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Category: Mental Health

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By Kelly M. Heitkamp, LISW-S

 

As someone who sits on both sides of the therapy couch – borrowing that perfect phrase from my colleague Dr. Laurie Bruce’s enlightening podcast “From Both Sides of the Couch” I’ve developed a unique perspective on depression treatment. Let me share what I’m seeing in the field today, both as a clinical social worker and as someone who’s personally navigated the winding path of mental health care. Let me share what I’m seeing in the field today, both as a clinical social worker and as someone who’s personally navigated the winding path of mental health care.

The Tried and True (But Sometimes Not Enough)

Cognitive Behavioral Therapy (CBT) remains one of the most effective approaches for treating depression. This structured therapy helps identify and change thought patterns that contribute to depressive symptoms. Along with other evidence-based approaches like Interpersonal Therapy and Mindfulness-based techniques.

Then there’s medication – those SSRIs and SNRIs that many people have complicated relationships with. Many find life-changing relief, while others struggle with side effects or minimal benefits. When therapy and standard medications work, they really work. But let’s be honest – for about a third of people with depression, these approaches aren’t enough, which is why I’m so excited about what’s emerging.

New Kids on the Treatment Block

Ketamine therapy has gained significant attention. Many patients report experiencing relief within hours rather than the weeks or months typical medications require. The treatment seems to work by creating new neural pathways, helping the brain “reset” established patterns associated with depression.

Right here in our region, the Lindner Center of Hope offers innovative ketamine treatment options. Patients undergo thorough evaluations before treatment helping you and your provider decide if the treatment is right for you. When you are receiving treatment the Center’s medical team carefully monitors each session.

Another exciting treatment offered at the LCOH is Transcranial Magnetic Stimulation (TMS). This non-invasive procedure uses magnetic fields to stimulate nerve cells in the brain and has shown promising results for those who haven’t responded to traditional treatments.

Tech Meets Therapy

The digital mental health space is also exploding. As someone who was initially skeptical about app-based therapy (can an app really replace human connection?), I’ve been surprised by the research showing legitimate benefits from some digital interventions. These tools can be particularly helpful for people who live in areas with therapist shortages or who cannot afford traditional therapy.

Evidence-based apps can serve as supplements to therapy – kind of like “homework” between sessions. They are not replacements for human connection, but they can be valuable additions to your treatment.

What This Means for You (or Someone You Care About)

If you’re struggling with depression, or supporting someone who is, know that the treatment landscape is more promising than ever. The stigma is slowly lifting, and our understanding of what works is expanding rapidly.

What I’ve learned both personally and professionally is that depression treatment isn’t one-size-fits-all. Sometimes it takes trying different approaches or combinations before finding what works. And that’s okay.

The most important thing is to keep going. Whether it’s traditional therapy, medication, newer treatments like ketamine, or some combination that ultimately helps – there are more pathways to healing than ever before.

And as someone who’s been on both sides of this journey, I can tell you that finding your way through is absolutely worth it – even when the path isn’t straightforward.

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By Kelly Heitkamp, LISW-S 

 

 

 

 

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

What Is Anxiety?

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

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

Why Does Anxiety Happen?

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

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

What Can Help? 

  1. Cognitive Behavioral Therapy (CBT)

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

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

How Professionals Can Help

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

What Can You Do?

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

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

A Hopeful Future

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

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

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By Megan Schrantz, Ed.D., LPCC
Lindner Center of Hope Outpatient and Residential Therapist

Many children and adolescents undergo difficult life experiences during their growing up years. Children may encounter a variety of events that are stressful to varying degrees, such as the divorce or separation of parents or the death of a beloved relative or friend. Many of these events would be considered as within the realm of human experience. Yet the nature of the event or events, as well as the unique characteristics of the child, may contribute to a posttraumatic stress response.

A traumatic event involves personal actual or threatened death or threat to life or bodily integrity, or witnessing an event that involves the death, injury, or threat to the physical integrity of another person. Traumatic events are often distinguished as sudden, unexpected, and shocking. Some examples of traumatic events include physical or sexual abuse; witnessing or being the direct victim of domestic, community, or school violence; severe motor vehicle or other accidents; life-threatening illnesses; natural and human-made disasters; the sudden death of a parent, sibling, or peer; and exposure to war or terrorism. The person’s response to such an event is one of intense fear, helplessness, or horror. It is important to note that chronic adverse experiences may detrimentally impact children similar to an acute adverse event. These ongoing events may be underrated or overlooked. Such experiences may include frequent conflict in the home, the various impacts of poverty on daily life, or living in an unsafe neighborhood, just to name a few.

Many people develop characteristic symptoms following exposure to a traumatic event. Common symptoms include fear, depression, anger, anxiety, and difficulty dealing with stress. In children, such an emotional response often presents itself as disorganized or agitated behavior. Children may spontaneously act out their emotions and perceptions of traumatic events through play. Typically, those with posttraumatic stress experience persistent thoughts and memories associated with the event(s), and subsequently attempt to avoid people and situations that are reminders of what happened. They may perceive themselves and others in a negative light or have difficulty trusting others.

A child’s response to a traumatic event will be influenced by his or her age and developmental level. The impact of an identical stressful event may vary from child to child depending on a child’s inherent resiliency and coping skills as well as external sources of family, emotional, and social support. The difference in responses from child to child also occurs because children have unique ways of understanding and making meaning of traumatic events.

The good news is that children and adolescents often respond well to psychotherapy specific to posttraumatic stress. One such evidenced-based intervention is Trauma-Focused Cognitive Behavioral Therapy. Components of trauma-focused cognitive behavioral therapy include:

1) psychoeducation for both children and parents;

2) relaxation/stress reduction;

3) emotional expression and modulation;

4) cognitive coping and skills training;

5) creation of the trauma narrative (story);

6) cognitive processing of the trauma narrative; and

7) looking to the future: safety planning and life goals.

One of the main objectives of TF-CBT is not only for a child to tell their story but to challenge and change their negative thoughts and self-beliefs about it. Importantly, the therapist assists the parent(s) or other adult to bear witness to the child’s narrative, with strength and compassion.

Play therapy utilizes play activities to help children who have experienced trauma process their emotions and experiences in a safe and controlled environment, allowing them to express their experiences through toys, art, and role-playing. Play therapy leverages a child’s natural inclination to play to access and process traumatic experiences in a way that aligns with their developmental stage. Through play, children can symbolically represent their trauma using toys and activities, which can be easier than verbalizing complex emotions. A play therapist observes the child’s play patterns and uses therapeutic interventions to help them understand and manage their emotions, develop coping strategies, and build resilience.

Eye Movement Desensitization and Reprocessing (EMDR) is a treatment modality used in therapy to reduce posttraumatic stress in children and adolescents. The primary goal of EMDR is to help a person transform their negative beliefs about themselves as related to their adverse experiences. Traumatic experiences can strongly impact a person’s sense of safety and control; additionally, such experiences often leave one feeling inadequate, irreparably damaged or responsible about what happened. The aim of EMDR is thus to reprocess irrational and negative thoughts, beliefs, and emotions related to the adverse event(s), as well as the associated negative physiological sensations.

Cohen, JA, Mannarino, AP, & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents, second edition. New York, NY: The Guilford Press.

Craske, MG, Kircanski, K, Zelikowski, M, Mystkowsi, J, Choudhury, N, & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5-27.

De Bellis, MD, Baum, AS, Birmaher, B, Keshevan, MS, Eccard, CH, Boring, AM, et al. (1999a). Developmental traumatology: Part I. Biological Stress Systems. Biological Psychiatry, 45, 1271-1284.

De Bellis, MD, Baum, AS, Birmaher, B, Keshevan, MS, Eccard, CH, Boring, AM, et al. (1999a). Developmental traumatology: Part II. Brain Development. Biological Psychiatry, 45, 1271-1284.

Deblinger, E, Mannarino, AP, Cohen, JA, & Steer, R. (2006). A follow-up study of a multi-site, randomized controlled trial for children with sexual abuse-related PTSD symptoms: Examining predictors of treatment response. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1474-1484.

Hensley, B. (2020). An EMDR therapy primer: From practicum to practice, third edition. Springer Publishing.

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By Dawn Anderson, LPCC-S
Lindner Center of Hope Staff Therapist/Supervisor

 

 

 

 

Child mental health therapy is a specialized form of counseling that helps children and adolescents cope with emotional, behavioral, and psychological challenges. It provides a safe and supportive space for young individuals to explore their thoughts, feelings, and experiences with a trained mental health professional. The purpose of child mental health therapy is to promote emotional well-being, improve coping skills, and foster healthy development.

There are various types of child mental health therapy, each tailored to address specific needs and preferences. Some common types include:

Cognitive Behavioral Therapy (CBT)/ Trauma Focused Cognitive Behavioral Therapy (TF-CBT): This evidence-based approach focuses on identifying and modifying negative thought patterns and behaviors. It helps children learn to challenge unhelpful thinking, develop healthier coping strategies, and build self-confidence. Trauma focused care adds additional expertise from the provider into how significant stressful experiences impact the child and caregiver.

Play Therapy: This therapeutic approach uses play as a medium for children to express themselves and process their emotions. Therapists observe children’s play to gain insights into their inner world and facilitate healing through guided play activities. This type of therapy helps the child communicate in the language they use most often.

Family Therapy: This type of therapy involves the entire family in the therapeutic process. It helps families improve communication, resolve conflicts, and develop healthier patterns of interaction. Family therapy can be particularly beneficial for children who are struggling with family-related issues or trauma.

Art Therapy: This creative therapy uses art as a tool for self-expression and emotional release. It allows children to explore their thoughts and feelings in a non-verbal way, fostering self-awareness and promoting healing.

Group Therapy: This type of therapy involves a group of children who share similar experiences or challenges. It provides a supportive environment where children can learn from each other, develop social skills, and feel less alone in their struggles.

Child mental health therapy offers numerous benefits for children and adolescents. Some of the key benefits include:

Improved Emotional Regulation: Therapy helps children develop healthier ways to manage their emotions, reducing the likelihood of emotional outbursts and impulsive behaviors. Being able to increase their emotional vocabulary is a crucial step to growth.

Enhanced Coping Skills: Children learn effective coping strategies to deal with stress, anxiety, and other challenges, promoting resilience and adaptability. Coping skills are like tools in the toolbox: you can’t fix everything with a hammer, we need variety.

Increased Self-Esteem: Therapy helps children build self-confidence and a positive self-image, fostering a sense of self-worth and empowerment. Knowing who you are, and liking yourself help us make more conscious decisions.

Improved Social Skills: Children develop better communication skills, empathy, and the ability to form healthy relationships with peers and adults.

Reduced Behavioral Problems: Therapy can help address behavioral issues such as aggression, defiance, and attention difficulties, leading to improved behavior and school performance. Many behavioral problems are attributed to impacted communication skills.

Trauma Recovery: For children who have experienced trauma, therapy provides a safe space to process their experiences, develop coping mechanisms, and heal from the emotional wounds of trauma.

Early Intervention: Seeking therapy early on can prevent more serious mental health problems from developing, allowing children to thrive and reach their full potential.

Child mental health therapy is an invaluable resource for children and adolescents facing emotional, behavioral, or psychological challenges. By providing a safe and supportive environment, skilled therapists can help young individuals develop the tools they need to overcome difficulties, build resilience, and lead fulfilling lives. If you are concerned about your child’s mental health, consider seeking the guidance of a qualified mental health professional. You can call Lindner Center of Hope at 513-536-0570 for more information.

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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 Danielle Johnson, MD, FAPA
Chief Medical Officer, Lindner Center of Hope

Mood disorders have distinct disturbances in emotions. Low moods are called depression and high moods are called hypomania or mania. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) categorizes mood disorders into bipolar disorders and depressive disorders. Mood disorders include major depressive disorder, bipolar I and bipolar II disorder, disruptive mood dysregulation disorder, premenstrual dysphoric disorder, persistent depressive disorder, and cyclothymic disorder. In the U.S., almost 1 in 10 (9.7%) adults experienced any mood disorder in the past year, with past year prevalence of any mood disorder being higher for females (11.6%) than for males (7.7%). More than 1 in 5 (21.4%) U.S. adults will experience any mood disorder in their lifetime. Mood disorders are common in children and adolescents with an estimated 15% having any mood disorder. Major depressive disorder and bipolar disorder are the most common mood disorders with 8.3% of all U.S. adults experiencing at least one major depressive episode in the past year and 2.8% of U.S. adults having bipolar disorder in the past year.

When people experience symptoms of a mood disorder that do not look like major depression or bipolar disorder this can lead to a delay in diagnosis and treatment as they might have difficulty articulating their symptoms and healthcare professionals might not ask questions about other disorders. Although other mood disorders are less common and less severe, they still impact quality of life and functioning.

Persistent depressive disorder (dysthymia) was added to DSM-5 in 2013, combining some criteria of dysthymic disorder and chronic major depressive disorder. With PDD, depressed mood occurs for most of the day, for more days than not, for at least two years (one year for children and adolescents). During a two-year period (one year for children or adolescents), a person has never been without symptoms for more than two months at a time. A major depressive episode can occur before PDD, or people can experience “double depression” when major depressive episodes occur during PDD.

Symptoms can include poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; or feelings of hopelessness. PDD is associated with greater childhood adversity and maltreatment, childhood loss of a parent, earlier onset of depression, and higher rates of chronic depression in relatives. People with PDD also experience a higher number of traumatic events during their lifetime. The 12-month prevalence ranges from 0.5% to 1.5%.

Cyclothymic disorder consists of episodes of hypomanic and depressive symptoms that do not meet the full criteria for bipolar or major depressive disorder. The lifetime prevalence is approximately 0.4%-1%. Symptoms last two years, for more days than not with stability of mood for no longer than two consecutive months. Symptoms of depression can include depressed mood, irritability, hopelessness, helplessness, insomnia, fatigue, anhedonia, avolition, negativity of affect, and suicidal ideation. Hypomanic symptoms can include impulsivity, grandiosity, racing thoughts, increased sociability, excess physical activity, and increased speech production.

People with cyclothymia may experience emotional lability, hypersensitivity, recurrent interpersonal altercations, incidents of self-harming, episodes of excessive gambling, reckless sexual activity, multiple divorces, legal or financial problems, and recurrent job loss. The chronic and pervasive nature of cyclothymic disorder can lead to misdiagnosis with cluster B personality disorders.

There are no FDA-approved medications for PDD or cyclothymic disorder. Your psychiatrist or psychiatric nurse practitioner will take a thorough history including past medical history, previous medical trials, and other psychiatric diagnoses and work with you to develop a treatment plan and choose appropriate medications and psychotherapy to treat depressive and/or hypomanic symptoms.

Sekhon S, Gupta V. Mood Disorder. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558911/

https://www.nimh.nih.gov/health/statistics/any-mood-disorder

https://www.nimh.nih.gov/health/statistics/major-depression

https://www.nimh.nih.gov/health/statistics/bipolar-disorder

Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK541052/

Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK541052/

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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/
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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

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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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An Untapped Resource in the Treatment Journey

 According to a February 2024 article in the Journal of American Child and Adolescent Psychiatry, the prevalence of mental health conditions in adolescents has been increasing worldwide, outpacing the availability of effective mental health care. More adolescents require acute inpatient psychiatric hospitalization, but do not have resources for sub-acute care after discharge. Step-down programs, often known as partial hospitalization or day treatment programs, are helpful in decreasing re-admissions but are often underutilized. These programs can also serve as a step-up from outpatient care if severity is escalating. Partial hospitalization is designed to offer this intermediate level of care between inpatient and outpatient services.

Given that adolescence is a dynamic stage of life full of transitions and a common time for symptoms of mental illness to first present, teens may have difficulty managing home, school, and social activities without therapeutic intervention. Adolescent partial hospitalization offers day treatment during weekdays, so evenings and weekends can be used for patients to test skills learned during treatment hours.

Though partial hospitalization programs primarily occur in group settings, programs should be designed in a way that meet the unique needs of each patient participating in the program.  Ideally, programing includes elements such as psychoeducation, individualized treatment planning and goal setting, a variety of psychotherapeutic experiences, psychiatric evaluation, educational support, and family involvement.

The most effective adolescent partial hospitalization programs are staffed by multidisciplinary treatment teams including a board-certified child and adolescent psychiatrist and psychiatric nurse practitioner, mental health specialist, specialized therapists, licensed social worker, psychiatric registered nurse, licensed teacher, and a dietitian.

Patients and families participating in adolescent partial hospitalization should benefit from tangible insights and skills that will foster resilience, improve communication, bolster coping skills and functioning. These tools are intended to help better navigate daily life and maximize a teen’s chances for success.

 

Lindner Center of HOPE in Mason, Ohio offers an adolescent partial hospitalization program for mental health. Learn more about the program at:  https://lindnercenterofhope.org/adolescent-partial-hospitalization-program/.