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Category: Disorders

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managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.

Understanding Bipolar Disorder: The Key to Long-Term Wellness

Managing bipolar disorder requires a combination of medical treatment, lifestyle adjustments, and emotional self-care. Whether you are a patient, family member, or healthcare professional, understanding the role of self-compassion in treatment adherence and daily stability can significantly improve mental health outcomes. Below are three essential pillars for maintaining balance and well-being.

  1. Stay Consistent with Medication: A Foundation for Stability

managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.Why It Matters:
Taking prescribed medications every day without missing doses is one of the most critical steps for mood stabilization. If you and your psychiatrist or mental health provider have identified an effective medication regimen, consistency is key to preventing mood swings and relapse.

Common Concerns:

    • “What if I don’t like the side effects?”
    • “How do I remember to take my medication daily?”

Tips for Success:

    • Use a daily pill organizer or medication reminder app.
    • Work closely with your doctor to adjust medications as needed.
    • Approach medication with self-compassion—understand that needing treatment does not mean weakness; it is part of managing a medical condition.
  1. Avoid Substance Use and Limit Alcohol: Protect Your Mental Health

managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.The Impact of Drugs and Alcohol on Mood Stability
Substance use—including recreational drugs and even medical marijuana—can significantly interfere with bipolar disorder treatment. Alcohol, even in moderation, may worsen symptoms or interact negatively with medications.

Common Questions:

  • “Is it okay to drink socially?”
  • “Does cannabis help or hurt bipolar symptoms?”

Practical Advice:

  • Prioritize your mental health over social drinking or self-medication.
  • Seek support if substance use is affecting your ability to stay stable.
  • Remember that managing bipolar disorder requires self-compassion—avoiding substances isn’t about restriction, it’s about self-care.
  1. Prioritize 8 Hours of Quality Sleep: A Non-Negotiable for Stability

managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.

Why Sleep is Essential for Mood Regulation
Sleep disruptions—whether caused by staying up too late, shift work, or traveling across time zones—can trigger mood episodes. Research has shown that consistent sleep is crucial for preventing both manic and depressive symptoms.

Tips for Better Sleep:

    • Maintain a regular sleep schedule, even on weekends.
    • Create a calming bedtime routine (e.g., reducing screen time, practicing mindfulness).
    • If you struggle with sleep, talk to your doctor about treatment options.

 

 

Additional Strategies for Bipolar Wellness

Recognizing Early Warning Signs of Mood Changes

Work with your healthcare provider to identify early symptoms of mania, depression, or mixed episodes. Write them down and share them with a trusted support person. This proactive step can help you get ahead of mood shifts before they escalate.

The Role of Therapy and Support Systems

Engaging in psychotherapy—such as cognitive behavioral therapy (CBT) or supportive therapy—can provide valuable coping tools and emotional support. A strong therapeutic relationship helps individuals navigate real-life challenges with greater resilience.

Final Thoughts: Practicing Self-Compassion in Bipolar Disorder Management

Managing bipolar disorder is an ongoing journey that requires patience, self-awareness, and a compassionate approach to self-care. Instead of viewing treatment as a burden, embrace it as an act of self-kindness. By staying consistent with medications, avoiding mood-destabilizing substances, and prioritizing sleep, you can create a strong foundation for stability and well-being.

If you or a loved one is struggling, reach out to a healthcare professional for guidance. You are not alone, and with the right support, stability is possible.

 

Paul Keck, MD, Senior Consulting Psychiatrist and Founding President and CEO – Emeritus is the author of this article. Dr. Keck is Emeritus Professor of Psychiatry and Behavioral Neuroscience at the University of Cincinnati (UC) College of Medicine. He is also Senior Consulting Psychiatrist and Emeritus Founding President and CEO of the Lindner Center of Hope, a state-of-the-science, UC-affiliated comprehensive mental health center in Mason, Ohio. Dr. Keck has conducted extensive research in bipolar disorder, depression and clinical psychopharmacology, supported by grants from the NIMH, NARSAD, the Stanley Foundation, the Marriott Foundation, and industry. Since 1996, he has been in the top 20 of the most cited scientists in the world publishing in the fields of psychology and psychiatry.

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By Kelly Heitkamp, LISW-S 

 

 

 

 

Anxiety touches everyone at some point. Whether it’s a fleeting worry before a big event or a chronic struggle that feels all-consuming, it’s important to know there’s hope—and help. Let’s break down what anxiety really is and explore effective ways to manage it, blending professional insight with actionable advice for everyday life.

What Is Anxiety?

Anxiety is more than feeling nervous. It can show up as physical symptoms like a racing heart, tight chest, or stomach troubles; emotional distress like dread or irritability; and persistent, overwhelming thoughts.

Different types of anxiety disorders—like generalized anxiety disorder (GAD), social anxiety, or panic attacks—bring their own challenges, but they all share one thing: they’re treatable. Understanding the roots of anxiety is the first step to taking back control.

Why Does Anxiety Happen?

Anxiety is the brain’s way of trying to keep you safe. When the amygdala (our fear center) senses danger, it activates the fight-or-flight response, releasing stress hormones like cortisol. For some, this system works overtime, reacting to things that aren’t actual threats.

Other parts of the brain, like the prefrontal cortex (responsible for rational thinking), might struggle to calm things down. Add factors like genetics, past trauma, or chronic stress, and you’ve got a recipe for anxiety that can feel hard to shake.

What Can Help? 

  1. Cognitive Behavioral Therapy (CBT)

CBT is like a mental toolbox for managing anxiety. It helps you identify unhelpful thoughts and replace them with more balanced ones. Some key tools include:

  • Challenging Fearful Thoughts: What’s the evidence for this worry? Is there another way to see it?
  • Exposure Therapy: Facing fears gradually, in a safe way, can help reduce their power.
  • Building Confidence: By tackling small, manageable steps, you can create positive change.
  1. Medications
    For some, medication can offer the boost needed to make progress. Options like SSRIs (e.g., sertraline) can balance brain chemicals, while beta-blockers are great for taming physical symptoms like a pounding heart. Always consult a doctor to find the right fit for your needs.
  1. Mindfulness and Relaxation
    Sometimes, the best way to quiet the mind is to connect with the present moment. Techniques that work wonders include:
  • Meditation: Spend even five minutes focusing on your breath or a calming mantra.
  • Progressive Muscle Relaxation: Tense and release each muscle group, noticing the contrast.
  • Deep Breathing: Inhale slowly, hold, and exhale—it signals to your body that you’re safe.
  1. Lifestyle Tweaks
    Small changes can have a big impact on anxiety:
    Move Your Body: Exercise releases feel-good endorphins and reduces stress hormones.
    Eat for Stability: Balanced meals keep blood sugar steady, which helps manage mood swings.
    Prioritize Sleep: Create a routine that supports restful nights.
    Reduce Stimulants: Too much caffeine or nicotine can amp up anxiety.
  1. Emotional Healing
    For some, anxiety has roots in unresolved feelings or past experiences. Therapies that explore deeper emotions or relationship patterns—like psychodynamic therapy—can bring clarity and relief.
  1. Complementary Supports
    From yoga to herbal supplements like chamomile, there are many ways to enhance traditional treatments. Always check with a healthcare provider before trying something new.

How Professionals Can Help

Mental health professionals bring expertise and empathy to the table. They use tools like the Generalized Anxiety Disorder-7 (GAD-7) to assess symptoms and create customized treatment plans. Their goal? Empower you to feel understood, supported, and equipped to manage anxiety.

What Can You Do?

If anxiety feels like it’s running the show, here are some starting points:

  • Reach Out: Whether it’s a therapist, friend, or support group, you don’t have to go it alone.
  • Learn the Signs: Understanding your triggers can help you respond more effectively.
  • Be Kind to Yourself: You’re not failing; you’re facing something challenging—and that takes courage.

A Hopeful Future

Anxiety treatment continues to evolve, with exciting innovations like virtual reality therapy and digital tools making care more accessible. The more we understand about the brain, the better we can help it heal.

Whether you’re a professional supporting clients or someone seeking relief, remember: anxiety doesn’t define you. With the right tools and support, you can reclaim your life and find peace.

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Heather Melena, MSN, APRN, PMHNP-BC

 

PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome and encompasses cases of strep induced neuropsychiatric presentations (PANDAS), as well as presentations brought on by other infections, toxins, or stress. To understand the mechanism in which this autoimmune response is triggered, we must understand how and what our immune system does. Our immune system (innate and adaptive) is responsible for several important roles in our bodies.  When our immune system wrongly identifies our own cells, which can resemble a pathogen’s cell, it attacks our own tissue and causes damage- otherwise known as molecular mimicry (Antoine, 2024). This is, very simply put, what evidence has shown to happen in autoimmunity. Autoimmune or autoinflammatory disease /illness (in PANS/PANDAS) is believed to be activated by exposure to several infectious pathogens that overthrow the immune system and/or generate abnormal reactions which then attacks neuronal cells, leading to inflammation and resulting symptoms (Pandas Physicians Network [PPN], 2024).

What are the hallmark signs and symptoms of PANS and PANDAS? Firstly, we see a very abrupt and severe onset of obsessive-compulsive disorder and/or severe restriction of food intake. With this initial onset, we usually see a rapid (which is unusual in most psychiatric conditions) onset of the following symptoms (PPN, 2024):

  • Severe separation and/or social anxiety (that is atypical for the person affected)
  • Severe mood lability
  • Irritability, aggression, or oppositional behaviors (that previously were not present)
  • Developmental regression
  • Significant and stark decline in school performance
  • Sensory integration dysfunction (to sounds, light, textures, smells
  • Tics or abnormal movements
  • Hypotonia, clumsiness, changes to fine motor skills
  • Enuresis (nighttime bedwetting)
  • Sleep disturbances (insomnia, night terrors)

It is important for people to understand that this is a very significant and drastic change that happens rapidly, if your child/adolescent is functioning normally, and then suddenly is struggling with these symptoms in a very severe manner that is out of character for their typical baseline, that is usually a tell-tale sign. If they have a history of psychiatric illness that ranges from mild to severe, and gets worse with an infection, that does not necessarily indicate PANS or PANDAS, though every case is unique. Approximately 88% of cases have a sudden onset, usually within 3 days (Antoine, 2024). Historically it was believed to have an onset from ages 3-11, though more recent evidence suggests that onset following puberty or even early adulthood, has been captured.

To diagnose, a very detailed and precise clinical picture must be obtained. We take a thorough history including past medical, surgical, and psychiatric history as well as understanding family history with an emphasis on autoimmune disorders. We complete a comprehensive physical exam and finally complete diagnostic studies to rule in/out other possible reasons for sudden and abrupt onset of symptoms as PANS & PANDAS is a diagnosis of exclusion. Lab studies including a complete blood count, complete metabolic panel, inflammatory markers, infectious disease, immune function, hormones, immunoglobins, nutritional deficiencies and autoantibodies are performed but is specific to the patient and their presentation.

How are PANS and PANDAS treated? Treatment is dependent on the severity of the case and at times can include a comprehensive treatment team to deliver care across several specialties including neurology, allergy/immunology, psychiatry, and more. More mild cases usually require antibiotics, steroids, anti-inflammatories, cognitive-behavioral therapy and very low doses of psychotropic medications (Neuroimmune Foundation, 2025). With more severe cases treatment can include IVIG, Plasmapheresis, longer courses of steroids, and other immunologic agents (Neuroimmune Foundation, 2025). It is important to help identify allergens, toxins, and environmental factors which could also be playing a role in the dysregulation of the immune system and continued inflammation.

References

Antoine, S. & Antoine, E. (2024). The comprehensive physicians’ guide to the management of PANS and PANDAS: An evidence-based approach to diagnosis, testing, and effective treatment. Forefront books.

Neuroimmune Foundation. (2025). What are PANS/PANDAS? https://neuroimmune.org/patient-and-family-resources/what-are-pans-pandas/

Pandas Physicians Network [PPN]. (2024). What is PANS/PANDAS? https://www.pandasppn.org/what-are-pans-pandas/

 Stanford Medicine Children’s Health. (2025). Diagnosis and Treatment for PANS and PANDAS. https://www.stanfordchildrens.org/en/services/pans-pandas/diagnosis-and-treatment.html

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By Angela Couch, RN, MSN, PMHNP-BC,
Psychiatric Nurse Practitioner, Lindner Center of Hope

The goal of treatment for OCD is not to get rid of the thoughts but to learn to tolerate uncertainty. For someone who struggles with OCD, the idea of this, of tolerating uncertainty, can create a lot of discomfort.  Medications will not get rid of the thoughts, unfortunately.  This is because we cannot “control” our thoughts or prevent them.  Thoughts come into our brains, often unbidden, and sometimes contain content we didn’t ask for or want, which may be scary or upsetting.  For someone who has OCD, this occurrence creates a more intense feeling of distress, which often leads to various compulsions, in an effort to relieve the distress and the uncertainty.

Medication is recommended for the treatment of OCD any time someone has a moderate to severe case of OCD. Appropriate psychotherapy is very important; generally, this is a sub-type of CBT (Cognitive Behavioral Therapy) called ERP (Exposure and Response Prevention), or sometimes ACT (Acceptance and Commitment Therapy). The combination of medication and psychotherapy is the most powerful between medication alone, psychotherapy alone or both together. Those who have completed appropriate psychotherapy also, have a lower risk of significant relapse if medication treatment is stopped.

Medication can help make the thoughts less “sticky” in the brain. It also can slow the thoughts down and somewhat reduce the level of distress caused by the thoughts. This can make it easier for someone to participate in the appropriate psychotherapy to manage the OCD.  Medication can help someone ride the waves of OCD/uncertainty more effectively. There are many treatment options, which should be individualized to the patient.

The frontline treatments for OCD are typically the SSRI (Selective Serotonin Reuptake Inhibitors) or the TCA (Tri-cyclic antidepressant) clomipramine, or sometimes an SNRI (Serotonin Norepinephrine Reuptake Inhibitors). These medications slowly build in the patient’s system after repeated administration to a steady state at which the medications begin to assert their effects. Dose increases are common because OCD typically requires higher dosing than when treating depression or anxiety disorders such as Generalized Anxiety Disorder, Panic Disorder, etc.
Sometimes, this may include “off-label” dosing (dosing higher than the FDA label for the drug). Typically, we don’t call a drug trial a true failure until the patient has taken the highest dose for up to twelve weeks because it often takes longer for the medications to impact OCD than the other disorders listed above.

Sometimes, an augmentation strategy is used in conjunction with the primary treatment. Augmentation strategies may more commonly include SDA’s (Serotonin Dopamine Antagonists, also called second-generation antipsychotics), or drugs that may impact the neurotransmitter glutamate such as NMDA receptor antagonists, certain mood stabilizers, or acetylcysteine. SDA’s or mood stabilizers are also commonly used when a patient has a concurrent bipolar spectrum illness, because treatment with an SSRI, SNRI, or TCA alone may cause mood switching.
Sometimes, when a patient has a diagnosis of OCD alone, they may very slowly taper off the medication after having a longer period of stability on the medication and psychotherapy. Sometimes this is successful for some period of time, but sometimes an individual’s brain simply needs the support to keep symptoms manageable, and that is okay, too. Patients who also have a mood or other type of disorder may need to take the medication longer term. These treatment decisions need to be tailored to the individual’s circumstances.

In conclusion, psychotherapy is a critical piece of the treatment plan, there are many medications that may provide benefit in the treatment of OCD, and treatment decisions should be individualized.

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By Whitney Peters LPCC
OCD Specialist, Lindner Center of Hope 

Beginning a successful journey in obsessive compulsive disorder (OCD) treatment starts with the right diagnosis. OCD occurs in people from any gender, age, or ethnicity, and happens to approximately 1 in 100 adults and 1 in 200 kids and teens. Many people think of OCD as being a germaphobe or preferring things to be organized, but the reality of OCD is far from the stereotype we think of.

People with OCD spend hours a day preoccupied with upsetting concerns that cause them feelings of anxiety and disgust, and in order to alleviate themselves or prevent those uncomfortable feelings, they must perform physical or mental acts. People with OCD can develop obsessions about anything they find to be important or valuable. This may include developing obsessions about things like their family, careers, spiritual beliefs, or identity, among many others.

For example, someone with Harm OCD might be bothered by an obsession around the possibility of having hit someone with their car. This obsession takes over their thoughts so that they spend a lot of time driving around looking for evidence, repeating memories of their drive to reassure themselves, and frequently checking their rear-view mirror. This is all to make sure they didn’t hit anyone. People with OCD realize what they are afraid of is unlikely, but the distress they face with these concerns make it difficult to resist checking, ruminating, or looking for reassurance that they are safe. OCD symptoms can become so intrusive that a person may have difficulty functioning in daily life or attending work or school. OCD is considered one of the top 10 most disabling conditions, and the symptoms of OCD can look very different depending on the person. It is critical that a clinician the individual is working with knows how to spot it. OCD assessment tools can help us more effectively identify symptoms, specific subtypes, and assess for severity.

Common OCD Assessment Tools and Screening Methods

The Obsessive Compulsive Inventory (OCI)

The Obsessive Compulsive Inventory (OCI) is a 42-item OCD screening tool and self-report measure used to identify common symptoms and track severity. This tool can be used independently by the patient or during a structured interview. The OCI measures OCD symptoms like Checking, Doubting, Ordering, Hoarding, and Neutralizing. This OCD inventory uses check boxes to rate the severity of symptoms and adds scores to determine how significantly OCD is impacting the individual. The OCI can also be used throughout treatment to track progress.

(Obsessive-compulsive Inventory (OCI) – Reproduced & adapted by permission of the authors: Foa, E.B., Kozak, M.J., Salkovskis, P.M., Coles, M.E., & Amir, N.)

Yale Brown Obsessive Compulsive Scale (Y-BOCS) and Child Yale Brown Obsessive Compulsive Scale (CY-BOCS)

The Yale Brown Obsessive Compulsive Scale (Y-BOCS), including the child version (C-YBOCS), is widely regarded as the gold standard obsessive compulsive scale. This assessment tool identifies both obsessions and compulsions by providing examples that patients can respond to independently or in a structured interview with a clinician. The Y-BOCS OCD assessment helps diagnose OCD and guides treatment by identifying specific thought patterns and behaviors.

(Adapted from Goodman, W.K., Price, L.H., Rasmussen, S.A. et al.: “The Yale-Brown Obsessive Compulsive Scale.” Arch Gen Psychiatry 46:1006-1011,1989; Scahill, L., Riddle, M.A., McSwiggin-Hardin, M., Ort, S.I., King, R.A., Goodman, W.K., Cicchetti, D. & Leckman, J.F. (1997). Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry, 36(6):844-852.)

Dimensional OCD Scale (DOCS)

The Dimensional Obsessive Compulsive Scale (DOCS) is a diagnostic and progress-tracking tool that breaks OCD symptoms into four primary dimensions: Contamination and Sickness, Responsibility for Harm or Mistakes, Unacceptable or Taboo Thoughts, and Incompleteness/Asymmetry. This OCD scale asks patients or providers to rate symptoms based on five domains, including time spent, distress intensity, avoidance behaviors, day-to-day impact, and difficulty dismissing compulsions. The DOCS is used periodically to evaluate symptom change over time.

(Abramowitz, J. S.; Deacon, B.; Olatunji, B.; Wheaton, M. G.; Berman, N.; Losardo, D.; Timpano, K.; McGrath, P.; Riemann, B.; Adams, T.; Bjorgvinsson, T.; Storch, E. A.; Hale, L. (2010). “Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale”. Psychological Assessment. 22 (1): 180–198. doi:10.1037/a0018260. PMID 20230164. S2CID 7206349.)

Family Accommodation Scale

When working with children or individuals who live with others, the Family Accommodation Scale can be a valuable OCD assessment tool. It identifies accommodations that family members may perform to reduce the patient’s distress, such as reassurance or participation in rituals. The scale helps identify unhelpful behaviors that may interfere with treatment. By regularly using this screening tool for OCD, families and providers can track changes and support treatment planning.

(The Family Accommodation Scale for Obsessive Compulsive Disorder – Self-Rated Version (FAS-SR) Copyright © 2012 by Anthony Pinto, Ph.D., Barbara Van Noppen, Ph.D., & Lisa Calvocoressi, Ph.D. The Family Accommodation Scale for Obsessive Compulsive Disorder – Self-Rated Version (FAS-SR) includes a modified version of the Yale Brown Obsessive Compulsive Scale (YBOCS) Checklist, copyright © 1986, 1989, with permission.)

Why OCD Assessments Matter

Using validated OCD assessment tools supports effective diagnosing of OCD, tracks treatment progress, and identifies areas where patients and families need support. Whether it’s the Y-BOCS assessment, the OCI OCD inventory, or other tools, structured assessments provide insights that lead to better outcomes for those living with OCD.

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By Shea Daniels Graham, LPCC-S, Outpatient Telehealth Counselor

One of my favorite metaphors comes from Shift Journal and describes autism as being a hair-dryer brained person in a toaster-brained world. To paraphrase: If we think about the brain as a machine made of wires and gears we inherit, there is an imaginary world where most people are born with those wires and gears turned into a toaster. In this world where most people have toaster brains there’s going to be a lot of toast—white, wheat, rye, everything bagels, cinnamon raisin bread—but it’s all toast. Making toast is almost effortless for most people in this imaginary world so it becomes an integral, expected part of existing in society. Some people, though, are born with hair dryer brains, and while they can make toast—because you can make toast with a hair dryer, after all—it is going to fundamentally take them intentional effort, time, and skill building, to do what comes effortlessly for the toaster-brained…and even with that effort, time, and skill building, someone with a hair dryer brain is never going to be able to make toast as effortlessly as someone whose brain is a toaster. Now, if the roles were reversed, society would be created around having a hair dryer for a brain and those born with toasters for brains would have trouble drying hair. But in this imaginary world there are more people with toasters for brains, so people with hair dryer brains put a lot of time and energy into simply existing.

The National Institutes of Health estimates, as of 2020, that approximately 1 in 45 adults in the United States are living with autism spectrum disorder. Various studies indicate between 20% and 50% of adults living with autism are undiagnosed. Our understanding of autism has shifted drastically since the term was first used in 1911 by German psychiatrist Eugen Bleuler to describe a form of severe schizophrenia (Bleuler 1950 [1911]), Evans 2013). It wasn’t until the growth of child psychology in the 1960s that we begin seeing anything resembling modern autism criteria, such as Victor Lotter et. al’s 1966 epigenetic study to identify prevalence of autism in Britain’s children. Their screener, which significantly mirrors current autism diagnostic criteria, included 24 items related to social and pragmatic communication; vestibular, proprioceptive, and auditory sensory differences; and, repetitive behaviors. It is interesting to note, here, that Lotter et. al’s original screening tool was based on an earlier screening tool by child psychiatrist Mildred Creak (Evans, 2013). Creak’s screening tools included reports of internal experience which Lotter et. al. excluded due to concerns internal experience was too subjective to be useful.

This trend towards excluding diagnostic criteria based on internal experiences continues even today. Compared to other mental health and neurodevelopmental diagnoses in the DSM, Autism Spectrum Disorder is the only diagnosis not to include any report of internal experiencing (American Psychiatric Association, 2013).

Going back to the example above of toaster brains and hair dryer brains: some hair dryer brains are going to be more effective at making toast than others. Some people with hair dryer brains might be able to optimize their settings, the bread they use, etc., to make toast almost as well as someone whose brain is a toaster. They might even become so effective at making toast with a hair dryer than we wouldn’t know their brains weren’t toasters, if they didn’t tell us about how difficult it is to live with a hair dryer brain in a toaster world.

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a short, reliable, accurate, valid, and current autism screener appropriate for outpatient clinical use. The CAT-Q is particularly special because it is the only such screener which measures the internal experience of autism. It includes 24 screening questions such as, “I rarely feel the need to put on an act in order to get through a social situation,” “I have developed a script to follow in social situations,” “In social situations, I feel like I am ‘performing’ rather than being myself,” and “in social situations, I feel like I am pretending to be ‘normal,’” each scored on a A-G scale from “Strongly Disagree” to “Strongly Agree.” The CAT-Q has a high internal consistency both for the total scale and for the three sub-scales of Compensation, Masking, and Assimilation. Test-retest reliability was good, as was the total stability of this screener (Jones, 2021). Results are normed by gender for women, men, and non-binary/transgender populations.

Identifying traits of autism in our patients is a crucial part of providing competent care. Regardless of whether or not a patient who scores above-threshold on the CAT-Q opts to pursue formal assessment for autism, for those patients with above-threshold results, we as clinicians can tailor our interventions to acknowledge the patient’s traits of neurodivergence.

At times, tailoring our treatment to account for diagnosed autism, or traits of autism, is simply best practices. For example, in their 2018 study Cooper et. al identified that “almost all” therapists found it necessary to adapt Cognitive Behavioral Therapy interventions due to the increased rigidity of thinking people with autism experience. Without adaptations, the CBT interventions did not produce comparable results for adults with autism compared to neurotypical adults engaged in comparable treatment protocols.

At other times, tailoring our treatment to account for diagnosed autism, or traits of autism, is not only best practices—it is a critical component of not causing harm to patients. In his 2014 presentation to the EMDR Europe Association Conference, S. Paulson explained that due to the variety complex neurological differences individuals with autism present with, trauma processing using EMDR can be more difficult, or even harmful, without appropriate modifications to the standard treatment protocol. With appropriate accommodations, however, EMDR is an incredibly effective treatment for adults with autism who have a co-occurring trauma history. Lobregt-van Buuren et. al found that after 6-8 weeks of standard therapy followed by up to 8 EMDR sessions, at a 6-8 week follow up patients “showed a significant reduction of symptoms of post-traumatic stress (IES-R: d=1.16).”

Ultimately research tells us that compared to same-age peers, people entering mental health services who are later diagnosed with autism experience higher rates of depression, anxiety, and psychosis (French et. al 2023). Not only do people with undiagnosed autism experience higher rates of troubling mental health symptoms, but a 2022 study in Britain found 10% of people who died from suicide had evidence of elevated autistic traits indicative of likely undiagnosed autism—a number 11 times higher than the rate of autism in the general population. As research tells us people with autism, or traits of autism, are unlikely to respond as well to therapeutic interventions unless those interventions are adapted appropriately, screening for traits of autism becomes a crucial best practice.

As a clinician I tend to utilize the CAT-Q screener as readily as I use a PHQ-9 or GAD-7. I use the CAT-Q any time a patient presents with a combination two or more diagnoses whose symptoms may align with autism. I also utilize the CAT-Q screener when I have a patient reporting chronic social difficulties or difficulties with sensory input, with patients who report a chronic history of ineffective mental health interventions, and with patients who report wondering if they have autism. Not every person with autism struggles with mental illness—but every person with autism who does enter mental health services has a right to high quality care tailored to their brains.
After all, if we only provide toaster mechanics, how will the hair dryers ever get a tune up?

Citations
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https://doi.org/10.1176/appi.books.9780890425596

Bleuler E. (1950[1911]) Dementia Praecox or the Group of Schizophrenias. New York: International Universities

Cassidy, S et al. Autism and autistic traits in those who died by suicide in England. BJPsych; 15 Feb 2022;
DOI: 10.1192/bjp.2022.21

Dietz, P. M., Rose, C. E., McArthur, D., & Maenner, M. (2020). National and state estimates of adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(12), 4258–4266. https://doi.org/10.1007/s10803-020-04494-4

French B, Daley D, Groom M, Cassidy S. Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review. J Atten Disord. 2023 Oct;27(12):1393-1410. doi: 10.1177/10870547231176862. Epub 2023 Jun 21. PMID: 37341291; PMCID: PMC10498662.

Jones, N. (2020, April 21). The CAT-Q. Embrace Autism. https://embrace-autism.com/cat-q/
Lobregt-van Buuren, E., Mevissen, L., Sizoo, B. B., & de Jongh, A. (2018, August).

Eye movement desensitization and reprocessing (EMDR) therapy as a feasible and potentia effective treatment for adults with autism spectrum disorder (ASD) and a history of adverse events. Journal of Autism and Developmental Disorders

Lotter V. (1966) ‘Epidemiology of Autistic Conditions in Young Children’, Social Psychiatry 1: 124–37 [Google Scholar]

Mary. (2010, October 11). A Hair-Dryer kid in a Toaster-Brained world.
https://www.shiftjournal.com/2010/10/11/a-hair-dryer-kid-in-a-toaster-brained-world/

Paulson, S. (2014, June). EMDR with autism. In EMDR clinical practice symposium (Marilyn Luber, Chair).
Symposium presented at the 15th EMDR Europe Association Conference, Edinburgh, Scotland

Rutter M. (1998) ‘Developmental Catch-up, and Deficit, following Adoption after Severe Global Early
Privation. English and Romanian Adoptees (ERA) Study Team’, Journal of Child Psychology and Psychiatry 39: 465–76 [PubMed] [Google Scholar]

 

 

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By Lauren Neiser, MSN, APRN, PMHNP-BC

Keto. Atkins. South Beach. NutriSystem. Weight Watchers. Intermittent Fasting. Paleo. Low-Carb. The HCG Diet. Raw. Jenny Craig. Slim Fast. What do all these diets have in common? They are all ineffective and potentially harmful.

We live in a diet culture driven society that celebrates thinness and is abundant with internalized fat phobia. In the United States (US), the diet industry capitalizes on our society’s obsession with thinness, generating, in 2023 alone, $90 billion dollars in profit (Research and Markets, 2024). Within the US, there is a constant captivation and fixation related to body weight, shape, and size, “healthy” eating, and exercise. This diet driven culture keeps many individuals stuck in a yo-yo dieting cycle, often leading to malnutrition, preoccupation with food, poor body image, and potentially developing a disordered relationship with food. So, if diets are effective, why is the diet industry continually growing?

 

The short answer is diets do not work and are unsuccessful because they are often very restrictive and therefore, not sustainable.

Many diets villainize whole food groups, such as carbohydrates or sugars, which is not feasible for long term health or overall well-being.

As humans, we need a variety of foods to function, including glucose and carbohydrates, for our brains to function. Our brain solely utilizes glucose, and we cannot produce glucose ourselves, resulting in a need to obtain glucose directly from food sources (Wolrich, 2021). The best source of glucose? Carbohydrates. If we completely cut out this category of food or are following a very restrictive diet, this limits our brain’s ability to function at its highest capacity. This often leads to difficulty concentrating, inattentiveness, irritability, lower mood, heightened anxiety, fatigue or low energy levels, and poorer sleep. Another often vilified food component is fat. Fat, however, is essential to many bodily functions, including absorbing micronutrients, such as vitamin D or E, forming cells, and for overall energy (Wolrich, 2021). Therefore, if we moderately or severely limit our fat intake, we may become deficient in vitamins essential for bone health and experience weakness or lethargy. Additionally, anytime we are assigning a food item or food group a label such as “unhealthy” or “bad”, we begin to appoint morality to food. This, in turn, can lead to disordered eating. The truth is food has no morality. Food cannot be “good” or “bad”, it is simply food, a collection of nutrients. We need a vast variety of foods, including fats, sugar, carbohydrates and proteins, in order to allow our body to operate at its full capacity for overall well-being, both physically and mentally.

Research has shown that less than 10% of dieting individuals are able to keep the weight they lost off for over a year (Kraschnewski, 2010). Part of this is simply due to biology because every individual has their own set point. Set point theory suggests “that body weight is regulated at a predetermined, or preferred, level by a feedback control mechanism” within the brain (Harris, 1990, p.3310). This means your body has a weight that keeps its homeostasis or “happy place” and will adjust in any way it can to maintain the weight where it feels safest. When we engage in purposeful restriction in order to lose weight, our brains cannot recognize whether this is intentional or unintentional, leading to a starvation state. This results in our body beginning to try and conserve the energy or food nutrients it currently has. This results in a slower metabolism, changes in the way your body absorbs nutrients, and storing fat to mitigate the risk of starvation (Harris, 1990). This is the science behind why 90% of individuals who diet gain most, if not all, the weight back within one year (Research and Markets, 2024).

In the end, an individual’s weight is not simply a factor of will power. Weight stems from many different, predetermined aspects, including biological, environmental, economic, behavioral, and genetics. This is a small glimpse into why diets do not work and how they are harmful for our bodies, our minds, and our relationship with food and movement. If you are struggling with body image, disordered eating, or anxiety related to food or your body, please call the Lindner Center of Hope at 513-536-HOPE to get connected with a clinician or provider who can help.

References:

Harris, Ruth. (1990). Role of set-point theory in regulation of body weight. The FASEB Journal. 4(15), 3310-3318. https://doi.org/10.1096/fasebj.4.15.2253845

Kraschnewski JL, Boan J, Esposito J, Sherwood N, Lehman EB, Kephart DK, Sciamanna CN. (2010). Longterm weight loss maintenance in the United States. International Journal of Obesity, 34, 1644-1654. https://www.nature.com/articles/ijo201094

Research and Markets. (2024). The U.S. Weight Loss Market: 2024 Status Report & Forecast. Marketdata LLC. 

Wolrich, Joshua. (2021). Food isn’t medicine. Random House. 

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

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

 

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

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

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

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

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

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

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Sidney Hays, MSW, LISW, DARTT, Outpatient Therapist, Lindner Center of HOPE

“Trauma” has been a buzzword in recent years. Accompanying it has been discourse around what counts as trauma. From the extreme of exaggerating minor inconveniences as trauma to the opposite end of the spectrum which attempts to gatekeep this term, reserving it for life threatening events only.

These extremes create confusion around not only the definition of the term and related concepts, but unnecessarily polarizes an already sensitive topic. As people debate the validity of traumas, it often reinforces the harmful self-judgements adopted by those who have experienced trauma. This reinforcement is often what keeps people stuck in self-blame and blocks actual healing.

It is common for those who have experienced trauma to blame themselves. This occurs for many reasons. One of the most obvious reasons lies in cultural messaging related to victim blaming, exaggerated self-reliance, and toxic positivity. The messaging of victim blaming often sounds like: What were you wearing? Were you drunk? Why didn’t you leave? Why didn’t you fight back? Why were you there in the first place? Are you really going to talk about your mom like that? Rather than holding those who caused the damage accountable, the responsibility gets shifted to the person who experienced it. This causes significant shame, often keeping people stuck in trauma responses and unhelpful patterns.

The worlds of toxic positivity and “just do it” often dismiss the significance of trauma, which impedes the ability to process and heal from trauma. It can sound something like: But you have so much to be grateful for. Your parents weren’t that bad. Other people have it much worse. Just count your blessings. Just decide to change and make it happen. You just need to (insert unhelpful platitude here). These responses encourage us to ignore the impacts of our trauma, which leads to trauma being stored in the body.

Another explanation of the self-blame that often accompanies trauma is that it gives the person who experienced it a false sense of control. If it was my fault, that means I should have just done better. If it was my fault, I can control the situation. If it was my fault, I can make sure it never happens again. Our brains are often much more comfortable with the notion that we messed up than the reality that other people and many events are outside our control.

Like with most debates and continuums, the surrounding discourse usually harms those who live a life of less privilege. Expanding our understanding of trauma and its impacts creates space for healing and growth.

The problem with many definitions of trauma lies in the focus of the definition. Most center around the event that occurred. However, this focus is incorrect and shortsighted. The most important factor in defining trauma is actually related to how a person experiences a moment, event, or series of events. Because of this, what is experienced as trauma will vary between person to person and moment to moment, which impacts how the body physiologically responds to a perceived threat.

Dr. Peter Levine, the developer of Somatic Experiencing, states that “trauma lives in the body, not the event.” When our nervous system perceives something as a threat, it reacts in kind, regardless of whether or not there is an objective threat. Most of us have heard of the fight (yelling, hitting, approaching), flight (running away from, avoiding), and freeze (immobilization, dissociation, disconnection) responses to a threat without fully understanding how these reactions come to be… These are states of our autonomic nervous system, which controls the automatic functions of the body (blood pressure, heart rate, breathing, digestion, hormones, immune response). This means that these reactions are unconscious, automatic, and the result of our nervous system attempting to protect us from a perceived threat.

When our brains perceive something as a threat, our nervous system does not always choose the most effective response. Our responses are informed by a lifetime’s cycles of threat and response. Because of this, the response of our autonomic nervous system is often the one we’ve used most in the past, or the response we wish we could have used then but didn’t have access or ability to use. This can explain many confusing patterns in our lives, such as a person who experienced emotional neglect as a child might struggle to share their emotions and needs even with a partner in a safe, healthy relationship down the line. These patterns require intentional work to mend to get our nervous system on board with responding in ways that may be more effective, or better in line with our values. In order to do this, we need adequate resources to increase our capacity to tolerate threats and distress.

Many factors impact our ability to cope with perceived threats such as: resources, support, physical health, and the level to which our needs are met. When these factors are well resourced, we have increased capacity to tolerate threat and distress. However, the inverse is also true. When lacking in any of these areas, our capacity drops.

Linda Thai brilliantly defines trauma as, “too sudden, too little, or too much of something for too long or not long enough without adequate time, space, permission, protection, or resources.” This inclusive definition accounts for the many nuances of the human experience, including generational trauma, and trauma resulting from racism, sexism, homophobia, fat phobia, colonization, and other various systems of oppression. Mindfulness of these nuances creates space for the full spectrum of human suffering to be seen, processed, and healed.

When we create this kind of space, increase access to resources, validate, and protect one another, we can be agents of healing in a world severely lacking at.

“If you want to improve the world, start by making people feel safer.”

-Dr. Stephen Porges