by Jessica Kraft, MSN, PMHNP-BC

 

 

 

 

Anxiety and mood disorders are amongst the most commonly diagnosed mental health conditions in the United States. While many find successful treatment through various psychotherapies or medications targeted at managing anxiety and depression, no medication will magically take away all anxiety or life stressors and it is not uncommon to experience breakthrough anxiety or symptoms of depression even while under the care of mental health professionals.  In today’s hectic world it can be challenging to juggle daily responsibilities and find ways and time to take a step back and practice mindfulness or focus on self-care. This article explores different mindfulness activities and alternative therapies, some of the benefits they illustrate, and how to include them in our day-to-day routines.

Meditation: Meditation has been practiced for thousands of years and is considered one of the oldest spiritual practices in ancient India and China. While it can be challenging to find an agreed upon definition for meditation, in general it is agreed upon that meditation is a practice and form of mental training with the goal of calming the mind (Wang et al., 2022). Meditation can look different to different people and can be practiced in as little as a few minutes every day.

Yoga: Yoga is an ancient spiritual practice with roots in Indian culture and is an alternative therapy often combined with meditation that focuses on breathwork and the adoption of physical postures.  There are multiple style of yoga that differ in intensity and length of time, but multiple individual studies and systematic reviews have concluded that yoga can benefit those struggling with depression with symptom reduction seen with 60-minute sessions per week (Saeed et al., 2019).

Exercise: There are numerous studies and clinical trials showing the benefits of exercise related to mental health, particularly for those who struggle with anxiety and depression. A meta-review examining the relationship between anxiety disorders and physical activity (especially aerobic and resistance exercises) with over 69,000 participants showed that on average participants reported significantly reduced anxiety over a 3-year period when engaging in physical activity on a regular basis. Analysis examining sedentary behavior showed an increased risk of depression over time compared to those who engaged in more physical lifestyle activities (Firth et al., 2020). While there can be limitations in studies related to exercise types, additional therapies, and other variables there is one thing that remains consistent: no trials have shown that physical activity worsens anxiety or depression (Saeed et al., 2019).

While mindfulness activities and alternative therapies sound great on paper, they can be challenging to practice regularly. Below are some tips for squeezing in mindfulness activities into a hectic schedule:

  • Utilizing meditation apps. Most popular meditation apps (Calm, Headspace, Healthy Minds Program) have lengthy daily meditations, but they also include quick 1-3 minute meditations/deep breathing exercises that can easily be practiced before going to bed, before starting the work day, or to take a time out when feeling overwhelmed
  • Find exercise you enjoy doing. Motivation to exercise can be challenging enough, but when it is for an activity you don’t even enjoy this can be even more challenging. Find an activity or sport that you actually enjoy or look forward to doing and this will help with consistency, especially if you are able to engage in the activity with friends or family and turn it into a social or group event
  • Make slow, incremental changes to routine. It’s not uncommon to make a self-care plan including things like exercising daily, meditating daily, and making dietary changes. When we try to make multiple changes like this overnight it is easy to get discouraged if we miss a day and sometimes, we don’t even get back to it. Focusing on one change at a time and incorporating it into your routine more slowly helps with habit changing
  • In short, set yourself up for success with the four laws of behavior change. 1) make it obvious – if you want to go to the gym after work every day pack your bag the night before, 2) make it attractive – get yourself a new pair of shoes or a new workout outfit, 3) make it easy – start with a few minutes per day, and 4) make it satisfying – set up incentives to motivate yourself and keep it going (Clear, 2022)

Sources:

Clear, J. (2022). Atomic habits: An easy & proven way to build Good Habits & Break Bad Ones: Tiny Changes, remarkable results. Cornerstone Press.

Firth, J., Solmi, M., Wootton, R.E., Vancampfort, D., Schuch, F.B., Hoare, E., Gilbody, S., Torous, J., Teasdale, S.B., Jackson, S.E., Smith, L., Eaton, M., Jacka, F.N., Veronese, N., Marx, W., Ashdown-Franks, G., Siskind, D., Sarris, J., Rosenbaum, S., Carvalho, A.F. and Stubbs, B. (2020), A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry, 19: 360-380. https://doi.org/10.1002/wps.20773

Saeed SA, Cunningham K, Bloch RM. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 2019 May 15;99(10):620-627. PMID: 31083878.

Wang, Zanyi1,; Rawat, Vikas1; Yu, Xinli2; Panda, Ramesh Chandra3. Meditation and its practice in Vedic scriptures and early Taoism scriptures. Yoga Mimamsa 54(1):p 41-46, Jan–Jun 2022. | DOI: 10.4103/ym.ym_48_22 (https://journals.lww.com/yomi/fulltext/2022/54010/Meditation_and_its_practice_in_Vedic_scriptures.8.aspx)

By: Elisabeth Renner LPCC-S, Lindner Center of HOPE Outpatient Therapist

 

 

 

In the journey of mental health and personal growth, two concepts stand out as essential: authenticity and vulnerability. These are not just buzzwords; they represent profound paths to healing and self-discovery. Drawing insights from the writings of physician and author Gabor Maté, let’s delve into the transformative power of authenticity and vulnerability.

Authenticity is the courage to be true to oneself, to honor one’s feelings, thoughts, and experiences without pretense. Authenticity begins with self-awareness and acceptance. It requires a deep dive into our inner world, acknowledging our strengths, weaknesses, fears, and desires. Authenticity invites us to embrace our imperfections and vulnerabilities, recognizing them as integral parts of our humanity.

 

Vulnerability is often misconstrued as weakness, when in fact, it is a profound strength. It is the willingness to expose our true selves, to open up and genuinely connect with others. Gabor Maté asserts that vulnerability is the gateway to intimacy and healing. When we allow ourselves to be vulnerable, we invite empathy, understanding, and support into our lives. It is through vulnerability that we break down walls of isolation and shame, forging authentic connections with others.

In our society, authenticity and vulnerability are often suppressed by societal norms and expectations. We are conditioned to wear masks, to hide our true selves. True liberation comes from shedding these masks, from embracing our authenticity and vulnerability unabashedly.

Practicing authenticity and vulnerability requires courage and resilience. It means stepping into discomfort, confronting our inner demons, and facing the judgment of others. Maté illuminates, it is only through embracing our shadows that we can bask in the light of self-acceptance and inner peace.

How can we cultivate authenticity and vulnerability in our lives? It begins with self-reflection and introspection. Take time to explore your inner landscape, to identify your values, passions, and fears. Embrace your vulnerabilities as valuable aspects of your humanity, rather than weaknesses to be hidden. Practice self-compassion, treating yourself with kindness and understanding as you navigate the ups and downs of life. Cultivate authentic connections with others by sharing your truth openly and honestly. Engage in deep, meaningful conversations that go beyond surface-level interactions. Create spaces where vulnerability is welcomed and celebrated, where individuals can show up as their authentic selves without fear of judgment.

In conclusion, authenticity and vulnerability are not just ideals to strive for; they are essential ingredients for mental and emotional well-being. The path to healing and self-discovery begins with embracing our authenticity and vulnerability wholeheartedly. Dare to be authentic, to be vulnerable, and to embark on a journey of self-discovery and growth with courage and grace

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

Elisha Eveleigh Clipson, Ph.D.
Child Psychologist, Lindner Center of HOPE
Assistant Professor – Clinical, University of Cincinnati College of Medicine
Department of Psychiatry and Behavioral Neuroscience

 

 

Parents bring their children for psychological testing to answer the same question: How do I best help my child navigate through life? Increased autism awareness has led to a greater sense of identity and connectedness among many members of the autism community. There have been opportunities to highlight the strengths of individuals with autism spectrum disorder (ASD) and their families. With increased autism awareness, more parents notice symptoms and wonder if the diagnosis applies to their child.

I spend much of my professional time determining whether a child meets the criteria for autism. Part of the process is ruling out other explanations, and possibly ruling out autism. Sometimes families are upset when their child does not meet the criteria for autism.

Recently, a teen without ASD symptoms reported she was upset I did not “give her the diagnosis of autism” because she knew she had it. I deeply wanted this teen to better understand her experience, but she was not sufficiently trained to provide an accurate diagnosis.

Psychologists aim for accurate diagnosis. This informs the answer to the question of how to best help a child navigate through life. It is worth educating parents on what other issues have overlapping symptoms with autism.

When it is Autism

Individuals with ASD have differences in social communication and social interaction. Part two of the diagnosis has to do with restricted, repetitive patterns of behavior, interests, or activities.

On the communication side, we see significant difficulty in the following areas:

  1. Social-emotional reciprocity.
    1. This may include trouble with back-and-forth conversations or failure to initiate or respond to social interactions.
  2. Nonverbal communication used for social interaction.
    1. For example, trouble understanding or using nonverbal gestures, lack of facial expressions or avoiding eye contact.
  3. Developing, maintaining, and understanding relationships.
    1. For instance, trouble sharing in imaginative play, making friends or a seeming absence of interest in peers.

Restricted, repetitive patterns of behavior might include:

  1. Repetitive motor movements or speech. Classic examples include repetitive phrases and unusually repetitive lining up of toys.
  2. Some children with autism have inflexible routines, unusual greeting rituals, or distress with small changes.
  3. The experience of abnormally restricted, fixated interests or preoccupations may be present.
  4. Many children with autism have differences in sensitivity to sensory input. This may include indifference to pain, excessive smelling of objects or visual fascination with the movement of an object.

 

What else could it be?

Social (Pragmatic) Communication Disorder

This involves persistent trouble with the social use of verbal and nonverbal communication. Symptoms include difficulty with:

  • Greeting others and sharing information.
  • Changing communication to match the context, e.g. communicating differently with a teacher than a peer.
  • Knowing how to use nonverbal signals to regulate social interactions.

Attention Deficit/Hyperactivity Disorder

  • Children with ADHD experience more sensory processing issues than other children. They may be more sensitive to sounds or smell.
  • They may have difficulty taking turns or picking up on social cues.
  • May become distracted and disengage in the middle of a conversation.
  • Some children with ADHD can become, “hyper-focused” on an interesting task.

Anxiety Disorders and OCD

  • Individuals with anxiety disorders may avoid social situations.
  • Anxiety can make a person feel less comfortable with eye contact.
  • Some children refuse to talk outside of the home.
  • Rigid patterns of behavior and thinking are possible.

Sensory processing difficulty

Individuals with a range of developmental and psychological experiences have sensory processing difficulty. This is more commonly experienced with mood disorders, anxiety or ADHD. It is also more prevalent in children with Intellectual Disability or Global Developmental Delay.

Behavioral concerns

  • Not all children with autism have behavior problems. In fact, many do not.
  • Children with behavioral concerns may have trouble understanding and regulating their emotions.
  • Some children with speech and communication delays exhibit behavior problems when unable to express themselves.

Depression

  • The range of facial expression or tone of voice may be more neutral.
  • A person may become socially withdrawn.

“Overcontrolled” personal traits

Some of my colleagues at LCOH provide Radically Open DBT. This is for people who experience a spectrum of problems that result in being “overcontrolled.”

  • May exhibit less emotional expression, saying, “I’m fine” when they are not.
  • Show a limited range of facial expressions.
  • Their lives may be rigid, and rule governed.
  • May seem aloof or distant in relationships. For instance, they might avoid sharing personal information.

 

Having Autism does not exclude a person from also experiencing the conditions described above. Yet, meeting the criteria for one or more of these conditions does not mean a person has autism. Providing an accurate diagnosis honors the experience of people with ASD and other conditions. It empowers families to best support their children throughout the lifespan.

Kaila Busken, Lindner Center of HOPE, Licensed Independent Social Worker

One moment you are bursting at the seams with overwhelming joy. Every fiber of your being is filled with love for this tiny human being in your arms. Looking in your baby’s eyes, you feel like you have found your life’s purpose. And still, motherhood is really hard. New motherhood is sitting in the messy middle of seemingly opposite feelings. You can feel a mixed bag of emotions: sad and happy, overwhelmed, and peaceful, grief and joy, lost and found.

The transition to motherhood and its ambivalence has its own name: matrescence (pronounced like adolescence). The term was first developed by medical anthropologist Dana Raphael in 1973. This term is used to describe the bio-psycho-social- spiritual change that occurs when a woman makes the transition to motherhood. Like in adolescence, matrescence is a physical, hormonal, and emotional change all happening at the same time. Matrescence recognizes the large shift in identity that occurs when a woman becomes a mother and helps to normalize what it feels like to be in the middle of a whirlwind of emotions. Motherhood is a magical metamorphosis, because once you have a baby, nothing will ever be the same. And that is both beautiful and sad.

Around 15-20% of women who birth a child will experience postpartum mood disorders such as depression and anxiety. But matrescence is a normal part of motherhood and it is normal to feel ambivalence in this season of life.

Here are some helpful tips for coping in this new season of life:

1. Let go of expectations.
From the time a woman decides she is going to have children she hears an influx of information about what it means to be a mom and how to care for her baby. One of the biggest things a mom may hear is “you don’t have time for yourself anymore.” An important thing to remember is that you are a person worth caring for. You deserve to eat. You deserve a hot shower. You deserve to hydrate yourself. And you deserve love. You may even have a “Pinterest” perfect image in your head of what motherhood would be like. You may have pictured a blissful bubble in which you only feel complete happiness, but it is important to allow yourself to embrace the messiness and imperfection that is motherhood.

2.  Build your support system.
Just as a baby was born, you as a mother were born too. It is okay to ask for help and it is important to find a group of people who will help care for you. Look for people who will help support you emotionally while you adapt to your new role. Also look for people who will provide practical support like doing that pile of dirty dishes in your sink or the endless pile of laundry that babies create. Babies are tiny but they certainly require a village.

3.  Practice self-compassion.
Being a new mother is difficult. Suddenly this new little life is depending on you day and night and it can be exhausting.  It can be easy in this new vulnerable state to be harsh and self-critical. During this time, it is especially important to practice self-compassion and remind ourselves of our own worth. It can be easy to believe that you are a “bad” mother and that you are not providing what your baby needs. An important self-compassionate reminder is that “you are the best mother for your baby”. The goal is not for you to be a perfect mother but rather to be a “good enough” mother and embrace all the imperfection that comes with raising a baby. Perfection in motherhood is not possible and practicing self-compassion can help in remaining resilient in the face of this new role.

4.  Embrace the ambivalence.
Motherhood is embracing so much of the messy middle between seemingly opposing emotions. It can be uncomfortable to be in this place, where you want to spend every moment with your precious newborn and to crave the independence and space you had prior to having a baby. Motherhood is about the “both/and”, knowing that good and bad can exist in the same place. It is possible for you to embrace them both at the same time. You can love your baby with every fiber of your being and miss a time when you were able to sleep through the night or drink a hot cup of coffee.

5.  Allow yourself to grieve.
It is okay to grieve in this new phase of life. We tend to believe that grief is only reserved for death, but we can grieve many things in this new phase of motherhood. You may grieve your old life, previous relationship dynamics, your body and how it may have worked before, your time, your envisioned birth plan, your envisioned feeding plan, or your expectation of what you thought motherhood would be like. Allowing yourself to feel the sadness in some of these losses will help you to move on and embrace your new role as a mother.

BY: Anna Guerdjikova, PhD, LISW, CCRC, Lindner Center of HOPE, Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program University of Cincinnati, Department of Psychiatry, Research Assistant Professor

 

An estimated 45 million Americans diet each year and spend $33 billion annually on weight loss products. WebMD lists over 100 different diets, starting with the African Mango diet, moving on to the South Beach and Mediterranean diets and ending up with the Zone. Most diets, regardless of their particular nature, result in short-term weight loss that is not sustainable. Weight cycling or recurrent weight loss through dieting and subsequent weight gain (yo-yo effect) can be harmful for mental and physical health for both healthy weight and overweight individuals. Furthermore, weight fluctuations have been related to increased risk of development of cardiovascular disease, Type 2 diabetes, and high blood pressure.

What is Dieting

The word “diet” originates from the Greek word “diaita”, literally meaning “manner of living”. In the contemporary language, dieting is synonymous with a quick fix solution for an overwhelming obesity epidemic. Dieting implies restriction, limitation of pleasurable foods and drinks, and despite of having no benefits, the omnipresent dieting mentality remains to be the norm.

Most diets fail most of the time. Repeated diet failure is a negative predictor for successful long term weight loss. Chronic dieters consistently report guilt and self-blame, irritability, anxiety and depression, difficulty concentrating and fatigue. Their self-esteem is decreased by continuous feelings of failure related to “messing my diet up again”, leading to feelings of lack of control over one’s food choices and further … life in general. Dieting can be particularly problematic in adolescents and it remains a major precursor to disordered eating, with moderate dieters being five times more likely to develop an eating disorder than those who do not diet at all.

Diets imply restriction. Psychologically, dietary restraint can lead to greater reactivity to food cues, increased cravings and disinhibition, and overeating and binge eating. Biologically, dieting can lead to unhealthy changes in body composition, hormonal changes, reduced bone density, menstrual disturbances, and lower resting energy expenditure.

The Potential Harmful Effects of Dieting

Aggressive dieting lowers the base metabolic rate, meaning one burns less energy when resting, resulting in significantly lower daily needs in order to sustain achieved weight after the diet is over. Returning to normalized eating habits at this lower base metabolic rate results in commonly seen post dieting weight gain. Biologically, dieting is perceived as harmful and physiology readjusts trying to get back to initial weight even after years since the initial rapid weight loss. Recent data examining 14 participants in the “Biggest Loser” contest showed they lost on average 128 pounds and their baseline resting metabolic rates dropped from 2,607 +/-649 kilocalories/ day to 1,996 +/- 358 kcal/day at the end of the 30 weeks contest. Those that lost the most weight saw the biggest drops in their metabolic rate. Six years after the show, only one of the 14 contestants weighed less than they did after the competition; five contestants regained almost all of or more than the weight they lost, but despite the weight gain, their metabolic rates stayed low, with a mean of 1,903 +/- 466 kcal/day. Proportional to their individual weights the contestants were burning a mean of ~500 fewer kilocalories a day than would be expected of people their sizes leading to steady weight gain over the years. Metabolic adaptation related to rapid weight loss thus persisted over time suggesting a proportional, but incomplete, response to contemporaneous efforts to reduce body weight from its defined “set point”.

Dieting emphasizes food as “good” or “bad”, as a reward or punishment, and increases food obsessions. It does not teach healthy eating habits and rarely focuses on the nutritional value of foods and the benefit of regulated eating. Unsatisfied hunger increases mood swings and risk of overeating. Restricting food, despite drinking enough fluids, can leads to dehydration and further complications, like constipation. Dieting and chronic hunger tend to exacerbate dysfunctional behaviors like smoking cigarettes or drinking alcohol.

Complex entities like health and wellness cannot be reduced to the one isolated number of what we weigh or to what body mass index (BMI) is. Purpose and worth cannot be measured in weight. Dieting mentality tempts us into “If I am thin- I will be happy” or “If I am not thin-I am a failure” way of thinking but only provides a short term fictitious solution with long term harmful physical and mental consequences. Focusing on sustainable long term strategies for implementing regulated eating habits with a variety of food choices without unnecessary restrictions will make a comprehensive diet and maintaining healthy weight a true part of our “manner of living”.

 

Reference: Obesity (Silver Spring). 2016 May ;Persistent metabolic adaptation 6 years after “The Biggest Loser” competition.; Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD.

 

 

 

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-Dr. Stephen Porges

Heather Melena, APRN, PMHNP-BC,

Psychiatric Nurse Practitioner, Lindner Center of HOPE

 

 

 

 

 

Living with a chronic illness can be difficult to manage not only physically but also emotionally and mentally as well. The challenges that can come with chronic illness include learning to cope with the symptoms of that diagnosis, figuring out ways to alleviate your symptoms, doctor’s appointments and strain to financial responsibilities and interpersonal relationships. On top of trying to figure out new ways to handle everything that comes with chronic illness, the emotional and mental strain can feel overwhelming and paralyzing.  Psychological distress has been shown to increase with chronic disease and its accompanying treatment protocols as well as the many other areas affected in one’s life. It has also been well documented that continued stress and/or distress can lead to poor health outcomes and mental illness (Sheth et al, 2023). Thus, finding ways to find acceptance, cope with the feelings of powerlessness, and learning to live within the limitations caused by one’s chronic illness is imperative to finding relief from the mental and emotional turmoil brought on by physiological changes of illness.

Seeking help from a mental health provider (with or without the use of medications), engaging in individual and group therapy, attending support groups are all ways to tackle the mental and emotional aspects of chronic illness. Studies have shown that engaging in acceptance and commitment therapy as well as learning mindfulness techniques can reduce pain intensity, depression, and anxiety with increased self-management and physical wellbeing for those living with chronic health conditions (Wallace-Boyd et al, 2023). Learning strategies such as active coping skills, planning, positive reframing, and emotional support will all be of value to learning to live with the changes experienced by persistent illness. In practice, discussion is had about learning how to live within these new limitations, being patient and kind to oneself, setting realistic expectations, and acknowledging that the way you feel physically may change from day to day- which can be extremely beneficial for someone experiencing chronic illness. Powerlessness is a tough emotional and mental barrier when struggling day to day, where much uncertainty feels uncomfortable. By practicing acceptance and self-love, we can learn to live in the present and move away from dwelling on what our bodies were once capable of or fearing what the future may hold.

The American Psychological Association (2023) defines self-efficacy as an individual’s belief in his or her capacity to engage in behaviors to achieve personal goals. This is reflected in the confidence one has to exert control over their own motivation, behavior, and social environment. Studies have shown that greater self-efficacy can increase one’s control (or belief of) over health outcomes (Sheth et al, 2023).  By learning more positive coping mechanisms and increasing self-efficacy, one can gain confidence in their ability to self-manage their illness and improve their quality of life.

While it may be a difficult task, especially for those that struggle with chronic health problems, engaging in physical activity three to five days a week can be extremely beneficial. There has been endless research on the benefits of physical activity including higher quality of life, lower mortality, reduction of pain, and improved mental health. It has been shown that physical activity can positively impact the overall relationship between inflammation and mental health symptoms, thus reducing inflammation will likely improve depression and anxiety symptoms (Sheth et al, 2023). Physical activity can also improve energy, mental clarity, cognitive ability, and reduce stress and anxiety. It has been shown to improve mood, sleep, and circulation (Sheth et al, 2023).. With that being said, be patient with yourself and listen to your body- if physical activity isn’t what your body needs- rest or try low-intensity activities such as yoga or swimming.

Self-care is something we hear about all the time now- but what does that look like in practice? Self-care is the action or behaviors we incorporate into our daily lives that help not only our physical health but overall mental wellness. Incorporating self-care into our daily lives will not only improve our mood, reduce the toll stress can have on our bodies (ie inflammation, fatigue, sadness), but improve our outlook on the constantly changing physical symptoms of chronic illness. Self-care should be personalized to your needs. In practice we often discuss what someone’s “life worth living” looks like and how to achieve this. Incorporating daily self-care is a step towards learning to live within the new limitation set by illness and reframing our thought processes to think more positively which will enable us to continue moving forward despite our body’s shortcomings. Self-care includes:

  • Seeking out professional help: Whether a therapist, mental health provider, nutritionist, personal trainer- all of which can help you navigate treating the many facets of chronic illness, including depression, anxiety, and stress.
  • Finding support: Joining a group of people or talking with others who suffer with similar conditions can be cathartic, oftentimes lowering distress levels, and offering ways to coping with the diagnosis.
  • Stress Reduction: Identifying sources of stress, finding ways to cut stress out of your life, and ways to better manage stress.
  • Physical activity
  • Eating well:  looking for ways to add foods to your diet that will be beneficial in reducing inflammation, improving immune function, and overall wellbeing. Learning moderation in the foods we eat rather than trying “crash” diets. When we eat foods aimed at healing our bodies, we find that our mood and mental health can improve.
  • Sleep: Adequate and restorative sleep is so important for everyone. Our bodies are in a reparative phase while sleeping- which is needed to heal! Try incorporating good sleep hygiene practices including going to bed around the same time each night, avoiding screens prior to sleep, meditation before bed.
  • Hobbies: Find things that make you feel fulfilled, and make you feel joy/bring joy to your life- whether they are the same hobbies or activities prior to your diagnosis- it is important to do things that make you feel good!

(Mended Hearts, 2023)

References

American Psychological Association (2023). Teaching tip sheet: Self-efficacy. https://www.apa.org/pi/aids/resources/education/self-efficacy

Ciotti, S. (2023). “I Get It, I’m Sick Too”: An Autoethnographic Study of One Researcher/Practitioner/Patient With Chronic Illness. Qualitative Health Research33(14), 1305–1321. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1177/10497323231201027

MedlinePlus (2022). Living with a chronic illness- dealing with feelings. National Library of Medicine. https://medlineplus.gov/copingwithchronicillness.html

MendedHearts(2023). Chronic illness and mental health blog. https://mendedhearts.org/chronic-illness-and-mental-health-9-tips-for-self-care/

Sheth, M. S., Castle, D. J., Wang, W., Lee, A., Jenkins, Z. M., & Hawke, L. D. (2023). Changes to coping and its relationship to improved wellbeing in the optimal health program for chronic disease. SSM Mental Health3. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1016/j.ssmmh.2023.100190

Wallace-Boyd, K., Boggiss, A. L., Ellett, S., Booth, R., Slykerman, R., & Serlachius, A. S. (2023). ACT2COPE: A pilot randomised trial of a brief online acceptance and commitment therapy intervention for people living with chronic health conditions during the COVID-19 pandemic. Cogent Psychology10(1). https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1080/23311908.2023.2208916

By Danielle Beltz, MSN, PMHNP-BC, Psychiatric Nurse Practitioner, Lindner Center of HOPE

Pregnancy and childbirth can be one of the most rewarding and fulfilling things a woman can do in her
lifetime but can hand in hand be one of most challenging and emotionally taxing times.
A female goes through not only physical changes throughout pregnancy but also hormonal, emotional,
and psychological changes. In addition, a pregnancy can bring stress and emotional hardship to their
interpersonal dynamics.

A lot of new moms experience postpartum “baby blues” after giving birth which differentiates from
postpartum depression. Symptoms usually include sadness, irritability, moodiness, crying spells, and
decreased concentration. Baby blues usually begin within 2 to 35 days after childbirth and can persist up
to 2 weeks. When these symptoms last longer than 2 weeks this is when the mother should consider talking
to a healthcare provider.

About one in seven women develop postpartum depression. It most commonly occurs 6 weeks after delivery but can begin prior to
delivery as well. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) a major depressive episode with the onset
of pregnancy or within 4 weeks of delivery is considered postpartum depression. Five of the nine symptoms must be present nearly every
day for at least two weeks and constitute a change from previous functioning to be diagnosed. Depression or loss of interest in addition
to the following symptoms must be present:

• Depressed mood (subjective or observed) most of the day
• Diminished interest or pleasure in all or most activities
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Feelings of worthlessness or guilt
• Loss of energy or fatigue
• Recurrent suicidal ideation, thoughts of death or attempts
• Diminished concentration or indecisiveness
• Change in weight or appetite (5% weight change over 1 month)

Fifty percent of postpartum major depressive episodes begin before
delivery so collectively these episodes are described as peripartum
episodes. Mothers with peripartum major depressive episodes commonly have severe anxiety and panic attacks.

The exact etiology of postpartum depression is unknown. Several factors have been reported to contribute to the development of
postpartum depression. The physical and hormonal fluctuations resulting from pregnancy influence postpartum women to develop
depression when stressful and emotional events coincide with childbirth. Some of these factors include the stress of motherhood, difficult
labor, poor financial and family support, and harmful health outcomes of childbirth. Lower socioeconomic demographic, personal or
family history of depression, anxiety, or postpartum depression, PMDD, complications in pregnancy and birth, and mothers who have
gone through infertility treatments have also all been suggested to be strong contributors.

Postpartum depression not only affects the mother’s health but also the relationship the mother has with her infant and that child’s
development. Studies have shown that children are at a greater probability of developing behavioral, cognitive, and interpersonal problems
whose mothers have postpartum depression. It can also lead to inability to breastfeed and marital conflict.

Postpartum psychosis is another severe kind of depression but is not the same thing as postpartum depression. Around 1 in 500 or 1 in
1,000 women has postpartum psychosis after delivering a baby. It commonly starts the first 2 weeks after giving birth. Women who are
also diagnosed with bipolar disorder or schizoaffective disorder are more prone to have postpartum psychosis than women who are not
diagnosed with other mental health conditions.

Postpartum psychosis is considered a psychiatric emergency with a capacity of suicide and infanticidal threat. Some symptoms include
delusions, hallucinations, unusual behavior, paranoia, and sleep disturbances. If postpartum psychosis is suspected help should be sought
immediately.

Psychotherapy and antidepressant medications are the first line treatments for postpartum depression. Psychotherapy is considered first
line for women with mild to moderate depression or if they have concerns of starting a medication while breastfeeding. For moderate to
severe depression therapy and antidepressant medications are recommended. The most common medication for postpartum depression is
an SSRI or selective serotonin reuptake inhibitor. Once an efficacious dose is reached, treatment should persist for 6-12 months to prevent
relapse of symptoms. Risk versus benefits of treated versus untreated depression while breastfeeding or pregnant should be discussed.
Transcranial Magnetic Stimulation (TMS) is an alternate therapy that can be used for women who have concerns about their child being
exposed to a medication. Although, the risk of taking an SSRI while breastfeeding is relatively low. ECT is another option for women with
severe postpartum depression who do not respond to traditional treatment. It can be particularly helpful with psychotic depression.

Zurzuvae (zuranolone) is the first oral medication approved by the FDA specifically for the treatment of postpartum depression in adults.
Until August 2023, treatment for PPD was only available as an IV (Brexanolone) and was only available at certified healthcare facilities.

People with depression especially new mothers and postpartum mothers may not identify or accept that they’re depressed. They also
may be unaware of the signs and symptoms of depression. If you are questioning whether a friend or family member has postpartum
depression or is developing signs of postpartum psychosis, assist them in pursuing medical treatment and recognize that help is accessible.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Commissioner, O. of the. (n.d.). FDA approves first oral treatment for postpartum depression. U.S. Food and Drug Administration. https://www.fda.
gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression#:~:text=Today%2C%20the%20U.S.%20Food%20
and,the%20later%20stages%20of%20pregnancy
Guo, L. , Zhang, J. , Mu, L. & Ye, Z. (2020). Preventing Postpartum Depression With Mindful Self-Compassion Intervention. The Journal of Nervous and
Mental Disease, 208 (2), 101-107. doi: 10.1097/NMD.0000000000001096.
Mayo Foundation for Medical Education and Research. (2023, April 14). “I’m happy to be a new mom. but why am I feeling
so sad?” Mayo Clinic. https://mcpress.mayoclinic.org/mental-health/im-happy-to-be-a-new-mom-but-why-am-i-feeling-sosad/?
mc_id=global&utm_source=webpage&utm_medium=l&utm_content=epsmentalhealth&utm_
campaign=mayoclinic&geo=global&placementsite=enterprise&invsrc=other&cauid=177193
Miller, L. J. (2002). Postpartum depression. JAMA : The Journal of the American Medical Association, 287(6), 762-765. https://doi.org/10.1001/jama.287.6.762
Mughal S, Azhar Y, Siddiqui W. Postpartum Depression. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519070/
Postpartum depression. March of Dimes. (n.d.). https://www.marchofdimes.org/find-support/topics/postpartum/postpartum-depression?gad_
source=1&gclid=EAIaIQobChMIqKLemfTfggMVq0VyCh3ouwGDEAAYBCAAEgKxjPD_BwE
Silverman, M. E., Reichenberg, A., Savitz, D. A., Cnattingius, S., Lichtenstein, P., Hultman, C. M., Larsson, H., & Sandin, S. (2017). The risk factors for postpartum
depression: A population-based study. Depression and Anxiety, 34(2), 178–187. https://doi-org.uc.idm.oclc.org/10.1002/da.22597
Stewart, D. E., & Vigod, S. (2016). Postpartum depression. The New England Journal of Medicine, 375(22), 2177-2186. https://doi.org/10.1056/NEJMcp1607649

 

by Dawn Anderson, LPCCS

Humans are a very resilient species. We have overcome generations of burdens to accomplish family unity, and yet this effort renews with new barriers and challenges each year. A vital component of a thriving family unit is the ability to co-regulate. Co-regulation describes the process in which a parent can identify their child’s need for help, recognize their own emotional reaction, and then help themselves cope to share that gift with their child.

Just like the airplane metaphor- you must put on your own oxygen mask before you can help others. As a parent, we are bombarded with requests for our time, resources, and attention. We have a certain amount of emotional energy in the day, and this is a renewable resource! Taking the time to take care of your own emotional health allows you to be more responsive in the ways we’d like to show up with our children. Another huge burden on parents is the one we place there ourselves- guilt. We fret about the choices to be made, the amount we’re able to give our children, and the perpetual feeling we aren’t enough. The reality is we all bring different types and amounts of skills and talents to the table.

Some of us have different capacities for stress, and that doesn’t make us good or bad. Sometimes it’s helpful to think of your stress tolerance as a cup- is yours a 12 oz picnic cup? A 2 oz bathroom water cup? An Olympic swimming pool? Whatever the size, we must take ownership of knowing where we are throughout the day, and how we are showing up in interactions with our children. We also need to be intentional about emptying said cup proactively throughout the day, so it doesn’t overflow. Overflow here is where we see the unintentional screaming at our precious ones, storming off, or being unable to play with them after our long day.

Lastly in explanation, its valuable to consider the way language impacts our thoughts, feelings, and behavior. In common language, we say things about children such as “they’re a mess,” “they’re not listening to me,” “they’re being a brat.” In all humans, we have a system in our brain that takes in information and decides if it’s safe or not, and then sends it to either the thinking part or the survival part of our brain. What our brains decide as safe depends on the person. Some of us have different themes that activate the threat systems in our own bodies, and with careful observation, you might be able to pin these down for your loved ones. If this feels difficult, a licensed clinical therapist can help.

Once the “threat center” of your brain decides something isn’t safe, we have survival reactions: our heart rate picks up, heavy breathing, we feel shaky, and/or we have a hard time thinking clearly due to the process where your brain diverts power from the thinking brain to the survival brain. That said, that’s part of why it’s hard to talk to someone who doesn’t feel safe. It’s hard for them to hear you, and hard for them to express how they feel in words. If we use compassionate language, it removes blame from the driver seat. Try “they look like they need help” or “they are having some big feelings” You and your child are a team, and teams are stronger when they work from the operating point that we win when we work together with our strengths.

That said, here are some helpful tips to regulate with your child:

  1. When you identify that your child needs help, first check in with yourself on what you need to be best able to respond to them. Its valuable to practice the breathing skills when you don’t need them, so you can use them in the moment when you do. Trying to only use them in a moment of crisis is like expecting yourself to learn to swim in the choppy ocean.
  2. Get on their level. Kneel, squat, or sit down if necessary. Looking up at someone activates the “threat” center of our brain and makes it harder to calm down.
  3. Use a low, consistent tone. If I want someone to hear me, I need to be quieter, not louder. Especially if they are yelling. Keep your messages concise and direct, such as “I want to hear you, and it’s easier when you’re at a level 2” or “Let’s take a deep breath together then we can put your toy back together.”
  4. Take a full, deep breath in your nose and exhale slowly out your mouth. Imagine feeling like you’re smelling something super pleasant and trying to cool off hot cocoa with the exhale. Even if they are not in the place to participate because they’re too dysregulated, their body will unconsciously mirror yours.
  5. If you’re not able to offer your child 1:1 proximity, or their bodies are not safe for you (i.e. hitting) consider regulating in the room by counting items together. Redirection is a powerful tool for the right moment. Again, a licensed therapist can help you catch these windows of opportunity.
  6. If appropriate, leave the room and regulate yourself before returning. Use your words to announce the intention “I need two minutes to regulate myself and I will be back to work on this with you.” Stepping away from the situation is a tool that can give teenage parents the break we need to not ground our child for the next 100 years when we’re both stuck in an argument.
  7. With any strategy, it’s important to come back together and process Use the compliment sandwich: Identify one thing that went well, offer constructive feedback, and close with another positive thing you noticed or future oriented reconnection point. “I’m proud of you for breathing with me. Next time, do you think it would help if we used the feelings chart? I’m glad I have you.”