struggles. Unfortunately, most kids won’t directly tell you they are struggling, so here are some signs to look out for:

-Talking about school becomes off limits, particularly about subjects in which your child may be struggling.

-Your child exhibits a major attitude change toward school. Children and teens may complain of being “bored”, which could also mean they do not understand the material.

-Your child exhibits changes in sleeping or eating patterns. Especially, look out for this on school nights.

-Your child spends too much time on homework. A rough estimate is that a child may have about ten minutes per grade level of homework per night. It’s important to be familiar with the teacher’s homework policy.

-Your child’s teacher explicitly expresses concerns. They see the behavior in school, BUT even they miss things, especially if your child tends to hold things in and is not disruptive.

-Your child begins to misbehave at school.

-Your child receives low grades and these are a drastic change from grades they previously earned.

-Your child spends much of the school day at the nurse with vague physical complaints, missing critical class time and socialization. At an extreme, your child may attempt to avoid going to school altogether.

Now that you’ve identified the problem, what can you do? Have an open conversation with your child – let them know what you’ve noticed and give them a chance to respond themselves. Try and stay open and really listen to their concerns without trying to assume your own interpretations like “they are lazy” or “they are overdramatic”. Remember, they may be guarded, so it’s important to gather additional information. Connect with your child’s teachers to get their thoughts. If difficulties are in one specific class, you could try tutoring or extra help from the teacher;  if they are more pervasive you may need to be more aggressive in how you address things. Try and determine the nature of the difficulty: is it more social/emotional or cognitive/academic? The school may be able to help distinguish this, and it’s okay to ask for additional help from a pediatrician, therapist or psychiatrist.

At public schools, you may formally request that the school evaluate your child’s needs by submitting a written request. Remember to sign and date the request, have the school sign and date when they receive the request and get a copy upon their acceptance of the letter. They have 30 days to respond and either agree to start an evaluation OR provide parents with a “Prior Written Notice” explaining why they do not think evaluation is warranted. This does not mean families cannot purse additional testing /evaluation on their own, but sometimes this can be costly.

Overt refusal to attend school is not a diagnosis in the psychiatric manual, but can point to a variety of psychological conditions like anxiety, trauma or depression. Approximately 2-5% of school children may experience school refusal. It’s important to remember this is NEVER normal. The failure to attend school has significant short and long-term effects on children’s social, emotional, and educational development. That said, it is a complicated problem and requires a collaborative approach to treat. Parents SHOULD NOT feel they are in this alone! Other members of the team may include a pediatrician, psychiatrist, or therapist. At some extremes, children may even require treatment in an inpatient psychiatric hospital or partial hospitalization program. It’s important to build relationships with the school and possibly others to help develop and plan for getting and keeping a child in school.

Typically, remote learning is not the answer to any school difficulties. Even prior to the pandemic, studies indicated that students who did remote learning were at a disadvantage. In 2015, a study of 158 virtual schools compared with traditional schools indicated virtual students obtained lower results in reading and math. In 2021, an analysis of virtual learning during the pandemic indicated a loss of five to nine months of learning with multiple psycho-social consequences including anxiety, depression, concentration difficulties, social isolation and lower levels of physical activity. In summary, there is little evidence of benefit with complete remote learning. More schools are offering hybrid learning models for students floundering in mainstream programs.

School is central to a child’s development. Parents now should have some tools and resources for identifying signs of struggle in their children. Early intervention is important to foster academic and social development and promote psychological well-being.

References:

NAMI. Mental Health in Schools. https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-in-Schools

Linnell-Olsen, Lisa. (2020, May 20). 7 Warning Signs Your Child is Struggling in School. Very Well Family. https://www.verywellfamily.com/warning-signs-your-child-is-struggling-in-school-2601436

Cincinnati Children’s Hospital Inpatient Handouts. SPED Request for Families.

Kawsar, MD S., Yilanli, M and Marwaha, R. (2021, June 11). School Refusal. StatPearls (Internet). https://www.ncbi.nlm.nih.gov/books/NBK534195/

Bissonnette, S and Boyer, C. (2021, July 27). The Effects of Remote Learning on the Progress of Students Before and during the Pandemic. Inciativa Educacao. https://www.iniciativaeducacao.org/en/ed-on/ed-on-articles/the-effects-of-remote-learning-on-the-progress-of-students-before-and-during-the-pandemic

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Thirteen months ago, the world was experiencing the onset of a shared trauma … a pandemic was sweeping over the globe. The actions that were taken to keep people safe included community shut downs, stay at home orders and mandated isolation. Lindner Center of HOPE, like mental health providers around the world, began to see spikes in mental illness and addiction. Individuals who were already struggling with mental illness or a pre-disposition, saw exacerbated symptoms and an increase in severity of illness. People who were managing, saw new onset at higher levels of acuity. As time has passed since the beginning of the pandemic, the trauma has been sustained with higher percentages of people still struggling with mental illnesses and addictions. Additionally, data shows people who have experienced COVID-19 infection are also suffering with co-occurring psychiatric symptoms.

Dr. Paul Crosby, Lindner Center of HOPE

Fortunately, vaccines have been released to protect the population from the physical health threats of COVID-19. However, Lindner Center of HOPE’s President and Chief Operating Officer, Paul R. Crosby, MD, states the vaccine also offers mental health benefits as well.

“The first mental health benefit of the vaccine is simple,” Dr. Crosby said, “since the risk of COVID-19 infection diminishes significantly with vaccination, receiving the vaccine would also protect individuals from co-occurring mental illness that has proven to manifest with COVID-19 infection.”

“The second mental health benefit of the vaccine is the reduction in overall anxiety and stress, as risk and fear of infection is reduced. Vaccinated individuals can lift their isolation from other vaccinated individuals, can begin to see a return to other activities that improve mental health, like more exercise, improved sleep, new experiences through travel and more. A return to these healthier activities can hopefully also lead to a reduction in substance use, overeating or lack of participation in other things that bring joy.”

“The COVID-19 vaccine has significant potential in improving your mental health.”

For individuals experiencing symptoms of mental illness, it is critical to access help. Mental illnesses are common and treatable and no one should struggle alone.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic services for all ages and short-term residential services for adults, and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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By Chris J. Tuell, EdD, LPCC-S, LICDC-CS
Lindner Center of HOPE, Clinical Director of Addiction Services; Assistant Professor, Department of Psychiatry & Behavioral Neuroscience
University of Cincinnati College of Medicine

At the end of the Vietnam War in 1975, 1 out of 5 soldiers (20%), returning to the United States from Southeast Asia, was addicted to heroin. It was estimated that approximately 100,000 American soldiers would be returning home, addicted to this destructive drug. Experts projected a drug epidemic, which would destroy countless lives and communities. It never happened.

Once soldiers returned home to families, friends and communities, the destructive nature of a hardcore drug, like heroin, failed to materialize. In fact, 95% of the soldiers who were once addicted to heroin, stopped using the drug almost immediately once they returned home.

For many years, our understanding of addiction was based on early research conducted in the first half of the 20th century. These studies involved rats and consisted of placing a rat in a solitary cage, providing the rat with a choice of water: plain water or water laced with cocaine or heroin. The study found that all the rats preferred the drug-laced water to the plain water. All the rats overdosed on the drug. The majority of the rats died in the study. This became our model of addiction for many years. The accepted belief became, if you are exposed to a drug, you will become addicted, and you may overdose and die.

Several years later, this original study was replicated, but with a significant difference. Researcher Bruce Alexander from the University of Vancouver, created, what was referred to as: a “rat park.” This park consisted of tunnels, multiple levels, toys, and other rat companions. Similar to the original study, all rats were given the same choice of water: plain water or water laced with heroin or cocaine. In Alexander’s study, rats preferred the plain water. Rates of overdose and death to the rats were significantly lower when compared to the initial study. How do we explain this difference in results? Perhaps, it is about the cage. Perhaps, it is about the environment.

Upon their return home, the soldiers from Vietnam who were struggling with a heroin addiction were able to re-connect with loved ones and community. A change in environment allowed for a change in connection, resulting in health, wellness and sobriety. Likewise, the environment of the rat in a solitary cage, as compared to the environment of the rat park, provided the rat with a “connection” with other rats, an environment which allowed the rat…to be a rat.

Individuals, who experience issues of mental illness and/or substance use disorders, have a natural tendency to withdraw and isolate from others. Depression, anxiety and addiction, greatly affect an individual’s ability to connect with others, let alone with one’s environment. This past year we have seen the devastating impact of COVID-19. We know that in order to maintain health and wellness, we need to maintain social distance and disconnect from one another. For now, this has and continues to be, what we need to do. It remains challenging for many of us to continue to avoid contact with loved ones and friends. We are separated from the very individuals who love us, support us, and are our sources of connection.

We have seen the rise of mental health issues during the past year. Nearly 20 percent of COVID-19 patients have developed a mental health issue (i.e., depression, anxiety) within three months of their diagnosis. During the past year, 4 in 10 adults in the U.S. have reported symptoms of anxiety or depression. Within the general population, rates of mental health issues and substance use have significantly increased across the board. In addition, the disconnection that we have witnessed has fragmented our society in general by harboring increased levels of fear, anger and animosity towards one another.

Hope on the horizon

Once “herd immunity” is achieved, the importance of re-connecting with one another becomes vital and essential to our health and mental wellness. We are social beings and need connection with one another. History has shown that the mental health impact of disasters outlasts the physical impact, suggesting today’s elevated mental health needs will continue well beyond the coronavirus outbreak.  Like the moth that needs to struggle out of the cocoon in order to develop the strength that it needs to survive in the world, we too are developing the strength that we need from the struggles we have endured.  Re-connecting with one another is an answer.  It gives us strength and it gives us hope.

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Transcranial Magnetic Stimulation (TMS) is an innovative treatment for depression. Depression is common and affects 1 in 10 adults. Only a fraction of individuals suffering from depression seek treatment. Of those who do, greater than 30% fail to achieve satisfactory improvement. Not all patients improve when treated with medications or psychotherapy. Up to 25% of people suffering from depression will not respond to multiple trials of medication due to a lack of efficacy or difficulty tolerating medication. Likewise, many people struggle to respond to the best efforts of psychotherapy, either due to a lack of response or a lack of time and/or financial resources that are necessary for psychotherapy interventions. Alternate treatment modalities are critical to addressing the ongoing needs of patients who suffer from the debilitating effects of depression.

Understanding the Benefits of Transcranial Magnetic Stimulation

Evidence shows that TMS is effective in the treatment of moderate to severe depression in patients with a history of treatment resistance. Depression has been linked to an abnormal function of nerve cells in a specific part of the brain. Highly focused magnetic field pulses used in Transcranial Magnetic Stimulation (TMS) therapy gently stimulates these nerve cells. New data emerging from recent studies suggests that in most patients, the clinical benefits of TMS therapy are maintained through 12 months. 

How Transcranial Magnetic Stimulation Works

TMS is a non-invasive, localized treatment conducted using a device that delivers rapidly pulsating and localized magnetic fields that activate a subset of nerve cells in the front part of the brain.

While treatment is administered patients remain awake while sitting in a comfortable reclining chair. A treatment coil is applied to the head and the system generates highly concentrated magnetic field pulses. Transcranial Magnetic Stimulation  is delivered in a series of 37-minute outpatient treatments, typically administered daily, (5 days per week) for 4 to 6 weeks. Technological advancements in equipment has led to decreased treatment durations.

Pros and Cons of TMS Therapy

Some advantages and disadvantages of TMS include:

  • It does not require anesthesia
  • Non-invasive
  • Well tolerated
  • An outpatient service and patient continues normal daily routines
  • Current data demonstrates efficacy in patients who have struggled with medication
  • May be good alternative for patients who responded to Electroconvulsive Therapy (ECT) in the past
  • No significant memory impairment
  • FDA Approved in 2008 for the treatment of depression

Cons of TMS Therapy

  • Facial twitching during the treatment
  • Skin redness at site of coil placement
  • Anxiety before and during treatment
  • Mild discomfort (usually dissipates by end of first treatment)
  • Headache
  • Process for insurance coverage can be cumbersome
  • Time required 30 treatments over 6 weeks

TMS at Lindner Center of HOPE

The Lindner Center of HOPE is a nationally recognized Leader in TMS Therapy. Our expert reputation is a result of years of clinical research and experience in mental illness and collaboration with academic centers such as Johns Hopkins and the Mayo Clinic through the National Network of Depression Centers. For patients, this means the best of the best – the best clinical minds, the best data and the best technology are being applied to achieve successful outcomes.

There is HOPE. For more information on TMS Therapy, call (513) 536-4674 or click here.

 

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By Danielle J. Johnson, MD, FAPA

Lindner Center of HOPE, Chief Medical Officer

Many people have experienced loss of several types during the COVID-19 pandemic – employment, financial security, social connections, a sense of safety, and loved ones.  The way we grieve has changed because we cannot rely on our support systems to be physically there for us due to restrictions with social distancing.  With the increasing number of COVID-19 cases, the holiday season will be different this year – no holiday parties, large family gatherings, or other traditions.  It is difficult to be physically separated from loved ones, but even more difficult for those who may be experiencing their first holiday season after the loss of a loved one.

 

What are some ways that we can manage grief during this unprecedented holiday season?

  • Take charge of your holiday season: Anticipating anxiety about the holiday, especially if it is the first one without a loved one, can be worse than the actual holiday. Taking control of your plans and deciding how you will spend your time can relieve anxiety.  Do not spend time where you do not feel emotionally safe or comfortable.
  • Find nourishment for the soul: Your faith community may offer resources. Look for a support group for people who have suffered a similar loss or for those who are alone.  Due to the pandemic, many support groups are online.
  • Give yourself permission to change your holiday traditions: Some traditions may be a comfort, while others may be painful. Some traditions will have to change due to the pandemic.  It is ok to start new traditions.  Many families are finding ways to celebrate virtually.
  • Change how you give: Give a gift on behalf of your loved one to someone else or donate to a charity in memory of your loved one.  If you are spending less due to not spending the holidays with loved ones, consider giving more to charitable organizations.
  • Do not let guilt overtake you: You can enjoy the holiday without your loved one.  Celebrating does not mean you do not miss or have forgotten about your loved one.
  • Be gentle with yourself: Realize that familiar traditions, sights, smells and even tastes, may be comforting, or may trigger strong emotions. Be careful with your emotions and listen to yourself.
  • Do not pretend you have not experienced a loss: Imagining that nothing has happened does not make the pain of losing a loved one go away or make the holidays easier to withstand. It is ok to talk with others about what you have lost and what the holidays mean to you.
  • Pay attention to your health: It is often difficult for people who have experienced a recent loss to sleep. Make sure you get regular rest.  If you feel overwhelmed, talk with your health care provider.
  • Experience both joy and sadness: Give yourself permission to feel happiness and pain. Do not feel like you must be a certain way because of your loss or because it is the holidays.
  • Express your feelings: Suppressing your feelings may add to distress. To express your feelings, talk with a supportive friend or journal.
  • How can support persons help those who are grieving during this holidays season if we cannot physically be there? Be available to listen. Send cards, gift cards for meals, offer to help shop, or decorate the outside of the home.  If you are concerned about their mental wellbeing, offer to help them find a support group or encourage them to reach out to their health care provider for help.

Resources

https://www.griefshare.org/holidays

https://whatsyourgrief.com/alone-together-14-ideas-for-a-virtual-holiday/

https://coronavirus.ohio.gov/wps/portal/gov/covid-19/families-and-individuals/resources-for-parents-and-families/holiday-celebrations

Crisis Text Line, text CONNECT to 741741 for 24/7 help from a crisis counselor.

Ohio Care Line, call 1-800-720-9616 for 24/7 support from behavioral health professionals.

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By Angela Couch, RN, MSN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE

Anxiety is a common symptom. Anxiety is a part of everyone’s lives, we have all experienced it to one degree or another. Believe it not, anxiety serves some useful purposes. Anxiety can help give you the drive to make a change, or complete task on time.Anxiety can activate the fight or flight instinct, in a “potentially” dangerous situation, giving you the drive to get out of there, or do something to prevent harm. Anxiety can occur when you are enduring multiple stressors, or there is uncertainty, and it’s not entirely unexpected.

For instance, say you hear layoffs are coming in the company, and you’re not sure if your department will be affected. You may experience physical symptoms of anxiety (which could include racing heart, nervous stomach, sweating, tremor, nausea, shortness of breath, and more), and you might also experience worry. COVID-19…yup, that can cause some anxiety, or worry, too! Situational anxiety is a part of life, and often can be managed by rational self-talk, problem-solving, and various positive self-care strategies. (For more on that, see some of our other recent blog articles, for lots of helpful ideas!) So how do we know when the anxiety is more than just “normal” or to be expected, and when to seek help?

According to the National Comorbidity Study Replication, about 19.1% of U.S. adults will have had an anxiety disorder in the past year, and 31.1% experience an anxiety disorder in their lifetime. In other words, it’s pretty common! There are various types of anxiety disorders, and most have an underlying common thread– difficulty in accepting uncertainty in some form. So how do you know if you may need to seek further assessment or help for anxiety, if it’s really so common? If everyone gets it, is it really a problem that requires treatment? The answer is yes, it might. Some symptoms that may indicate problematic anxiety include:

* Feeling “paralyzed” by fear.

* Anxiety is causing you to avoid things you used to be able to do without anxiety, or things that are important to you (this could include social activities, leaving your house, going to your job, driving, engaging in spiritual activities, etc.).

* You have difficulty staying present “in the moment”, which may repeatedly distract you from attending to conversations, being able to complete work or school tasks because of lack of focus.

* You are having difficulty with sleep or eating due to excessive worry or anxiety.

Anxiety is causing significant physical symptoms.

* You cannot determine a cause for the anxiety and the symptoms are persistent or very bothersome.

* You worry about “everything” or “all the time”.

* The anxiety/worry you are experiencing about situations seem excessive.

* You need to engage in compulsive or repetitive behaviors, or do things in a certain way, in order to avoid significant anxiety/worry.

* Anxiety is causing you to turn to self-medication with alcohol or substances.

So you’ve determined you should seek help, now what? Psychotherapy can be helpful for anxiety, and is a very important component of treatment. Psychotherapy may include several modalities such as cognitive behavioral therapy, addressing faulty beliefs contributing to anxiety, psychoeducation about anxiety and worry, problem-solving, exercise and wellness activities/lifestyle changes, addressing sleep hygiene, skills for time management and stress reduction, or exposure therapy, just to name a few.

How do you know if psychotherapy is enough to manage the symptoms? Medication can be a helpful component in treatment of anxiety, particularly if symptoms are not improving with other psychotherapeutic interventions mentioned above. Medications alone are rarely enough to treat anxiety disorders adequately. Medication can often make it easier to engage in meaningful psychotherapy, to make those helpful lifestyle changes, or try new ways of coping with the anxiety/worry. If you are experiencing suicidal thinking or significant depression, medication should be a consideration. If the anxiety symptoms are preventing you from being able to work or do other essential tasks, medication may be indicated. If your therapist suggests a medication consultation, you should consider it.

The important things to remember are, everyone has some anxiety, not all anxiety is bad, and when anxiety does become problematic or excessive, there are evidence-based treatments to help, so don’t be afraid to reach out for help!