Category: Health

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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 By Kristina Tracy, LISW-S
Outpatient Therapist

 

 

 

 

What is kindness? Kori Miller defines kindness as a benevolent and helpful action intentionally directed towards another person, it is motivated by the desire to help another and not to gain explicit reward or to avoid explicit punishment. Kindness is about showing up in the world with compassion and acting for the greater good of all. Kindness is a conscience choice to extend warmth, compassion, generosity, and empathy towards others. Kindness is doing the things that may go without acknowledgment and thanks and does not expect anything in return. Kindness goes a step beyond!

The influence of kindness can significantly enhance our lives by fostering happiness, connections, and promoting personal development. Kindness can bring people together regardless of age, race, ethnicity, religion, status, and identity. Kindness plays a vital role in community building, bridging relational gaps, and fostering a sense of belonging and connection. Kindness allows our bodies to produce less cortisol leading to a calmer state. Kindness motivates us to action and makes a positive impact. Kindness promotes understanding and it combats negativity. Kindness fosters unity and can transcend cultural and social barriers.

There is a positive relationship between the number of kind acts and the level of happiness someone experiences. Performing acts of kindness improves and increases happiness as well as increasing the physical and mental health of both the giver and receiver. Studies have shown that giving to others makes us happy, even happier than spending on ourselves. Our kindness creates a virtuous cycle that promotes lasting happiness and altruism. Resulting in a “positive feedback loop” between kindness and happiness, signifying one encourages the other. Therefore, it has the potential to create ripple effects of positivity.

Kindness plays a vital role in self-improvement, and it enables growth and development as an individual.” Kindness allows us to have a sense of belonging and strengthens our relationships. Practicing kindness can reduce state level social anxiety and is positively related to better self-regulation and less emotional reactivity. By showing kindness it creates a positive impact one lives but also cultivates a sense of resilience with yourself. Kindness teaches us to respond to challenging situations with empathy and understanding.

Ways to practice Kindness:

  • Being Empathetic
  • Generosity
  • Showing Compassion
  • Use manners, turn-taking, and include others
  • Show gratitude
  • Listen to understand and not problem solve

Key Characteristics and Attributes of a kind person:

  • Empathy
  • Good listening skills
  • Being generous
  • Charitable
  • Helpful
  • Courteous
  • Engage in perspective-taking
  • Caring/Nurturing

The benefits of kindness are substantial. Research shows that being kind boosts production of serotonin and dopamine which give us a feeling of satisfaction and well-being. Kindness leads to reduction in risks for disease and reduces psychological flourishing. Kindness reduces stress, promotes trust, and increases life satisfaction as well as improves how others see you and accept you. Kindness boosts social relationships, promotes oxytocin, elevates mood, and produces a “helper high.”

Kindness expands the more we share it and being kind to someone else can improve our own psychology and physical health. Being kind is a simple yet beneficial act! Kindness is an important part of being a human being. Making more of an effort to incorporate the power of kindness into our lives will considerably enhance us all!

References

Cypress (2024). The Power of Kindness: Cultivating Happiness, Connection, and Personal Growth.

Alex Dixon (2011). Kindness makes you Happy…and Happiness makes you kind. gratergood.berkeley.edu

Robyne Hanley-Dafoe (2023). Why Kindness Matters. Psychology Today.

Tchlkl Davis (2024). Why Be Kind? 5 Ways Kindness Is Good For Well-Being. www.psychologytoday.com

Laura Gabayan (2024). The Strength of Kindness. www.pscynologytoday.com

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By Jennifer Farley, PsyD
Associate Chief of Psychological Services, Lindner Center of Hope

 

 

 

In many areas, autumn’s colorful trees and darker mornings are reminders of the transition from summer to winter. Evening hours just don’t feel the same compared to the long days of summer when people are more active from sunrise to sunset. While it is common to experience life differently at different times of the year, approximately 10 to 20 percent of people in the United States experience a mild depression during the darker seasons, and 4 to 6 percent of Americans experience moderate or severe depression.

Seasonal Affective Disorder (SAD) is a clinical depression triggered by seasons of the year. SAD is believed to be associated with seasonal changes in the amount of daylight. For most people with SAD, symptom onset is in the fall or early winter, and relief starts in spring. Symptoms of SAD can last up to 5 months. SAD is more common in women than men and is typically not experienced prior to 20 years old. SAD is more common among young adults and the risks of developing SAD decrease with age. People with a depressive disorder or Bipolar Disorder and people with family members with SAD or other forms of depression raises the risk of having SAD. Living in sunnier regions and closer to the equator decreases the risk of SAD, validating why many people become “snow birds” and go south for the winter.

Because SAD is a depressive disorder, individuals experience at least some symptoms of Major Depressive Disorder. These can include feeling depressed most of the day, nearly every day, having less interest in enjoyable activities, sleep problems, feeling sluggish or agitated, having low energy, and feeling hopeless or worthless. Additional symptoms can include overeating, social withdrawal, and poor concentration. It is common for people with SAD to oversleep by going to bed earlier and/or waking later. A clinical diagnosis of SAD requires a full remission of symptoms when the season ends and 2 consecutive years of episodes in the same season.

Causes of SAD include lower levels of the neurotransmitter serotonin, disruption of the circadian rhythm, increased melatonin, and a deficiency in Vitamin D. SAD is most typically diagnosed by primary care physicians, but psychiatric clinicians (medication prescribers and therapists) can also identify SAD.

Though there is not much that can be done to avoid getting SAD, symptoms can be managed to reduce their intensity. Some people start treatment or interventions before SAD symptoms start or before the season changes. Methods of treatment include light therapy (i.e., light boxes), medication, cognitive-behavioral therapy, increased Vitamin D, and lifestyle changes. Taking care of one’s body by eating healthy and getting sufficient sleep, exercising, and avoiding alcohol and drugs can help. Managing stress is important, as is being around others. Isolation and loneliness may fuel depression. Planning pleasant daily or weekly indoor or outdoor activities can be helpful to help fight “hibernation”. People also benefit from planning a vacation somewhere warmer and sunnier during the winter, and the experience of anticipating something positive helps reduce depression. Though some people use tanning beds in the winter months, this is NOT recommended due to the harmful exposure of U/V rays.

Individual therapy and/or medication treatment can be quite helpful for those with SAD, and it is especially recommended when depression is at a moderate or severe intensity. Cognitive-Behavioral Therapy in particular helps by replacing negative thoughts about winter with more positive thoughts. Discussing ways to implement lifestyle changes and planning for enjoyable activities can be helpful. Therapy can also offer opportunities to learn and practice mindfulness and to explore how to radically accept the fall and winter by “leaning in” to its opportunities. People do not have to live through darker months with dark mood.

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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 Nik Raju, MD
Lindner Center of Hope Staff Psychiatrist

Disclaimer: This was written for general informational purposes only and should not be viewed as medical advice. Please consult with your personal physician/care provider and/or registered dietitian for specific recommendations tailored to your individualized needs.

As the saying goes, food is medicine. While we often think of medicine as the medications prescribed by physicians and healthcare providers, the types of foods we eat on a day-to-day basis can also have an impact on our overall physical and mental well-being. Nutritional psychiatry is an emerging field within the medical specialty of psychiatry that essentially involves applying principles of nutrition to optimize brain health. Despite the tendency at times in medicine to separate the brain and the mind from the rest of the body, what is good for the body is often what is good for the brain. One of the main pioneers of nutritional psychiatry, Dr. Drew Ramsey is a psychiatrist who is a clinical professor at Columbia University as well as a farmer, and he provides his own explanation of nutritional psychiatry in this short video: https://drewramseymd.com/brain-food-nutrition/what-is-nutritional-psychiatry/. 

Nutritional psychiatry does not recommend one particular diet, though there is growing evidence that a plant-based, whole food-based diet can optimize mental and physical health, as long as some of the nutrients we usually obtain from meats and dairy products are received through proper supplementation. Given the high energy consumption and the amount of open land required to maintain cattle and livestock within our planet’s agricultural system, a whole food, plant-based diet can minimize environmental impacts while also improving our own health. This is a win-win for the planet and human health.

Dr. Ramsey and Dr. Uma Naidoo, another expert psychiatrist who is also a trained culinary chef and nutritionist based at Harvard Medical School, do not suggest that meat and seafood be eliminated completely from day-to-day food consumption but instead suggest we should be mindful of what protein sources we are eating. Regular consumption of red meats, such as beef and pork, as well as processed deli meats can produce generalized inflammation in the body, including in the brain, and inflammation in the cells and tissues that make up neural circuits in the brain is one of many hypothesized causes of depression. Unprocessed poultry meats and certain types of seafood are less likely to promote this inflammation in the brain. Shifting to foods with natural sugars, such as fresh fruit, and foods with high fiber content, including certain unprocessed grains and vegetables, can keep us full for longer periods of time, which can help us make more mindful food choices.

Nutritional psychiatry also emphasizes the gut-brain connection, as the brain cells (called neurons) comprising neural tracts in the brain communicate with cells in the gastrointestinal (GI) tract. The GI tract is actually the largest source of serotonin in the body, with approximately 90% of serotonin produced in the GI tract and 10% of serotonin produced in the brain. Serotonin is an essential (but not the only) neurochemical that regulates mood in the brain, and the SSRI antidepressants such as fluoxetine, sertraline, and escitalopram function partly by increasing the concentration of serotonin in neural circuits involved in depression. Some of the emerging research has found that maintaining healthy gut bacteria by consuming certain foods can also help reduce symptoms of depression and anxiety, and the neural networks communicating from the brain to the gut are considered to be one of the main mechanisms.

The concepts in nutritional psychiatry do not suggest foods can replace medications for mental health disorders. For conditions such as moderate to severe anxiety, depression, bipolar disorder, and schizophrenia, medication management is still usually required despite optimizing one’s diet. However, a medication regimen can at times be modified to require fewer psychiatric medications and maintained at lower doses by optimizing one’s diet and engaging in appropriate physical activity.

For further nutritional psychiatry concepts and practical information as to what foods to eat to optimize mental health, I often recommend Dr. Uma Naidoo’s This is Your Brain on Food and Dr. Drew Ramsey’s Eat to Beat Depression and Anxiety to my patients. Both books are written for the general public, and Dr. Ramsey’s book even includes recipes and meal prep ideas with optimizing one’s diet. I am also by no means an expert on nutrition, so I recommend following up with a registered dietitian to optimize your meals and food intake. Regardless, I do hope you come away from this article with general ideas and further suggestions on how to optimize what you eat to also ensure optimal brain health.

nik rajuDr. Raju is a staff psychiatrist at Lindner Center of Hope and Assistant Professor of Clinical Psychiatry and Neuroscience at the University of Cincinnati College of Medicine. All views expressed in this article are his own.

 

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Harnessing the power radical openness to enhance connection and psychological well-being.

We as humans, from a biological perspective, are meant to be vulnerable and connected beings. We aren’t the strongest or fastest species, and yet humans dominate the animal kingdom. We do this because of our ability to have and express our emotions and thoughts to others, listen to and respect the thoughts and emotions of others, and to connect and work together.

Despite this innate human characteristic, many of us struggle to let our guards down and be open to others. We often find ourselves compulsively striving for perfection or insisting our way is the right way. Somewhere along the way, we got the message that if we only try harder and be better, our life too will be better. Or we may have come to believe that showing emotions makes us weak and pushes people away. This way of coping is like a suit of armor, we might feel it protects us and makes us stronger, but it actually weighs us down and guards us from others. Remember that we are meant to live in connection with other people, and research shows that this “over-controlled” form of coping contributes to anxiety, depression, and emotional loneliness because it works against connection.

Instead of coping in this way, radical openness is the pathway to well-being. It connects us with our core, authentic human nature and involves three main components:

  • Openness and Receptivity
  • Authenticity and Vulnerability
  • Flexibility and Silliness

Openness And Receptivity.

“We don’t see the world as it is, we see it as we are.” Our unique brains and experiences contribute to how we see the world; thus we are all going to experience the world differently. Examine this inkblot. What do you see? What is the “right” answer?

There isn’t one. How often do we get so stuck on our perspective that we reject others in the process? Radical openness encourages us to acknowledge our own inner experiences, while holding space for other people’s experiences. It is being aware of our own bias and allowing ourselves to grow and learn from what the world has to offer. Doing so will help us live more harmoniously with others and in turn, enhance our own well-being.

Vulnerability and Authenticity. Despite how scary it might feel, being open with ourselves and vulnerable with others builds connection. When was mask our emotions, hide behind the façade that “all is well,” or compulsively strive for perfection, we create emotional loneliness in our own lives. Research shows that people like people who openly revel themselves, they are seen as more trustworthy, and we want to spend more time with them. When we are authentic and vulnerable with the world, others feel safer with us, and in turn we feel more connected to others. Vulnerability creates peace in our inner world and builds community in our outer world.

Flexibility and Silliness. We live in a world that is constantly changing and is unpredictable. Yet, we feel we must be in control and expect ourselves to be perfect all the time. Sometimes we take life too seriously and block ourselves from joy. Radical Openness encourages us to be flexible, to step outside our comfort zone, and have some fun. We are not production robots. We are humans with a life, and life is meaningful when we allow ourselves to flexibly participate. Having a balance between productivity and enjoyment helps sustain our psychological health.

So remember, when it comes to navigating this crazy thing called life, do so with openness, vulnerability, and flexibility. That is what it means to be human. Embrace your humanness and embrace the humanness in others. Connection is the key.

Written by Allison Mecca, PsyD

Staff Psychologist

Lindner Center of Hope

 

 

Concepts based on Lynch, T. R. (2018). The Skills Training Manual for Radically Open Dialectical Behavior Therapy. If you interested in learning more about radical openness and treatment for over-controlled coping, please contact the Lindner Center of Hope or visit lindnercenterofhope.org/dialectical-behavioral-therapy/.

 

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By Stacey Spencer, EdD
Lindner Center of Hope, Staff Psychologist

 

 

 

Executive functioning and self-regulation are crucial skills for children and teens to learn to best manage their academic, social and personal lives. These skills are not just abstract concepts but are foundational to a child’s ability to succeed in various aspects of life. But what exactly are these skills, and why are they so important?

 Executive Functioning

Executive functioning refers to a set of cognitive processes that are necessary for planning, organizing, sequencing, and managing tasks. If your brain were an orchestra with multiple sections, our executive functioning system is the conductor. Having strong executive functioning skills allows a child or teen to set goals, monitor their own progress towards their goals and to make changes along the way as necessary. Without strong executive functioning skills, children and teens are disorganized, distractible, unprepared and will have difficulties completing goals and tasks in a timely manner. 

Key components of executive functioning include:

Working Memory: The ability to hold and manipulate information over short periods. For instance, remembering a set of instructions or following a multi-step process in a classroom setting.

Inhibitory Control: The skill to control impulses and resist distractions. This includes the capacity to stay focused on a task despite potential interruptions.

Cognitive Flexibility: The ability to switch between tasks or adjust strategies when faced with new information or changing circumstances.

Planning and Organization: The capability to create and follow through with a plan, manage time efficiently, and keep track of various tasks and deadlines.

If your child or teen has ever been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), then you have likely noticed that your child struggles with executive functioning skills. Deficits in these areas are often a component of ADHD.

 Self-Regulation

Self-regulation, which is often linked with executive functioning, refers to the ability to manage one’s emotions and behaviors in different situations. It involves:

Emotional Regulation: The ability to handle emotional responses in a healthy way. For example, calming oneself down when frustrated or managing anxiety before a big test.

Behavioral Control: The capacity to control impulses and act in a manner that aligns with long-term goals rather than immediate gratification.

Stress Management: Techniques and strategies used to cope with stress and remain focused and productive despite challenges.

For children and teens, self-regulation skills are essential for academic success, social interactions, and overall well-being. These skills help students work and play well with others, and to respond appropriately to situations at work and at home. They also play a critical role in emotional resilience and behavioral control, which are necessary for maintaining positive relationships and managing the ups and downs of adolescence.

How Do We Teach These Skills

Parents, educators, and caregivers can play a pivotal role in nurturing executive functioning and self-regulation skills in children and teens. Here are some strategies:

Establish Routines: Consistent routines help children develop organizational skills and manage their time effectively. Routines create a predictable structure that can reduce anxiety and improve focus.

Encourage Planning: Help children break tasks into manageable steps and use tools like planners or digital reminders. Teaching them to set specific goals and track their progress fosters planning and organization.

Model Self-Regulation: Demonstrate self-regulation techniques such as deep breathing, taking breaks, and using positive self-talk. Children often mimic the behavior of adults, so showing them effective strategies can be impactful.

Provide Opportunities for Problem-Solving: Allow children to experience challenges and work through solutions on their own. This enhances cognitive flexibility and problem-solving skills.

Positive Reinforcement: Acknowledge and reward progress in managing tasks and emotions. Positive reinforcement can motivate children to continue developing these skills.

 Conclusion

Executive functioning and self-regulation are integral to a child’s development and success. By understanding and supporting these skills, parents and educators can help children and teens navigate their world with greater confidence and competence. Investing in the development of these abilities sets the foundation for lifelong success and resilience.

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Cultivating hope to improve wellbeing

By Elisha Eveleigh Clipson, Ph.D.
Child and Adolescent Psychologist
Assistant Professor, University of Cincinnati College of Medicine
Department of Psychiatry and Behavioral Neuroscience

 

 

Why hope?

Daring to hope improves our overall well-being. People with more hope report less anxiety, depression and stress.  Hopeful employees are more productive than their counterparts. Hopeful students have higher tests scores and better academic achievement. They are less likely to drop out of college. Hope is associated with better self-esteem, a stronger sense of purpose in life, and better coping with physical injury or disease. Hope promotes the belief that our challenges are temporary.

What is hope?

Hope is something good we want to happen in the future, but the good thing might be hard to obtain. For instance, we do not hope for the air we are breathing right now. We already have it. It’s reasonable to believe we will still have it in an hour. In contrast, a person might hope to grow closer in a relationship or finish a marathon. Hope is different than optimism in that someone can have hope without being optimistic. I can hope my sports team will win without being optimistic. In personal matters, some people say that hope, unlike optimism, is a verb. That we take action to hope.

How do we hope?

Sometimes we have hope without much ability to change the outcome. For instance, I hope my friend’s adoption goes smoothly. But researchers have identified ways to actively cultivate hope in general. Hope can be learned and practiced. It’s not something we have or don’t have.

The first step involves identifying a goal. Philosophers and researchers tend to agree that people must believe what they hope for is possible, if difficult to attain. To practice, choose something that is helpful to you, others or society. Keep values in mind to provide direction. Questions to guide the process might include, “What are you aiming toward in your development as a person? Who’s helping you along this path? How do you want to develop in a way that promotes good for others in your community, or in society in general?

Next, find pathways to the goal. Use imagination to identify several different ways to reach a goal, and ways to work around barriers to the goal.

Find agency or motivation to move toward the goal. Agency can be developed through positive self-talk, getting encouragement from others, and prayer/meditation. This may involve reading stories about people who have overcome adversity. Practice hopeful mantras like, “I have what it takes” “I just need to do my best” or “I’m doing the best I can.”

Practical Tips:

Practice giving to others. Donate time or resources to an organization that provides animals, clean water, etc. to other children. Volunteer to help a grandparent neighbor.

Discuss the future with others and set small goals along the way to a larger goal.

Researchers have shown that cultivating spiritual practices can be an effective way to build hope. Even family rituals or traditions cultivate hope. This might include yearly traditions, serving the community together, or cooking family recipes.

When working with children and adolescents, cultivate the idea that they are capable of handling tough things and can rely on trusted others to help them.

Therapeutic approaches can help develop the skills of hope. For instance, Dialectical Behavior Therapy teaches acceptance (not approval) of life circumstances which can allow for more future-focused thinking. It also teaches tolerance of distress and mindfulness techniques, both of which can help when practicing hope.

Avoid too much exposure to bad news. Instead, find and share inspiring stories of courage and hope.

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By Erin Snider, APRN, PMHNP-BC

 

 

 

 

 

 

With the increased availability and potency of cannabis, the potential for “addiction” has never been more relevant. The Diagnostic and Statistical Manual-V (DSM-V) does not use the term “addiction” but classifies the diagnosis as “Cannabis Use Disorder” from mild to severe. The diagnostic criteria consist of problematic patterns of cannabis use leading to clinically significant impairment in an individual’s life. The presence of “Tolerance” and “Withdrawal” are not necessary for a diagnosis but are often present in the presentation of those with moderate to severe cannabis use disorder.

With the increased availability and potency of cannabis, the potential for “addiction” has never been more relevant. The Diagnostic and Statistical Manual-V (DSM-V) does not use the term “addiction” but classifies the diagnosis as “Cannabis Use Disorder” from mild to severe. The diagnostic criteria consist of problematic patterns of cannabis use leading to clinically significant impairment in an individual’s life. The presence of “Tolerance” and “Withdrawal” are not necessary for a diagnosis but are often present in the presentation of those with moderate to severe cannabis use disorder.

 

THC Delta-9 ‐tetrahydrocannabinol (THC), the main psychoactive component in cannabis (marijuana) and can lead to dependence, tolerance, and withdrawal. “Dependence” refers to needing the substance to function both physically and psychologically where “tolerance” is defined as needing more of the substance to get desired effect. Withdrawal is identified by the presence of physical and psychological signs and symptoms when cannabis is abruptly stopped. “Withdrawal” can occur with cessation of cannabis in moderate to heavy users, which is defined in DSM-V as almost daily for at least a few months.

The DSM-V does classify a diagnosis of “Cannabis Withdrawal” and it is estimated that up to one third of all individuals who have used cannabis “regularly” during their lifetime will experience withdrawal. “Heavy” cannabis users report 50-95% occurrence of withdrawal symptoms.

Withdrawal symptoms from cannabis vary based on frequency and duration of use as well as individual metabolism. These symptoms can cause clinically significant distress or impairment in social, occupational, or other areas of functioning. Withdrawal symptoms do not typically require medical attention however they can make it difficult for individuals trying to quit, often contributing to “relapse”. Symptoms start 24-72 hours after last dose and peak

Cannabis Withdrawal: 

1 week after last use. They usually resolve after 2 weeks. Sleep disruption can last up to 30 days.

Signs and Symptoms:

The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, restlessness, disturbed sleep, insomnia disturbing dreams, depressed mood, and decreased appetite.

Less common physical symptoms include chills, headaches, shakiness/tremor, physical tension, sweating and stomach pain.

Management:

Supportive Counseling and Psychoeducation: These are the first-line approaches for managing cannabis withdrawal.

Medications: While no specific medications are approved for cannabis withdrawal, some have been used to manage short-term symptoms (e.g., anxiety, sleep, nausea).

Promising Pharmacological Agents: Several medications have shown promise in controlled trials, but further research is needed.

Inpatient Admission: For patients with significant comorbid mental health disorders and polysubstance use, inpatient admission may be necessary to prevent severe complications.

Clinical Significance: Cannabis withdrawal symptoms can precipitate relapse to cannabis use.

Complicated withdrawal may occur in individuals with concurrent mental health issues and polysubstance use and precipitate a mental health crisis.

Remember that everyone’s experience with withdrawal is different. If these symptoms feel overwhelming, or you are having severe withdrawal symptoms or are worried about dependence, it’s essential to seek professional assistance. Don’t hesitate to reach out to a healthcare professional for guidance and support. Help is available, and you don’t have to go through this alone.

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By Laurie Little, PsyD
Lindner Center of HOPE, psychologist

 

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

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

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

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

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

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

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

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

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

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

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

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

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