Category: Disorders

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Nutritional Psychiatry and Wellness

By Anna I. Guerdjikova, PhD, LISW, CCRC
Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program

The connection between health in general and the foods we consume has been known since the dawn of human kind, and Hippocrates is credited with the “Let food be thy medicine” saying. The narrower connection between overall diet quality and common mental disorders, in particular depression and anxiety, is a much newer field and the term “nutritional psychiatry” was not coined until the most recent decade. Initially, the focus of this discipline was on researching single foods or nutrients and their role in mental health. Gradually, it has been recognized that proper nutrition for good mental health is a very complex landscape. What we consume and how it affects us cannot be researched in isolation and what we eat in excess can be as important as what we do not eat enough of.

The growing data in the field of nutritional psychiatry is encouraging. A recent systematic literature review derived a list of antidepressant nutrients linked to the treatment and prevention of depression1. The twelve identified antidepressant nutrients included: folate, iron, long-chain omega-3 fatty acids, magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc. The most nutrient-dense individual animal foods to fight depression were oysters, mussels and seafood, all rich in DHA which helps form strong membranes that easily transport nutrients into brain cells, lowers inflammation and raises serotonin levels. From plant-based foods leafy greens, lettuces, peppers, and cruciferous vegetables received the highest score, suggesting that regularly incorporating those veggies in one’s diet might improve mood dysregulation.

Another study followed up with patients for 12 weeks in a randomized controlled design study to examine efficacy of adjunctive dietary intervention in the treatment of moderate to severe depression2. The intervention consisted of seven individual nutritional sessions to support adherence to the recommended diet, encouraging consumption of the following key food groups: whole grains (5–8 servings per day); vegetables (6 per day); fruit (3 per day), legumes (3–4 per week); low-fat and unsweetened dairy foods (2–3 per day); raw and unsalted nuts (1 per day); fish (at least 2 per week); lean red meats (3–4 per week),chicken (2–3 per week); eggs (up to 6 per week); and olive oil (3 tablespoons per day), while reducing sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). The group receiving dietary support along with therapy or medication, showed significantly greater improvement in depressive symptoms suggesting dietary improvement may provide an efficacious and accessible treatment strategy for the management of depression.

A recent review summarized data from 20 longitudinal and 21 cross-sectional studies and concluded that adhering to a healthy diet, in particular a traditional Mediterranean diet (meals built around plant-based foods like  vegetables, fruits, herbs, nuts, beans and whole grains with moderate amounts of dairy, poultry,  eggs and seafood), or avoiding a pro-inflammatory diet (deficient in fruits and vegetables and containing excessive amounts of meat, refined grain products, and dessert foods) might confer some protection against depression in observational studies3.

A healthy gut environment (microbiome) supports production of vitamins, helps train the immune system, supports cleansing of the body and helps modulate the nervous system. The microbiome can be influenced by our diet, providing the direct link between the brain and the gut, as 90% of our serotonin receptors are located in the gut. Consuming a diet rich in both prebiotics (the fiber that feeds the probiotics in our gut found in onions, leeks, asparagus, bananas and garlic) and probiotics (good bacteria that are found in fermented foods like sauerkraut, yogurt with active cultures, pickles, kefir, kimchi, kombucha) is recommended for keeping the microbiome well balanced. Probiotics are associated with a significant reduction in depression and anxiety in two recent analyses, reviewing over 30 individual studies4,5. Moreover, overconsumption on ultra-processed food leads to inflammation in the gut and might dysregulate the microbiome, possibly contributing to a plethora of diseases6.

While the field is still working through challenges to identify a clear set of biological pathways and targets that mediate the brain-gut connection, the following few simple recommendations might be helpful as complementary interventions benefiting mild to moderate depression and anxiety:

  • Regulated eating habits (3 meals and 1-2 snacks/day) decrease blood sugar variations and helps stabilize moods
  • Follow a diet comprising mostly of real foods (Mediterranean diet)
  • Probiotic-rich foods and limiting processed food (shopping the “perimeter of the store” preferentially )supports the health of the gut-brain axis and can be beneficial for mood regulation
  1. LaChance LR, Ramsey D. Antidepressant foods: an evidence-based nutrient profiling system for depression. World J Psychiatry. 2018;8:97-104.
  2. Jacka F, O’Neil A, Opie R, et al. A randomized controlled trial of dietary improvement for adults with major depression. BMC Med. 2017;15:23.
  3. Lassale C, Batty GD, Baghdadli A, et al. Healthy dietary indices and risk of depression outcomes; a systematic review and meta-analysis of observational studies. Mol Psychiatry. September 26, 2018
  4. Ruixue Huang, Ke Wang, Jianan Hu  Effect of Probiotics on Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Nutrients 2016 Aug 6;8(8):483
  1. Richard T Liu, Rachel F L Walsh, Ana E Sheehan  Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials Neurosci Biobehav Rev,  2019 Jul;102:13-23.
  2. Marit K Zinöcker, Inge A LindsethThe Western Diet-Microbiome-Host Interaction and Its Role in Metabolic Disease Nutrients   2018 Mar 17;10(3):365.

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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!

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

Everyone needs to shop from time to time, but at what point does shopping become a problem? And is this a diagnosis? Compulsive buying disorder (CBD) is a mental health condition characterized by “excessive, impulsive, and uncontrollable purchase of products in spite of severe psychological, social, occupational and financial consequences”. While this diagnosis is not found in the DSM-V, shopping addiction was described and discussed clinically in the early 20th century by Bleuler and Kraepelin (Black, 2007). There is still much to be learned about the causes of CBD or shopping addiction, but several factors thought to be contributing include materialism, social anxiety, a general lack of social support, loneliness, or trauma history (Harnish, Bridges, Gump, & Carson, 2018). It is not uncommon for those with CBD to also struggle with anxiety disorders, mood disorders, substance use disorders, eating disorders, or disorders of impulse control.

Most consumers of goods take value and usefulness into consideration when making a decision about a

purchase and emotion is not often involved in the decision. This has also been referred to as “utilitarian shopping”, where someone only shops when they need something. Those who struggle with CBD more often make purchases in order to improve their mood, cope with stress, gain social approval, or improve their self-esteem. This has been referred to as “hedonic shopping” where the primary purpose of shopping is for entertainment, distraction, or pleasure. Research has shown that CBD has relation to reward sensitivity and the mesolimbic dopamine reward circuit in the brain (Günüç & Doğan Keskin, 2016). Over time this behavior becomes reinforced and can create a pattern similar to those seen with behavioral addictions like gambling, sexual addiction, or internet addiction (Granero et al., 2016).

Some might think that during a global pandemic with economic uncertainty people would be less likely to spend and work towards curbing unhealthy shopping impulses. For some who struggle with CBD, this isn’t necessarily the case. With the emphasis and ease of online ordering and curbside pick-up options combined with the increased stress that many are feeling related to the pandemic, coping with shopping addiction has been more challenging for some. This year credit and debit card use increased by 79% in May compared to April in New Zealand. As shops reopened in Australia over the summer there were “Christmas size crowds”. A recent study in the UK showed that those with underlying mental health conditions (primarily depression and anxiety) were more likely to resort to “panic buying” or compulsive buying in response to the pandemic (Jaspal, Lopes, & Lopes, 2020). Considering that loneliness is a contributing factor to compulsive buying as well as the need to cope with stress it really isn’t very surprising that the pandemic has exacerbated these unhealthy buying behaviors in those who struggle with CBD.

What are the symptoms of CBD?

  • Urges to make a purchase are strong and the act of purchasing creates a “high” feeling
  • Preoccupation with shopping or planning purchases
  • Making a trip to the store and purchasing more items than originally intended
  • Most purchases made are unnecessary items
  • Debt, maxed out credit cards, or spending beyond one’s means
  • Hiding purchased items from family members or friends due to guilt
  • Feeling unable to stop oneself from shopping or making unnecessary purchases

What can you do to decrease urges to shop?

  • Seek professional help. While there are few evidence-based treatments for CBD there has been interest and anecdotal success with antidepressants (SSRIs),  cognitive behavioral therapy (CBT), and habit reversal training (HRT)
  • Join a support group or surround yourself with understanding and supportive people
  • When feeling the urge to purchase something make yourself wait a minimum of 24-hours
  • Declutter your space, organize, and get a better idea of what you have and what you love
  • Identify and avoid triggering situations – for example, unsubscribe from e-mails from your favorite stores if this has led you to make unnecessary and impulsive purchases in the past
  • Be mindful of who you follow on social media and how this influences your shopping behaviors
  • When looking at an advertisement ask yourself what they are trying to sell you and how this makes you feel about yourself. For instance, does this company benefit financially from you feeling badly about yourself or wanting a different lifestyle?

 

Sources:

Black, D. W. (2007). A review of compulsive buying disorder. World Psychiatry, 6(1), 14-18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805733/#B1

Granero, R., Fernández-Aranda, F., Mestre-Bach, G., Steward, T., Baño, M., del Pino-Gutiérrez, A., … Jiménez-Murcia, S. (2016). Compulsive Buying Behavior: Clinical Comparison with Other Behavioral Addictions. Frontiers in Psychology, 7(914). https://doi.org/10.3389/fpsyg.2016.00914

Günüç, S., & Doğan Keskin, A. (2016). Online Shopping Addiction: Symptoms, Causes and Effects. Addicta: The Turkish Journal on Addictions, 3(3). https://doi.org/10.15805/addicta.2016.3.0104

Harnish, R. J., Bridges, K. R., Gump, J. T., & Carson, A. E. (2018). The Maladaptive Pursuit of Consumption: the Impact of Materialism, Pain of Paying, Social Anxiety, Social Support, and Loneliness on Compulsive Buying. International Journal of Mental Health and Addiction, 17. https://doi.org/10.1007/s11469-018-9883-y

‌Jaspal, R., Lopes, B., & Lopes, P. (2020). Predicting social distancing and compulsive buying behaviours in response to COVID-19 in a United Kingdom sample. Cogent Psychology, 7(1). https://doi.org/10.1080/23311908.2020.1800924

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CBT and Psychosis

Many think that psychosis cannot be targeted with cognitive behavioral therapy, but that is not the case. There is a specific form of therapy that was developed for psychosis called CBTp. One important point to mention is that the symptoms are only targeted when they are distressing to the client and they interfere with their functioning or safety, not because one believes them to be untrue or abnormal. The main tenet is to join with the client and build rapport while not directly challenging their psychosis, which is referred to as working within their belief system. Once this is established, gradually helping them think differently about some of their experiences or beliefs is possible, but not in all cases. In some cases, the cognitive therapy is used to help them live their life and meet their goals in spite of their experiences or beliefs.

Combatting Stigmatization

One useful technique with this therapy is to help them feel less stigmatized and normalize some of their experiences. There are specific websites out there that detail stories and list famous people out there who have struggled with psychosis, which can be very helpful for the client to read about. One such website is intervoiceonline.org.

Effective Coping Strategies

Another very practical technique is helping them set smart and realistic goals. This can be done by asking what their goals are and developing a shared goal that can be accomplished. For example instead of “wanting the voices to stop” a smart goal could be “by the fourth session I will have learned and used two different coping strategies that reduce how much distress the voices cause from 100% to 75%”.

Other strategies that CBTp utilizes are coping strategy enhancement. First you figure out what they already are using to cope and figure out if they need to be refined or improved. Helping them figure out the time of day to use these strategies is important. They are likely to be most helpful when their voices are triggered, such as certain times of the day, a specific place, a certain smell, or certain feeling. Some strategies that can be useful to use before their voices are triggered include progressive muscle relaxation, deep breathing, and practicing mindfulness of the present moment such as identifying things in the room. Strategies that can be helpful once the voices are already triggered include: using an ipod and listening to a feel good songs playlist; playing the look, point and name; using sub vocal speech or singing under one’s breath which can interrupt the voices; focusing on voices (hearing out in order to change relationship with voice); entering into dialogue with them, and setting specific times for listening to voices.

CBTp Objectives and Techniques

When targeting voices in sessions, there are several main goals. One is to help the client understand how their beliefs and thoughts relate to the voices and influence their feelings, mood, and coping.  Another is to help them identify their beliefs about their voices. Helping them explore evidence for and against their distressing beliefs is important. One can also develop behavioral experiments to test out the reality of their belief. Helping them generate alternative explanations and thoughts about their voices is also helpful. Providing behavioral interventions to reduce distress associated with their voices is key as well. Lastly, helping them change their relationship to their voices is important.

As you can see, there are many strategies that can be useful in psychosis treatment for this presenting problem.
The key it to present it in a way that is collaborative with the client and doing so in a trusting professional relationship. Meeting the client where they are at is important. It is also helpful to keep in mind that these techniques take some time to work and for the client to be able to use them, so patience is key as well.

 

 Nicole Bosse, PsyD

Staff Psychologist, Lindner Center of HOPE

 

 

 

 

Established in 2008, Lindner Center of HOPE has stood as a beacon of support for countless individuals grappling with mental health issues or addiction. Contact the Lindner Center of HOPE today to learn more about our comprehensive suite of mental health treatments and services, our environment fosters enduring recovery. Powered by our dedicated psychologists, the Lindner Center of HOPE is wholly devoted to instilling hope and guiding you on your personal journey to wellness.

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Binge eating disorder (BED) is the most common eating disorder, with an estimated prevalence of 3% in the US population. It is also the most common eating disorder among men. BED is characterized by regularly recurrent episodes of eating unusual amounts of food within a discrete time frame (usually <2hrs), which are associated with loss of control and significant psychological distress. Unlike people with Bulimia nervosa, those with BED do not engage in purging behaviors (such as fasting, driven exercise or self-induced vomiting). Untreated BED is a risk factor for obesity, metabolic disorders, mental health problems and poor quality of life. Although psychotherapy and medications have demonstrated effectiveness in treating BED symptoms, the vast majority of patients with BED remain undiagnosed and untreated.

Patients with BED face significant barriers to evaluation and treatment. First, there are patient-related barriers such as lack of awareness of BED as a medical condition, where the patient may attribute their loss of control to having no willpower. Moreover, patients may be reluctant to discuss their eating behavior and weight out of shame or fear of being judged. Finally, past experience may lead patients to assume that their primary care provider is unwilling or unable to address their disordered eating. Providers also face challenges in identifying BED in the primary care setting: Some patients with BED may have a normal BMI, which makes providers assume that they do not have an eating disorder. In addition, BED often co-occurs with psychiatric disorders such as depression and anxiety, which can lead to attributing the BED symptoms to the patient’s mental health diagnosis or the effects of psychotropic medications. Finally, lack of knowledge about treatment options and underestimation of the impact of BED on medical conditions, leads many primary care providers to overlook BED as a target for evaluation and treatment.

The reality is that primary care providers have much to offer patients with BED. Screening, education, self-management tools and in some cases, referrals to specialty care or medication. Screening for and treating BED can be advantageous when managing patients with diabetes, where decreasing the frequency of binges can lead to significant improvement in metabolic parameters. A BED diagnosis is useful when selecting psychotropic medications with lesser potential to aggravate binge eating. Finally, diagnosing a patient with BED can alleviate the patient’s distress and stigma. Patients who struggle with BED are often relieved and thankful that they have a treatable medical condition rather than attributing their bingeing to a character flaw and feel empowered and thankful for any help in managing their disorder. Since untreated BED poses a challenge in treating conditions such as diabetes and dyslipidemia, diagnosing and managing BED can benefit all areas of patient health.

Although there are still significant barriers to screening, diagnosis and treatment, primary care providers have the means to improve health outcomes among their patients with binge eating. Primary care is the ideal setting for raising awareness of the problem of binge eating among the general population, to address patient’s disorder eating concerns and start patients on their journey to recovery. First of all, routine procedures such as weighing patients, offer opportunities to ask patients whether they have any concerns about their weight or eating patterns. These questions can also be added to the medical history updates hat patients complete prior to office visits. Routine screening of special populations such as patients with diabetes, those attempting weight loss or receiving psychotropic medication is of great help in managing those comorbidities. The SCOFF questionnaire is a brief screen for eating disorders suitable for primary care*. Providers interested in providing medication management for BED should also screen for psychiatric comorbidities and substance use disorders to guide their medication choices.

In summary, patients with BED are largely undiagnosed and untreated, which complicates the management of their medical and mental health issues. Although access to specialty continues to be a challenge, primary care providers have the means to start patients on their road to recovery and improve overall health outcomes and quality of life.

The Research Institute at the Lindner Center of HOPE is a world leader in Binge eating disorder research. For more information about our current studies, call 513-536-0710.

*The SCOFF questionnaire is available at:
http://cedd.org.au/wordpress/wp-content/uploads/2014/09/The-SCOFF-Questionnaire-SCOFF.pdf

References:
Chao AM, Rajagopalan AV, Tronieri JS, Walsh O, Wadden TA.
Nurs Scholarsh. 2019 Jul;51(4):399-407. doi: 10.1111/jnu.12468. Epub 2019 Mar 1.

Javaras KN, Pope HG, Lalonde JK, et al. Co-occurrence of binge eating disorder with psychiatric and medical disorders. J Clin Psychiatry. 2008;69(2):266-273. doi:10.4088/jcp.v69n021

Nicole Mori RN, MSN, APRN-BC
Nurse Practitioner, Lindner Center of HOPE Disorder Services

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Fortunately, our culture has recently seen a gradual erosion of the stigma regarding emotional disorders, along with an increased understanding of such conditions. However, a less well-understood aspect of emotional disorders is the impact that they have on the cognitive functioning of those who are afflicted. Disorders such as Major Depression, Bipolar Disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, and Schizophrenia all tend to interfere with one’s ability to access the full extent of their cognitive abilities, adding to the burden that these conditions create.

Regarding Major Depression, it is the one disorder that the DSM-V lists cognitive difficulties as one of the diagnostic criteria (diminished ability to think or concentrate, or indecisiveness, nearly every day). As a neuropsychologist, I routinely encounter patients who are all too aware that their depression impacts their ability to think clearly, to focus, and to recall everyday interactions. Part of the reason for this is that depression causes a reduction in processing speed, as well as the energy that it takes to attend to conversations and events. Difficulties with maintaining attention, and “keeping up” with things going on around them, these patients experience troubles recalling information, sometimes so profoundly that they begin to fear that they may have dementia. However, as their depression is more effectively treated, they regain full access to their cognitive skills and abilities.

Anxiety disorders also are accompanied by significant cognitive difficulties, for a couple of reasons. First, when the mind is anxious, most of the brain’s resources (blood flow, oxygen, glucose, etc.) are redirected to the emotional centers of the brain (the limbic system), and away from parts of our brain that mediate higher-level thinking and logic. Secondly, those who are anxious tend to be rather “internally-oriented” in their thinking, and so they are not as attentive to external events. In other words, because they become preoccupied with their fears and worries, the ordinary events of the external world can be largely overlooked. As a result, these ordinary events are not well-encoded into the memories of anxious patients, and therefore they cannot easily be recalled. As with depression, as anxiety becomes better managed, these cognitive issues largely resolve.

Two other diagnoses have profound implications for cognitive functioning. Bipolar disorder has a well-established pattern of cognitive difficulties, including diminished attention, verbal memory, and executive functioning abilities (planning, anticipating, problem-solving, emotional regulation, staying focused and attentive to personal goals, etc.) These difficulties, fortunately, are typically limited to times that these patients are actively experiencing a mood episode, whether it be depression or mania. Regarding those with schizophrenia, they experience similar cognitive difficulties. However, they often continue to experience such cognitive difficulties even when their symptoms of schizophrenia have been well-controlled with treatment. This is why the DSM-V lists “associated features” of schizophrenia specific to these difficulties, explaining that, “Cognitive deficits in schizophrenia are common and are strongly linked to vocational and functional impairments.”

Fortunately, over the past 20 years there have been treatments and interventions to address such cognitive difficulties. Cognitive Enhancement Therapy, or CET, has been developed and implemented for the mentally ill for whom cognitive problems are getting in the way of living independently, maintaining employment, and sustaining meaningful relationships. It has proven to be an effective means to address such difficulties, and for providing a much higher quality of life. It is anticipated that, as the benefits of CET become more evident to those working with the mentally ill, its positive impact will widen in both its breadth and depth.

Thomas A. Schweinberg, PsyD Staff Psychologist Lindner Center of HOPE

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Many who struggle with OCD are probably noticing a spike in their symptoms during these unprecedented times. Stress and uncertainty can often make OCD symptoms flare. Those who struggle with specific types of OCD may be having an even harder time: specifically those with contamination concerns and those concerned with harming others. Another symptom of OCD that may be particularly hard currently are perfectionism tendencies. While it may be harder to fight back against OCD with everything going on right now, it is more important than ever to not give in to compulsions and let them take over your life. One simple step you can take is to stay connected to your therapist, likely via telehealth at the moment. Having regular sessions during this time is key, especially as symptoms flare. Staying connected to others online or through social media options is also important, as the more you are connected to others the less stress you will notice. Another key piece is to continue to do things you enjoy and that bring you pleasure, as this will help lessen stress as well. Keeping a structured routine can be helpful and can help make things to continue to feel more normal. It can be important to try to continue with whatever routine you had going before that you are still able to do, for instance still getting at the same time in the morning and getting ready for work even if you are working from home. Adding consistent exercise into that routine will also be helpful, as this helps create endorphins and naturally lessens anxiety. Lastly, avoid reading the news all day, which will only lead to more stress and anxiety. It is important to limit access to only a couple of trusted sites and not get carried away with reading up on everything all day long.

Some specific OCD related steps you can take will vary depending on the type of OCD you have. For those who struggle with contamination concerns, get familiar with the CDC guidelines for the current pandemic and do not add other steps that are not recommended. For instance, they are recommending only washing hands for 20 seconds after being outside or in public, before eating, after going to the bathroom, and after you’ve coughed/sneezed/blown your nose. If soap and water are not available, they recommend you use hand sanitizer that contains at least 60% alcohol. They also only recommend disinfecting surfaces once per day. This should only take a few minutes per day and they suggest only focusing on the surfaces in your home that are frequently touched. It is also important to think about whether this is truly needed (for example, if you stayed home all day and had no visitors, do you really need to disinfect that doorknob?). It is also important to avoid some news sources that might not offer expert recommendations but rather their own opinions.

For those who struggle with fears of harming others, these symptoms might tackle the current pandemic and cause you to obsess about whether or not you might have infected someone or whether or not you might infect someone in the future. This might be a similar theme to past fears of contamination concerns, but it will still be helpful to alert your therapist to the new content so that new exposures can developed.

For those who struggle with perfectionism tendencies, this might be an especially trying time. The perfectionism could target all of the changes going on and adaptations people are having to make to conduct
their jobs, manage their families etc. It is important to give yourself a break and realize that it is impossible to be perfect in anything we do, but especially now during all of this change and uncertainty. Practice doing one or two things imperfectly on purpose as an exposure.

One important exercise I make sure to encourage all of my patients to do is to keep track of their victories against OCD, whether the victories are big or small. Keeping track of successes and not dwelling on everything that is going wrong is a helpful way to stay on track and to realize everything that you are doing to fight OCD, which is likely a lot. It can sometimes be hard to pick out the successes and often others only notice the failures or slips, but there are victories in there as well that deserve your attention and that can help give you confidence to fight back even harder next time

Nicole Bosse, PsyD
Lindner Center of HOPE, Staff Psychologist

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Peter White, M.A., LPCC
Lindner Center of HOPE, Addictions Counselor

Due to the COVID-19 pandemic, this is a period of unprecedented changes marked by great uncertainty shared by literally everyone. One of the complex realities of dealing with this much uncertainty is that we should feel a wide variety of difficult emotions – confusion, fear, disorientation, sadness, and anger to name a few. In a way, it is healthy to not feel okay at this time. But at the same time, it is important for us to acknowledge that we want to manage these difficult emotions in a healthy way. One common vulnerability in managing difficult emotions is depression. Although challenging, we can get good at identifying and countering the presence of depression during difficult times. We can effectively treat and manage depression so that it does not make our coping less effective.

Depression is a condition involving thoughts, emotions and physical reactions. It is opportunistic in periods of uncertainty expanding its ability to disempower and disquiet ourselves and our relationships. Depression’s biggest advantage is its negative judgement – hopelessness, helplessness, worthlessness and guilt are all hallmarks of depressive thought process. “It’s not going to get better. There is nothing I can do to make it better. I don’t deserve to have it be better,” are all examples of depressive distortions that can plague the mind and divorce us from our natural capacities to endure and thrive. In a way, depression fills the mind with judgements that are fundamentally untrue. There is always hope. Things can always improve. We always have some options to improve our situations, or at least find how to endure with as much forbearance and gratitude as possible. And of course, we all deserve to have our suffering relieved. They may seem like simple reframes, but they are the fundamental effort of successfully countering depression so that we can move forward with all our strengths and resources. Fear is appropriate and understandable in times like this with major uncertainties and potential pending losses of security and predictability. I always encourage clients to honor their fear, comfort themselves with the many blessings of their lives that help them endure and rebound from loss, and resist the power of depression to convince them that they are alone and without options

As noted, depression infects both the mind and the body. Depression disrupts our metabolism, so we might experience fatigue, sleep disruption, changes in our appetites, difficulty in concentrating and decision making. Given that depression has a corrosive effect on body, mind and spirit, it is most effective to counter it with body, mind and spirit. Keep moving, maintain a wholesome routine mixing both work and pleasure. An easy acronym to remember is GRAPES. G. stands for gentleness and gratitude in thought. R. stands for relaxation, even for brief moments. A. stands for the recognition of our accomplishments, especially the simple ones-caring for ourselves and our loved ones is always an accomplishment. P. stands for pleasure, again especially the simple ones- food, music, reading, nature, or whatever there is that reminds you that life has its joys. E. stand for exercise, or if not rigorous physical activity, any movement that brings the reward of the body moving through space. And S. stands for remaining social. All of the above are anti-depressive activities – effective reminders that hopelessness, helplessness and especially worthlessness are untruths to be dispelled during our moments of fear and doubt.

Let me end just highlighting the social. All humans, especially so right now, share the experience of fear and doubt related to uncertainty. Near invariably, we are all comforted when these fears are shared amongst our loved ones and our fellows in a spirit of honor and trust. Nearly all of us have experienced a darkness of spirit that is quickly dispelled by kind words from friends. If nothing else, resist the power of depression to convince you that you are alone and do not deserve the fellowship of loved ones and peers. Clearly now, our experience of uncertainty is a deeply shared experience. I encourage you to become robustly social, so that within the shared uncertainty, we can all experience the power of ourselves and others to endure and overcome this frightening time strengthened in our spirit of togetherness.

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Paul R. Crosby, MD

Lindner Center of HOPE, Chief Clinical and Operating Officer, Psychiatrist

4075 Old Western Row Rd.

Mason, OH 45040

513-536-HOPE

Most of us are weeks into the significant life changes caused by the novel coronavirus.  Even as we work to adjust to our new normal, there continues to be changing instructions and sometimes confusing and frightening information to process.  Daily, we are being asked to make sacrifices and critically important decisions for the safety and welfare of our family and our communities.  It is important during this crisis to remember to monitor and maintain our own mental wellness.

Some tips to manage the stress of today’s circumstances include avoiding excess exposure to media, including social media, taking care of yourself through exercise, eating healthy foods, getting enough sleep, and talking to friends and family.  Cultivating a practice of mindfulness and gratitude is another evidence-based way of improving wellness and alleviating stress-related mental health symptoms.  For people new to the idea of meditation and to those with more experience, there are many apps, such as Headspace www.headspace.com, to guide the process.  Also, even though social distancing is necessary during these times, seek out safe ways to stay connected with others.  The American Psychological Association, The National Alliance on Mental Illness, and Mental Health America are advocacy organizations that have a wealth of information about supporting your mental wellbeing during this crisis. www.apa.org  www.nami.org www.mhanational.org

With most students out of school and engaged in some combination of home-based and online learning, the situation is understandably stressful for both children and parents.  It can be hard to know where to start; but, try and establish a regular routine.  Children (and most adults) are reassured by structure and predictability.  Try to keep in mind that children learn from watching and listening to the adults around them.  They will be very interested in how you respond to news about the coronavirus outbreak.  Let children know that there are lots of people helping the people affected by the coronavirus outbreak.  This is a good opportunity to show children that when something scary or bad happens, there are people to help. Try to create an open and supportive environment where children know they can ask questions.  It is also important to remember that most children may be more interested in playing games, reading books, and other physical and recreational activities than discussing current events or following the news about what is happening across the country or elsewhere in the world.  The American Academy of Child and Adolescent Psychiatry’s website is an excellent resource with advice to help families help the children in their lives through the pandemic.  www.aacap.org

When there are many changes and uncertainties that are beyond our control, heightened stress and anxiety are normal feelings.  A time of crisis can also be a trigger for the onset or reoccurrence of mental health symptoms.  If anxiety and/or stress related feelings are causing you significant discomfort or are interfering with relationships, work, or other areas of your life, it may be time to seek help from a mental health professional.  Other symptoms to look for include:

  • Behaving, thinking, or feeling in ways that are out of character
  • Withdrawing from social contacts
  • Lack of interest in things that would normally bring joy
  • Becoming consistently irritable
  • A change in sleep patterns
  • Changes in eating habits and/or weight
  • Increased use of intoxicating substances

It is essential to remember that mental health services are still available during the COVID-19 crisis.  For individuals already receiving mental health and/or substance use disorder treatment services, it is important to continue with these services during this difficult time.  To follow social distancing guidelines, outpatient services for mental health assessment and treatment are being offered virtually via a simple phone call or one of several easy-to-use, secure video conferencing apps.  When needed, in-person services are still being offered with added health and safety measures to keep patients and staff safe throughout their treatment.

Similar to adults, children who become overly preoccupied with concerns about the coronavirus outbreak should be evaluated by a trained and qualified mental health professional.  Other signs that a child is struggling and may need additional help include ongoing sleep disturbances, intrusive thoughts or worries, recurring fears about illness or death.  If you notice similar symptoms or other behaviors, thoughts, or feelings that seem out of character for your child, seek a consultation with a pediatric mental health professional.  For help finding such a provider, your child’s pediatrician, family physician, or school counselor are good places to seek a referral.

Unfortunately, stigma about mental illness remains the key reason that people do not access care.  It is important to know that more than 50 percent of the population will suffer from a diagnosable mental illness at some point in their life and about 20 percent every year.  Only a small fraction of these individuals ever seek treatment.  One way to start breaking the stigma is to start talking about mental illnesses as a part of normal conversation, similar to how we may discuss illnesses like diabetes or high blood pressure.  Mental illnesses are common, biological illnesses that tend to respond very well to treatments that are typically very safe.  The goal of mental health treatment is to get back to feeling completely like yourself again.  In most cases, treatment is highly effective and allows individuals to function to their full potential.

When it comes to mental health, we need to start treating ourselves more gently.  We also need to extend that compassion to those around us.  We may be social-distancing but we are all in this together.  As, together, we work to fight off this pandemic and take up the challenge of recovering from it, kindness to ourselves and others has never been more important.

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call:

  • 911
  • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)
  • The National Suicide Prevention Line: 800-273-8255

 

 

 

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

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

5 Common Misperceptions of Psychiatric Medications

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

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

2 – “I don’t want to be a zombie.”

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

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

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

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

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

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

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

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

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

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