Category: Mental Health

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En esta oportunidad quiero compartir con ustedes el articulo que escribimos en mi Grupo de estudio Psicoanalisis de Cara a lo Social integrado por Manuel Llorens, Alicia Leisse, Carmen Elena Dos Reis, Claudia Alvarez, Yone Alvarez y esta servidora.  Nos reunimos de forma “virtual” cada 15 dias para discutir trabajos y temas de corte psicoanalitico y tambien social. Somos todos venezolanos conectados desde el exilio o desde la emigracion elegida.  Espero que les resulte de utilidad en estos tiempos de incertidumbre…

UNA CONVERSACION CON LA INCERTIDUMBRE

Una de las anécdotas que ha circulado ampliamente en medio de la pandemia es de la antropóloga Margaret Mead cuando un estudiante le preguntó que cuál era, a su juicio, el hallazgo que evidenciaba el comienzo de la cultura. Esperando escuchar algo como potes de arcilla o cabezas de flechas, el estudiante se sorprendió al escuchar “un fémur roto que fue curado”.

La pandemia ha servido para subrayar la íntima conexión de la humanidad entera. La manera en que los hábitos alimenticios, los sistemas de gobierno, los medios cada vez más veloces de transporte, y hasta nuestra manera de saludarnos, influyen en el curso de un virus que ha detenido todo el planeta. El coronavirus ha puesto de rodillas el poderío humano: paralizó el comercio, las olimpiadas, los aeropuertos, las protestas públicas y más.

Sumado a las consecuencias de la salud de los contagiados, los sistemas sanitarios, la economía mundial y las adaptaciones a la vida cotidiana que ha exigido la pandemia, ha habido un repunte a nivel mundial de trastornos de ansiedad. Por ende se les pregunta a los profesionales de la salud mental: ¿cómo se lidia con las angustias que todo esto despierta?

Circulan muchas recomendaciones, ideas, gestos salvadores, actos creativos que dan cuenta de que, en lugares geográficos con mayor piso de respuesta social, los daños ciertamente están, pero el músculo creativo se reinventa al servicio del otro y de uno con el otro y del sí mismo. Muchas de las recomendaciones, útiles  sin duda, se anclan en el terreno de las acciones concretas y conscientes que podemos incluir en nuestras rutinas para sobrellevar la angustia, el tedio, la pérdida o el conflicto que desata las medidas de protección que han alterado nuestras vidas.

Creemos, sin embargo, que puede ser útil tomar un paso al costado y escucharnos desde otro lugar. Hay por lo menos dos elementos fuera de las prescripciones más concretas que valen la pena considerar. El primero, es que la pandemia nos ha colocado de manera dramática frente a la vulnerabilidad humana. Ante esto, algunos han querido continuar como si nada, como los presidentes de Brasil y México, besucones desafiantes, que parecerían estar en negación de los riesgos que implica el COVID-19. Lo cierto, es que desde el Príncipe Carlos hasta los plebeyos estamos expuestos. La omnipotencia no está resultando buena consejera.

A la vulnerabilidad se le suma una gran cuota de incertidumbre. Nuestros parámetros de control han sido trastocados. Hay recomendaciones que nos pueden ayudar a sobrellevar el día a día, pero inevitablemente necesitamos escuchar y articular el temor que surge. El miedo, lo sabemos, pero se nos olvida, es una alerta que necesita ser atendida, para poder prepararnos para lidiar con una amenaza. Lidiar con el miedo sin negarlo, pero sin quedar sobrepasado por el desespero, es parte de la tarea.

La escucha y el esfuerzo por darle palabra a nuestro mundo interno, es parte de una solución que lidia con la incertidumbre sin pretender tener las respuestas de antemano. Una de las maneras en que la psicoterapia psicoanalítica ha sido descrita es como una “conversación con la incertidumbre”. La gran verdad, es que ni los expertos tienen la respuesta completa de las dimensiones del problema ni de su solución. Lo más probable es que tengamos que hablar y escucharnos para descifrarlo en conjunto.

Lo que estamos diciendo, y que lleva al segundo elemento, es que el problema tiene que ver con la interdependencia humana, y su solución, probablemente también. Una de las medidas preventivas curiosamente se ha llamado “distanciamiento social”, cuando lo que necesitamos es distanciamiento físico, pero no social. Tanto por el proceso de concebir soluciones a un problema de dimensión sistémica, como por el funcionamiento biológico individual: la conexión humana es esencial. Sabemos que el sistema de defensa inmunológico está íntimamente relacionado con la vinculación interpersonal, la soledad nos hace más propensos a enfermar.

Nos estamos quedando en casa, aunque parezca paradójico, como gesto de profundo reconocimiento del otro. Nos quedamos en casa, para cuidar a los demás tanto como a nosotros mismos. Nos quedamos en casa, porque el bienestar del otro es indispensable para el bienestar nuestro. Visto así, nuestro encierro no es aislamiento. Las redes de solidaridad, para estar atentos a las personas de nuestro vecindario que no se pueden valer por sí mismas, el comunicar nuestra preocupación por el otro, el pedir ayuda, la música en los balcones o los aplausos a los operarios de salud, son gestos indispensables de conexión humana, necesarios para mantenernos sanos y cuerdos.

No olvidemos finalmente que los riesgos y las desventajas tienden a multiplicarse, por lo que, aquellos que vienen arrastrando desventajas, están ahora en una situación multiplicada de riesgo. Los que tienen alguna situación previa de vulnerabilidad, por edad, por salud, por pobreza, por red de apoyo limitada, están mucho más expuestos y haremos bien en pensar en el problema priorizando las necesidades de aquéllos que la van a sufrir más.

La cuarentena es un alto obligatorio que puede ayudar a hacer un parado en una vida que no deja de exigir apresuramiento, un llamado a abrir espacios para la reflexión, para recalibrar nuestras prioridades y para hacernos más conscientes de nuestra interdependencia, nuestra necesidad del otro, fomentar nuestra capacidad de construir la cultura en los términos que propuso Margaret Mead.

 

 

Margot Brandi, MD,
Sibcy House, Medical Director

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Tracy S. Cummings, MD Psychiatrist, Lindner Center of HOPE Chief of Child and Adolescent Psychiatry Medical Director of CCHMC Services at LCOH

On a large scale, our world continues to adjust to the new normal enacted for our safety in the wake of COVID19. And while we may be interested in global responses and big picture outcomes, this tends to pale in comparison to the level of concern a family holds for its members and home. Our definitions of “family” may vary, and our abilities to handle stress can be wide-ranging, but we all likely share our desire to see the system succeed. Having tangible options to put into action in our households right now can give us a sense of purpose and accomplishment while keeping those that mean the most to us moving forward in positive directions through this uncertain time. Consider the following acronym, HELP, to help keep your family functional:

H– Heed the advice of our trusted medical and community leaders.

  • Staying up to date on current safety recommendations from the CDC, WHO and governmental leaders is important.
  • Understanding what local resources may be needed and taking the time to consider your home’s personal emergency plan is worthwhile.
  • Creating a sense of control over those things that are within your grasp will feel rewarding, even if there is some anxiety around the situation.
  • Once you have the general information you need to proceed with helping your family, limit exposure to crisis-related media.

E– Enact the recommendations of the leaders and your personal plan.

  • In order for this to be successful for families, there will need to be good communication about its importance. Talking about the virus in a way everyone can understand (particularly if there are young children in the home) will pose a worthwhile challenge. Consider this as an opportunity to demonstrate empathy and compassion for each other when our particular ways of acknowledging, responding to, and addressing stress becomes apparent.
  • Take the universal precautions immediately: good hand hygiene, covering coughs/sneezes, frequently clean/disinfect, maintain social distancing, wear a mask if in a public setting, stay home as much as possible and absolutely if sick.
  • Remember that younger members in the home will be watching those around them for cues on how to handle this situation, so reinforce the recommendations through modeling the appropriate behaviors as much as possible. If the adults in the home are struggling with how they are personally managing the stress of today, seeking assistance for mental health strength should not be delayed.

L– Listen to the needs of your individual household and make room for those in the necessary changes.

  • Label priorities for your family: academics, virtual lessons, family meals, general chores, and what needs to be done on a given day.
  • The use of a broad-strokes calendar may be helpful here, so as to set some daily standards and routines. With so much changing around us (ie. schools closed, remote working requirements, conveniences disrupted), having some predictability to the day can provide security to adults and children alike. Do you have to set up a strict schedule for every hour of the day and follow it militantly?  No, but knowing there is some allotted time for a few essential activities a day is reasonable, and IT CAN CHANGE as needed.
  • Emphasize flexibility over perfection these days.

P– Protect your unity.

  • Emotions can run high during this time of collective crisis. Accepting how difficult these changes are for us all can be freeing.
  • It is ok to grieve the loss of all the special moments and events that have been postponed or canceled due to COVID19. Whenever possible, consider ways to creatively experience those moments in an alternative fashion. Can’t go to Disney?  How about making a Disney movie night and riding some virtual rides that are posted for the park?
  • Keep in contact with those who are important to your family as much as possible. Use the technology available to your advantage. Virtual birthday parties and gatherings, like many current classrooms, are being readily utilized with success. Phone calls with or without video, texts, and even sending letters/cards are simple ways to avoid isolation while maintaining social distancing.
  • Staying connected doesn’t mean you have to spend every moment together, though. It might be nice, and likely necessary, for family members in the same home to have some time to themselves. Use these moments to recharge and encourage young ones in the home to appreciate this personal time as well.

These are uncharted waters for our families, our communities, our planet. We cannot expect to know how to handle our current circumstances flawlessly, but we can keep trying.  All we need is a little HELP.

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Megan Schrantz, Ed.D., LPCC

Students everywhere are struggling to engage in their studies meaningfully during the coronavirus crisis. For now, gone are the comfortable routines, activities, and structured in-person expectations of the school week.

Children, teenagers, and college students need adequate sleep, healthy meals, and regular exercise.   Healthy habits are particularly important for young people who may be struggling with anxiety or depression. Losing reliable routines can be a big source of stress.  Many students feel unfocused and unproductive. It’s ok to dial down expectations of oneself and others.

It’s important to simply acknowledge your feelings. It is normal to feel worried, lonely, and frustrated. Here are some strategies for students of all ages to thrive during this unusual time:

Stick to your pre-coronavirus routine.  Although students are likely sleeping in a bit later, it is helpful to wake up and go to bed at about the same time as on a regular school night.

Move your body. The recommendation to hunker down does not prevent going for a walk, bike ride, run, or just playing outside (assuming you’re not in complete quarantine). Movement is a great way to relieve stress, notice the big wide world, and get fresh air.

Sleep. Sleep restores us like nothing else. Create a sleep schedule to wake up about the same time every day, which can add some structure to your day and help regulate your circadian rhythm. Keeping a consistent sleep schedule, with predictable times to wake up and go to bed, is especially important in maintaining a positive mood and the ability to fulfill academic expectations.

Limit video game time.  Enough said.

Take care of your mental health.  Practice mindfulness. Being mindful helps us to slow down and reduces anxiety. A few deep breaths can reduce stress. Play outside and notice the magical changes of spring.  Being mindful for one minute can be a welcome change from worries, and it can help us to focus on what’s truly important.

Maintain social connections. Those connections can mean the world. Check in on others, including family members, friends, and classmates.  Ask how they’re doing. Let them know you care. Imagine what you can do virtually, in pairs, in small groups, or in larger gatherings!  Dance, sing, read, play games, create.

Mix it up. If you’re staring at a screen too long, take a break, move around, and shift your gaze.  Limit news-watching to reduce anxiety.  If you crave a change of scenery, take a walk, or if you can’t get outside, escape into a book or creative activity. Make up a game.  Try a wacky science project.  Plan for an optimistic future- think of what you can look forward to.

 

It can be a challenge to structure your day when all classes are from home.  These ideas can help establish a more comfortable and efficient routine.

Make a plan.  Consider unplugging from time to time to supplement digital apps and online learning portals with a paper planner or notebook.  Recording assignments and projects in a paper planner can help you learn and remember your schedule.

Create a cozy and ideal learning environment.    Make a “classroom” free of unwanted distractions.  Keep all needed materials organized in one place.

Hide or put down the phone!!  Close all unnecessary tabs when in learning mode.  Quiet all notifications.

After studying, practice explaining what you’ve learned.  If you can explain the lesson to someone else, then your studying has paid off. A simple but effective study tip is to describe what you studied. There are several ways you can do this while still observing social distancing:

  • Practice explaining what you’ve learned to family members.
  • Practice virtually with friends online.
  • Practice in front of a mirror.
  • Record yourself explaining what you’ve learned.

Study with friends … online.  We all crave social interaction in learning environments. Consider organizing virtual study groups with your friends to get your dose of socializing while staying at home,  and to hold each other accountable to academic goals.

Limit social media.  Too much social media wastes time and can be a source of stress or uncertainty.

Break up learning into chunks of time.  Try to finish your work when school would be over for the day.  After “school hours”, do something fun and relaxing.

Ask for help.  Teachers are available online.  It’s ok to ask parents for help, too.

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Paul R. Crosby, MD

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

4075 Old Western Row Rd.

Mason, OH 45040

513-536-HOPE

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

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

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

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

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

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

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

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

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

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

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

 

 

 

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You can’t affect the cards that are dealt, but you can determine how you play them.

Milton Erickson, MD
Psychiatrist
The father of modern hypnotherapy

When we think of hypnosis, we typically think of a stage performance in which the subject is crowing like a rooster or engaged in some outlandish behavior designed to entertain. Many view hypnosis as a “party trick” or an “act” for amusement. However, the practice of medical hypnosis can be traced back thousands of years in cultures around the world. It was once used for pain management during surgery until doctors started using ether. Today, physicians, licensed psychotherapists and psychologists commonly use it as a tool for change. Hypnosis or hypnotherapy, has been known to help patients with everything from depression, anxiety and phobias to smoking cessation, weight loss, stress management and irritable bowel syndrome. Some hospitals even use it as a tool to reduce pain in individuals before, during and after surgery, as well as in patients with chronic conditions or diseases. Hypnosis is a human condition involving focused attention, reduced peripheral awareness, and an enhanced capacity to respond to suggestion.

One major myth regarding hypnosis is that the individual is unconscious – and powerless. Most people have a clear memory of what happens during hypnosis, while another’s recollection might be not as clear. Some might be able to move their head or lift a finger if they’re prompted, whereas others will remain impassive. Everyone’s experience with hypnosis can differ. While “under” hypnosis, you are not rendered unconscious; you are simply in a deeply relaxed state. In fact, we enter “trance” states all the time. Most of us are familiar with highway hypnosis, the phenomenon in which the person can drive a vehicle great distances, responding to external events in the expected, safe and correct manner with no recollection of having consciously done so. Another example of a common trance state is watching a movie. When we watch a movie, we know actors are up on the screen. We know that this story is not happening in real life. But for those few hours, we can experience emotions and a connection to the story. A movie can create an experience of happiness, sadness, suspense, fear or joy.

Hypnosis is a deeply relaxed state in which suggestions can be given to assist the individual in changing a maladaptive behavior. Do you remember when you were playing as a child and fell down, and your parent kissed your “boo boo,” and you instantly went back to play? Suggestion can change our behaviors.

One of the major problems within the field of research is when clinical trials are conducted and a medication or placebo is given to a subject, the placebo (a sugar pill) turns out to work too well. Researchers don’t like this. Unaware subjects who receive the placebo should not report a difference from the sugar pill, but sometimes they do. The subject’s belief or the “suggestion” that the “pill” is going to improve how one feels, in fact, improves how he or she feels. Recent studies have also found that even a physician’s own presentation of the effectiveness of a new medication to the patient, can result in a patient’s higher perception that the medication is going to be effective, resulting in a more positive result for the patient.

Even though hypnosis has faced many misconceptions through the years, it remains an effective technique in making behavioral changes and improving the lives of many individuals. Not everyone may respond to hypnotherapy in the same way, but this can also be said about other treatment approaches. In searching for a hypnotherapist, find a licensed professional within the mental health or medical fields, and who has been certified to conduct this clinical hypnosis. The American Society of Clinical Hypnosis is a resource, which can assist in locating a certified hypnotherapist in your area. Like meditation, guided imagery, acupuncture, and music therapy, Hypnotherapy can be a valuable tool in providing a healing science to facilitate the body’s innate healing response.

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by: Lindner Center of HOPE’s Spiritual Care Team

Research has shown that laughter has tremendous benefit to your emotional and physical health. One study in Norway even concluded that people who laugh a lot live longer! It is good medicine for the soul and the mind. Consider:

  • Laughter stops distressing emotions. You can’t feel anxious, angry, or sad when you’re laughing.
  • Laughter helps you relax and recharge. It reduces stress and increases energy, enabling you to stay focused and accomplish more.
  • Laughter shifts perspective, allowing you to see situations in a more realistic, less threatening light. A humorous perspective creates psychological distance, which can help you avoid feeling overwhelmed and diffuse conflict.
  • Laughter draws you closer to others, and we all need people we can count on.[1]

Having a sense of humor is not necessarily natural to everyone. But finding the funny can be developed.

  • Smile, it is the start of laughter
  • Consider your blessings, it will make you more open to humor.
  • Pull it into your life. Ask others for their funniest stories.
  • Schedule time to look for the funny. Today’s tech makes this so very easy!

All of us could use more laughter. Find people who are playful and play. Listen for laughter and go find out what is so funny. Watching a baby laugh seems to work magic on our own funny bone. And laughing at ourselves is always a good practice.

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by: Elizabeth Mariutto, PsyD, Lindner Center of HOPE, Psychologist and Clinical Director of Partial Hospitalization/Intensive Outpatient Adult Eating Disorder Services

With all of the news and changing regulations in our current times, it can be very hard to manage anxiety and mood related to coronavirus. Below are 10 tips on how to manage your mental health.

1. Limit your access to the news and social media. With everything changing minute by minute, it is easy to find yourself constantly scrolling various sources. Possibly set a certain number of times per day or a set amount of time that you are “allowed” to check one news source that you trust. Some find it helpful to set an appointment with themselves to do so and limit their checking to this appointment. Some phones allow to you track or limit your screen time, which can be a beneficial tool. It can also be helpful to physically put your phone or computer in a separate place, or to go in a separate room from your TV.

2. Practice mindfulness. Try to take it day by day and remember that all of this is temporary. Use of apps such as Headspace and Calm can help promote mindfulness.

3. Use gratitude. Identify 1-3 things each day that you are grateful for. Don’t neglect things that we take for granted, such as our physical health, the ability to use technology to keep us connected, and all of those working at those grocery stores to keep the shelves stocked as much as possible.

4. Focus on what matters in the big picture. Taking steps to practice social distancing is to help our healthcare system avoid being overwhelmed and to help healthcare workers save lives. These could be those that you love, or loved ones of your loved ones.

5. Stay active. Exercise releases endorphins and can help us stay both physically and emotionally happy when done in moderation.

6. Go outside. Vitamin D can positively impact our mood and energy level, and a great source is from the sun.

7. Stay connected with others. This is key when practicing social distancing. Facetime is a great way to be present with those you love without increasing anyone’s risk.

8. Perform acts of service. Volunteering can lead to improvements in mental health, so offering to bring groceries to an elderly neighbor or donating to a local food pantry can both help others as well as boost our mood.

9. Engage in hobbies. One of the best ways to fight depression is to engage in behavioral activation, or do things that are fun for you. This may be a great time to try a new recipe if you enjoy cooking, or to take that online course on photography.

10. Get connected with resources if needed. Many therapists are switching to use of different technologies for therapy to help with social distancing, and you can find self-help resources online to help cope with stress

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by: Tracy S. Cummings, MD, Psychiatrist, Lindner Center of HOPE

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.

Everyone reacts differently to stressful situations.  How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.

People who may respond more strongly to the stress of a crisis include

  • Older people and people with chronic diseases who are at higher risk for COVID-19
  • Children and teens
  • People who are helping with the response to COVID-19, like doctors and other health care providers, or first responders
  • People who have mental health conditions including problems with substance use

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

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

Stress during an infectious disease outbreak can include

  • Fear and worry about your own health and the health of your loved ones
  • Changes in sleep or eating patterns
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Increased use of alcohol, tobacco, or other drugs

People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms.

Things you can do to support yourself

  • Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
  • Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
  • Make time to unwind. Try to do some other activities you enjoy.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.

 

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by: Tracy S. Cummings, MD, Psychiatrist, Lindner Center of HOPE

Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

Not all children and teens respond to stress in the same way. Some common changes to watch for include

  • Excessive crying or irritation in younger children
  • Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
  • Excessive worry or sadness
  • Unhealthy eating or sleeping habits
  • Irritability and “acting out” behaviors in teens
  • Poor school performance or avoiding school
  • Difficulty with attention and concentration
  • Avoidance of activities enjoyed in the past
  • Unexplained headaches or body pain
  • Use of alcohol, tobacco, or other drugs

There are many things you can do to support your child

  • Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand.
  • Reassure your child or teen that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
  • Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
  • Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
  • Be a role model.  Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.

The emotional impact of an emergency on a child depends on a child’s characteristics and experiences, the social and economic circumstances of the family and community, and the availability of local resources. Not all children respond in the same ways. Some might have more severe, longer-lasting reactions. The following specific factors may affect a child’s emotional response:

  • Direct involvement with the emergency
  • Previous traumatic or stressful event
  • Belief that the child or a loved one may die
  • Loss of a family member, close friend, or pet
  • Separation from caregivers
  • Physical injury
  • How parents and caregivers respond
  • Family resources
  • Relationships and communication among family members
  • Repeated exposure to mass media coverage of the emergency and aftermath
  • Ongoing stress due to the change in familiar routines and living conditions
  • Cultural differences
  • Community resilience
For 7 to 10 year olds

Older children may feel sad, mad, or afraid that the event will happen again. Peers may share false information; however, parents or caregivers can correct the misinformation. Older children may focus on details of the event and want to talk about it all the time or not want to talk about it at all. They may have trouble concentrating.

For preteens and teenagers

Some preteens and teenagers respond to trauma by acting out. This could include reckless driving, and alcohol or drug use. Others may become afraid to leave the home. They may cut back on how much time they spend with their friends. They can feel overwhelmed by their intense emotions and feel unable to talk about them. Their emotions may lead to increased arguing and even fighting with siblings, parents/caregivers or other adults.

More on taking care of your family

Disasters and other crisis events have the potential to cause short- and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. It’s important that pediatricians, and all adults in a position to support children, are prepared to help children understand what has happened and to promote effective coping strategies. This will help to reduce the impact of the disaster as well as any associated bereavement and secondary stressors.

Stress is intrinsic to many major life events that children and families face, including the experience of significant illness and its treatment. The information provided about how to help children cope after disaster and crisis is therefore relevant for many encounters that pediatricians will have with children, even outside the context of a disaster.

Talk about the event with your child. To not talk about it makes the event even more threatening in your child’s mind. Silence suggests that what has occurred is too horrible to even speak of. Silence may also imply to your child that you don’t think their reactions are important or appropriate.

  • Start by asking what your child has already heard about the events and what understanding he or she has reached. As your child explains, listen for misinformation, misconceptions, and underlying fears or concerns, and then address these.
  • Explain – as simply and directly as possible – the events that occurred. The amount of information that will be helpful to a child depends on his or her age. For example, older children generally want and will benefit from more detailed information than younger children. Because every child is different, take cues from your own child as to how much information to provide.
  • Encourage your child to ask questions, and answer those questions directly. Like adults, children are better able to cope with a crisis if they feel they understand it. Question-and-answer exchanges help to ensure ongoing support as your child begins to understand the crisis and the response to it.
  • Limit television viewing of disasters and other crisis events, especially for younger children. Consider coverage on all media, including the internet and social media. When older children watch television, try to watch with them and use the opportunity to discuss what is being seen and how it makes you and your child feel.

Healthy Children. Org provides additional insights

  • Recognize that your child may appear disinterested. In the aftermath of a crisis, younger children may not know or understand what has happened or its implications. Older children and adolescents, who are used to turning to their peers for advice, may initially resist invitations from parents and other caregivers to discuss events and their personal reactions. Or, they may simply not feel ready to discuss their concerns.
  • Reassure children of the steps that are being taken to keep them safe. Terrorist attacks and other disasters remind us that we are never completely safe from harm. Now more than ever it is important to reassure children that, in reality, they should feel safe in their schools, homes, and communities.
  • Consider sharing your feelings about the event or crisis with your child. This is an opportunity for you to role model how to cope and how to plan for the future. Before you reach out, however, be sure that you are able to express a positive or hopeful plan.
  • Help your child to identify concrete actions he or she can take to help those affected by recent events. Rather than focus on what could have been done to prevent a terrorist attack or other disaster, concentrate on what can be done now to help those affected by the event.

AACAP Recommendations for talking to children about COVID-19 :

Talking to Children About Coronavirus (COVID19)

  • Remember that children tend to personalize situations. For example, they may worryabout their own safety and the safety of immediate family members. They may alsoworry about friends or relatives who travel or who live far away.
  • Be reassuring, but don’t make unrealistic promises. It’s fine to let children know that they are safe in their house or in their school. But you can’t promise that there will be no cases of coronavirus in your state or community.
  • Let children know that there are lots of people helping the people affected by the coronavirus outbreak. It’s a good opportunity to show children that when something scary or bad happens, there are people to help.
  • Children learn from watching their parents and teachers. They will be very interested in how you respond to news about the coronavirus outbreak. They also learn from listening to your conversations with other adults.
  • Don’t let children watch too much television with frightening images. The repetition of such scenes can be disturbing and confusing.
  • Children who have experienced serious illness or losses in th
  • Although parents and teachers may follow the news and the daily updates with interest and attention, most children just want to be children. They may not want to think about what’s happening across the country or elsewhere in the world. They’d rather play ball, go sledding, climb trees or ride bikes.

 

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Anna I. Guerdjikova, PhD, LISW, CCRC

Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program

Currently over 50% of the world’s population is living in urban areas with limited opportunity to engage with nature. In North America most adults spend ∼90% of their time indoors. Ecotherapy, also known as nature therapy or green therapy, is the applied practice of the rapidly evolving field of ecopsychology, a term coined by Theodore Roszak in 1992. Ecotherapy builds on the biophilia hypothesis proposed by E. O. Wilson which suggests that human beings are genetically hardwired to “affiliate with other forms of life”. He proposed that the connection humans seek and have with other life forms and nature is deeply rooted in our biology. If prevented from sufficient contact with nature, we are at risk for developing a “nature-deficit disorder” which can lead to negative consequences for our mental and physical health.

It is established through research from all over the world that people with good access to natural environments are more likely to experience wellness. For example, green space has been associated with improvements in cognitive functioning and self-esteem and reductions of depression, stress and anxiety. Blue spaces, defined as environments predominately consisting of water, lower levels of anxiety and mood lability, and are positively associated with self-reported mental and general health. Physical activities in natural settings are associated with less anger, fatigue, and sadness and might reduce the blood flow to the part of the brain responsible for despondency. Mere exposure to nature can be healing, it has been consistently shown that simply looking at environments dominated by greenery or water is significantly more effective in promoting recovery and restoration as compared to milieus lacking nature.

Nature based interventions (NBIs ) include programs and activities engaging people in nature-based experiences to enhance general health through promotion of wellness and prevention of illness. NBIs include interventions that alter the environments where people live and interventions designed to change individual’s behavior (such as promoting walks outside or gardening).

Prescription: A Dose of Nature

Some examples of NBIs as listed below. Of note, nature based interventions can be a helpful adjunct in the treatment of mental illness along with pharmacotherapy and psychotherapy.

  • Physical exercise outdoors: walking, jogging, biking, doing yoga or other exercises in a park fosters increased awareness of the natural world and can be recommended for reducing stress, anxiety, depression, and anger. Walk-and-talk therapy is a gaining popularity treatment model, encouraging patients to be more physically active for mental and physical reasons and helping them move forward, literally and metaphorically speaking, when facing challenging problems
  • Nature meditation: using nature as focus point and incorporating it in meditation and mindfulness experiences. Forest bathing, for example, is a well stablished practice in Japan since the 1980s. It requires that one just sits in the presence of trees, without engaging in any physical activity. It has been shown that in the week after the forest visit, the activity of human natural killer cells (implicated in cancer prevention and immunity) increases and those positive effects can last up to a month following each weekend in the woods. Furthermore, forest environments might help decrease contisol, pulse rate, and blood pressure as compared to city environments.1
  • Horticultural therapy: Various forms of gardening and landscaping are known to improve community connectedness, create a sense of purpose and can promote better eating habits.
  • Animal-assisted therapy: Extensive data supports the use of this complementary type of therapy, with canine and equine-assisted therapy being the most well researched, to improve the social, emotional, or cognitive functioning in various settings  (mental health centers, nursing homes, schools and prisons) and across diagnoses (dementia, ADHD, PTSD and autism to name a few).2
  • Indoor nature exposure- enriching indoor work and living spaces with nature elements (plotted plants, pictures and photos with view of nature, window view of grass or woods etc.) are known to improve attention, moods and productivity and  to reduce stress and heart rate. In one study, for example, sunlight and/or a nature view increased job satisfaction, reduced intention to quit and lowered feelings of being  worn out uptight.3

A study published in the summer of 2019 examined a representative sample of over 20000 people in England and concluded that a “two-hour “dose” of nature a week significantly boosts health, and life satisfaction”, including among those with long-term illness and disabilities.4  If spending only twenty minutes per day in natural environments can make a difference, it is certainly worth giving it  a try.

References :

  1. Environ Health Prev Med. 2010 Jan;15(1):18-26. The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y.
  2. Complement Ther Med. 2018 Dec;41:203-207.”We need them as much as they need us”: A systematic review of the qualitative evidence for possible mechanisms of effectiveness of animal-assisted intervention (AAI).Shen RZZ, Xiong P, Chou UI, Hall BJ.
  3. Health Promot Int. 2015 Mar;30(1):126-39  Indoor nature exposure (INE): a health-promotion framework. Mcsweeney J, Rainham D2, Johnson SA, Sherry SB, Singleton J.
  4. Sci Rep. 2019 Jun 13;9(1):7730.Spending at least 120 minutes a week in nature is associated with good health and wellbeing. White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, Bone A, Depledge MH, Fleming LE.