Category: Mental Illness

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By Shea Daniels Graham, LPCC-S, Outpatient Telehealth Counselor

One of my favorite metaphors comes from Shift Journal and describes autism as being a hair-dryer brained person in a toaster-brained world. To paraphrase: If we think about the brain as a machine made of wires and gears we inherit, there is an imaginary world where most people are born with those wires and gears turned into a toaster. In this world where most people have toaster brains there’s going to be a lot of toast—white, wheat, rye, everything bagels, cinnamon raisin bread—but it’s all toast. Making toast is almost effortless for most people in this imaginary world so it becomes an integral, expected part of existing in society. Some people, though, are born with hair dryer brains, and while they can make toast—because you can make toast with a hair dryer, after all—it is going to fundamentally take them intentional effort, time, and skill building, to do what comes effortlessly for the toaster-brained…and even with that effort, time, and skill building, someone with a hair dryer brain is never going to be able to make toast as effortlessly as someone whose brain is a toaster. Now, if the roles were reversed, society would be created around having a hair dryer for a brain and those born with toasters for brains would have trouble drying hair. But in this imaginary world there are more people with toasters for brains, so people with hair dryer brains put a lot of time and energy into simply existing.

The National Institutes of Health estimates, as of 2020, that approximately 1 in 45 adults in the United States are living with autism spectrum disorder. Various studies indicate between 20% and 50% of adults living with autism are undiagnosed. Our understanding of autism has shifted drastically since the term was first used in 1911 by German psychiatrist Eugen Bleuler to describe a form of severe schizophrenia (Bleuler 1950 [1911]), Evans 2013). It wasn’t until the growth of child psychology in the 1960s that we begin seeing anything resembling modern autism criteria, such as Victor Lotter et. al’s 1966 epigenetic study to identify prevalence of autism in Britain’s children. Their screener, which significantly mirrors current autism diagnostic criteria, included 24 items related to social and pragmatic communication; vestibular, proprioceptive, and auditory sensory differences; and, repetitive behaviors. It is interesting to note, here, that Lotter et. al’s original screening tool was based on an earlier screening tool by child psychiatrist Mildred Creak (Evans, 2013). Creak’s screening tools included reports of internal experience which Lotter et. al. excluded due to concerns internal experience was too subjective to be useful.

This trend towards excluding diagnostic criteria based on internal experiences continues even today. Compared to other mental health and neurodevelopmental diagnoses in the DSM, Autism Spectrum Disorder is the only diagnosis not to include any report of internal experiencing (American Psychiatric Association, 2013).

Going back to the example above of toaster brains and hair dryer brains: some hair dryer brains are going to be more effective at making toast than others. Some people with hair dryer brains might be able to optimize their settings, the bread they use, etc., to make toast almost as well as someone whose brain is a toaster. They might even become so effective at making toast with a hair dryer than we wouldn’t know their brains weren’t toasters, if they didn’t tell us about how difficult it is to live with a hair dryer brain in a toaster world.

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a short, reliable, accurate, valid, and current autism screener appropriate for outpatient clinical use. The CAT-Q is particularly special because it is the only such screener which measures the internal experience of autism. It includes 24 screening questions such as, “I rarely feel the need to put on an act in order to get through a social situation,” “I have developed a script to follow in social situations,” “In social situations, I feel like I am ‘performing’ rather than being myself,” and “in social situations, I feel like I am pretending to be ‘normal,’” each scored on a A-G scale from “Strongly Disagree” to “Strongly Agree.” The CAT-Q has a high internal consistency both for the total scale and for the three sub-scales of Compensation, Masking, and Assimilation. Test-retest reliability was good, as was the total stability of this screener (Jones, 2021). Results are normed by gender for women, men, and non-binary/transgender populations.

Identifying traits of autism in our patients is a crucial part of providing competent care. Regardless of whether or not a patient who scores above-threshold on the CAT-Q opts to pursue formal assessment for autism, for those patients with above-threshold results, we as clinicians can tailor our interventions to acknowledge the patient’s traits of neurodivergence.

At times, tailoring our treatment to account for diagnosed autism, or traits of autism, is simply best practices. For example, in their 2018 study Cooper et. al identified that “almost all” therapists found it necessary to adapt Cognitive Behavioral Therapy interventions due to the increased rigidity of thinking people with autism experience. Without adaptations, the CBT interventions did not produce comparable results for adults with autism compared to neurotypical adults engaged in comparable treatment protocols.

At other times, tailoring our treatment to account for diagnosed autism, or traits of autism, is not only best practices—it is a critical component of not causing harm to patients. In his 2014 presentation to the EMDR Europe Association Conference, S. Paulson explained that due to the variety complex neurological differences individuals with autism present with, trauma processing using EMDR can be more difficult, or even harmful, without appropriate modifications to the standard treatment protocol. With appropriate accommodations, however, EMDR is an incredibly effective treatment for adults with autism who have a co-occurring trauma history. Lobregt-van Buuren et. al found that after 6-8 weeks of standard therapy followed by up to 8 EMDR sessions, at a 6-8 week follow up patients “showed a significant reduction of symptoms of post-traumatic stress (IES-R: d=1.16).”

Ultimately research tells us that compared to same-age peers, people entering mental health services who are later diagnosed with autism experience higher rates of depression, anxiety, and psychosis (French et. al 2023). Not only do people with undiagnosed autism experience higher rates of troubling mental health symptoms, but a 2022 study in Britain found 10% of people who died from suicide had evidence of elevated autistic traits indicative of likely undiagnosed autism—a number 11 times higher than the rate of autism in the general population. As research tells us people with autism, or traits of autism, are unlikely to respond as well to therapeutic interventions unless those interventions are adapted appropriately, screening for traits of autism becomes a crucial best practice.

As a clinician I tend to utilize the CAT-Q screener as readily as I use a PHQ-9 or GAD-7. I use the CAT-Q any time a patient presents with a combination two or more diagnoses whose symptoms may align with autism. I also utilize the CAT-Q screener when I have a patient reporting chronic social difficulties or difficulties with sensory input, with patients who report a chronic history of ineffective mental health interventions, and with patients who report wondering if they have autism. Not every person with autism struggles with mental illness—but every person with autism who does enter mental health services has a right to high quality care tailored to their brains.
After all, if we only provide toaster mechanics, how will the hair dryers ever get a tune up?

Citations
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https://doi.org/10.1176/appi.books.9780890425596

Bleuler E. (1950[1911]) Dementia Praecox or the Group of Schizophrenias. New York: International Universities

Cassidy, S et al. Autism and autistic traits in those who died by suicide in England. BJPsych; 15 Feb 2022;
DOI: 10.1192/bjp.2022.21

Dietz, P. M., Rose, C. E., McArthur, D., & Maenner, M. (2020). National and state estimates of adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(12), 4258–4266. https://doi.org/10.1007/s10803-020-04494-4

French B, Daley D, Groom M, Cassidy S. Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review. J Atten Disord. 2023 Oct;27(12):1393-1410. doi: 10.1177/10870547231176862. Epub 2023 Jun 21. PMID: 37341291; PMCID: PMC10498662.

Jones, N. (2020, April 21). The CAT-Q. Embrace Autism. https://embrace-autism.com/cat-q/
Lobregt-van Buuren, E., Mevissen, L., Sizoo, B. B., & de Jongh, A. (2018, August).

Eye movement desensitization and reprocessing (EMDR) therapy as a feasible and potentia effective treatment for adults with autism spectrum disorder (ASD) and a history of adverse events. Journal of Autism and Developmental Disorders

Lotter V. (1966) ‘Epidemiology of Autistic Conditions in Young Children’, Social Psychiatry 1: 124–37 [Google Scholar]

Mary. (2010, October 11). A Hair-Dryer kid in a Toaster-Brained world.
https://www.shiftjournal.com/2010/10/11/a-hair-dryer-kid-in-a-toaster-brained-world/

Paulson, S. (2014, June). EMDR with autism. In EMDR clinical practice symposium (Marilyn Luber, Chair).
Symposium presented at the 15th EMDR Europe Association Conference, Edinburgh, Scotland

Rutter M. (1998) ‘Developmental Catch-up, and Deficit, following Adoption after Severe Global Early
Privation. English and Romanian Adoptees (ERA) Study Team’, Journal of Child Psychology and Psychiatry 39: 465–76 [PubMed] [Google Scholar]

 

 

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By: Laurie Little, PsyD
Chief Patient Experience Officer and Staff Psychologist,
Lindner Center of HOPE

In recent years, there has been a growing interest in exploring alternative and innovative treatments for mental illness. Among these novel approaches, ketamine has emerged as a promising treatment for various mental health disorders. Traditionally known as an anesthetic and pain-relieving medication, ketamine has shown potential in treating mental health disorders such as depression and anxiety.

History of Ketamine

Ketamine was originally discovered by chemist Calvin Stevens in 1962 for Parke Davis Company and was Food & Drug Administration (FDA)- approved for medical use as an analgesic and anesthetic in 1970.  It is considered a “Dissociative Anesthetic” with different dosages leading to differing effects. Lower dosages can lead to a psychedelic experience and higher dosages can lead to complete dissociation or analgesia. When using Ketamine as an analgesic, researchers noticed an intriguing off-label effect: a rapid and pronounced improvement in mood and depressive symptoms in some patients. This discovery sparked interest in exploring ketamine’s potential as a novel treatment for mental health disorders.

To curb its illicit and recreational use, the United States categorized Ketamine as a Schedule III federally controlled substance in 1999, however research into its mental health benefits continued to flourish. In 2019, the FDA approved the first ketamine derived therapy, called Esketamine, as a therapy for treatment-resistant depression.

Ketamine and Depression

Ketamine’s antidepressant effects are unique compared to traditional antidepressant medications, which typically take several weeks to produce noticeable results. Ketamine often provides immediate relief to patients who are suffering. Ketamine promotes the release of Glutamate, an essential neurotransmitter that is related to cognition, memory and mood.  Traditional antidepressants often affect neurotransmitters such as Serotonin and Dopamine and take longer to notice an improvement in symptoms.

A recently published large, systematic review of published journal articles on Ketamine treatment found “support for robust, rapid and transient antidepressant and anti-suicidal effects of ketamine. Evidence for other indications is less robust but suggests similarly positive and short-lived effects.“ The findings suggest that ketamine facilitates rapid improvements in symptoms among patients with major depressive disorder (MDD), bipolar disorder and suicidality, lasting up to 7-14 days after treatment. In some cases, effects last up to four weeks, depending on the number of ketamine sessions and the underlying mental health conditions.

There is also preliminary but growing evidence base supporting the efficacy of ketamine therapy for substance use disorders, anxiety disorders (generalized, social, OCD, PTSD)  and eating disorders.  However, just like its antidepressant effects, ketamine’s reductions in anxiety are also short-lived, and symptom recurrence is common after several weeks.

Patients who receive adjunctive psychotherapy appear to achieve the most long-lasting benefit compared with ketamine administration alone.

Ketamine Assisted Psychotherapy

Research shows that Ketamine is most beneficial when it is combined with psychotherapy. There is no current standard for how therapy and Ketamine should be combined. Some practitioners combine lower doses of Ketamine and engage in therapy during the treatment. Other practitioners use higher doses of Ketamine and have the patient engage in therapy either the following day or later in the week. Since patients notice an immediate improvement in their mood, they are more able to benefit from therapy and are more open and receptive to thinking about their current circumstances in a new, helpful way.

The Benefits and Challenges of Ketamine Treatment

The most notable benefit of ketamine treatment is its rapid and profound antidepressant effect. Unlike traditional medications, ketamine can provide relief within hours. This immediate response is particularly crucial for patients in crisis, who are suicidal or those struggling with treatment-resistant mental health conditions.

Moreover, ketamine treatment may benefit individuals who cannot tolerate or have not responded well to other standard treatments. Unfortunately, a significant percentage of patients do not find relief from standard therapies and it is important to have multiple treatment options available.

However, ketamine treatment does come with its challenges and risks.

  • Long-Term Data. One major obstacle is the lack of long-term data on the safety and efficacy of ketamine as a mental health treatment. While research has shown short-term benefits, the question of how long the benefits last requires additional investigation.
  • Misuse. Due to its powerful impact, Ketamine is also often misused. Research is still needed on the abuse potential of Ketamine. Interestingly, there is some evidence to suggest that Ketamine itself can be effective in the treatment of other substance use disorders such as alcohol and heroin. There is still much more to be learned
  • Insurance Coverage. Ketamine treatment is often not covered by insurance for mental health conditions, making it financially inaccessible for many patients. The cost of treatment, coupled with the need for repeated administrations to maintain benefits, raises concerns about equitable access to this innovative therapy.

Ketamine treatment represents a groundbreaking shift in the approach to mental health treatment. Its rapid and transformative effects on depression, anxiety and other mental health conditions have sparked hope for those who have exhausted conventional therapies. While ketamine shows immense promise, ongoing research is needed to fully understand its long-term safety and efficacy.

As the field of mental health continues to evolve, ketamine treatment has the potential to offer a lifeline to those who struggle with treatment-resistant conditions. It is crucial for the medical community, researchers, clinicians, policymakers, and insurers to collaborate in ensuring equitable access to this promising therapy.

Ketamine Therapy & Treatment in Cincinnati

If you’re seeking Ketamine Therapy in Cincinnati, the Lindner Center of HOPE is an excellent place to begin your mental health care journey. Reach out to explore your available options.

 

References

Banoff, MD, Young, JR, Dunn, T and Szabo, T. (2020). Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: A review of the literature. CNS spectrums, 25(3), 331-342.

Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, R., Charney, D. S., & Krystal, J. H. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351-354.

Feder, A., Rutter, S. B., Schiller, D., & Charney, D. S. (2020). The emergence of ketamine as a novel treatment for posttraumatic stress disorder. Advances in Pharmacology, 89, 261-286.

Krupitsky, E. M., & Grinenko, A. Y. (1997). Ketamine psychedelic therapy (KPT): A review of the results of ten years of research. Journal of Psychoactive Drugs, 29(2), 165-183.

Mia, M. (2021) Glutamate: The Master Neurotransmitter and Its Implications in Chronic Stress and Mood Disorders. Front Hum Neurosci. 15: 722323.

Murrough JW, Iosifescu DV, Chang LC, Al Jurdi RK, Green CE, Perez AM, Iqbal S, Pillemer S, Foulkes A, Shah A, Charney DS, Mathew SJ. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013 Oct;170(10):1134-42. doi: 10.1176/appi.ajp.2013.13030392. PMID: 23982301; PMCID: PMC3992936.

Chadi G. Abdallah and Lynnette A. Averil

Ragnhildstveit, A., Roscoe, J., Bass, L., Averill, C., Abdallah, C. and Averillhe, L.. (2023). Potential of Ketamine for Posttraumatic Stress Disorder: A Review of Clinical Evidence. Ther Adv Psychopharmacol, Vol. 13: 1–22, DOI: 10.1177/.

Reznikov L. R., Fadel J. R., Reagan L. P. (2011). “Glutamate-mediated neuroplasticity deficits in mood disorders,” in Neuroplasticity, eds Costa e Silva J. A., Macher J. P., Olié J. P. (Tarporley: Springer; ), 13–26. 10.1007/978-1-908517-18-0_2

Walsh, Z., Mollaahmetoglu, O., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D., and Morgan, C. (2022). Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych Open (2022) 8, e19, 1–12. doi: 10.1192/bjo.2021.1061

Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Australian & New Zealand Journal of Psychiatry. 2020;54(1):29-45. doi:10.1177/0004867419883341

Wolfson, P., & Hartelius, G. (Eds.). (2016). The ketamine papers: Science, therapy, and transformation. Multidisciplinary Association for Psychedelic Studies.

Zarate, C. A., Singh, J. B., Carlson, P. J., Brutsche, N. E., Ameli, R.,

Luckenbaugh, D. A., … & Manji, H. K. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856-864.

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

 

 

 

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

 Executive Functioning

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

Key components of executive functioning include:

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

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

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

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

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

 Self-Regulation

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

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

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

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

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

How Do We Teach These Skills

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

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

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

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

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

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

 Conclusion

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

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By Laurie Little, PsyD
Lindner Center of HOPE, psychologist

 

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

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By Jennifer B. Wilcox Berman, PsyD, Lindner Center of HOPE

 

OCD and OCPD are often mistaken for one another or used interchangeably. Although there is some overlap between the two disorders, it’s important to distinguish between them because they are quite different in many ways. It is important to note that although there are differences, some people may have symptoms of both OCD and OCPD. The two disorders are differentiated below.

Obsessive-Compulsive Disorder (OCD) is a debilitating psychiatric disorder that presents in many forms. OCD is comprised of obsessions, which are persistent and unwanted intrusive thoughts, images, or urges. To reduce or eliminate this distress or discomfort, OCD sufferers begin to engage in compulsive behavior, which is ritualized behavior or mental acts, that serve to reduce their discomfort and anxiety. It should be noted that not all compulsions are outwardly observable and may include avoidance of triggers or engaging in mental compulsions. Unfortunately, engaging in compulsions or avoidance of triggers reinforces obsessive thinking. Therefore, the goal of treatment is to reduce compulsions while learning how to tolerate the distress that comes from intrusive thoughts. Some subtypes of OCD include fears related to contamination, scrupulosity (religious-based fears)/morality, fear of harming others (aggressive or sexual), ordering and arranging, repeating, and checking. There are several other subtypes of OCD not noted here. In OCD, these intrusive thoughts are considered ego-dystonic, meaning they are inconsistent with someone’s self-image, beliefs, and values. Therefore, these obsessions cause significant distress, anxiety, and worry and can greatly interfere with one’s life. People with OCD tend to seek help when these thoughts and behaviors cause problems in their life.

According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), Obsessive-Compulsive Personality Disorder (OCPD) is “a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control.” Due to this, people with OCPD struggle with flexibility, openness to new ideas, and are often inefficient at completing tasks due to perfectionism. Their rigidity and inflexibility can lead to preoccupation with details, rules, lists, order, organization, and schedules. They can hold themselves to perfectionistic standards that interfere with their ability to complete tasks. They are often overly devoted to work and productivity at the expense of leisure activities and interpersonal relationships, leading to a poor work-life balance. People with OCPD can be overly conscientious, very scrupulous, and are often inflexible about matters of ethics, morality, and personal values. Some people with OCPD tend to be miserly, may hoard money for the future, and may have difficulty discarding worn-out or useless items. They may appear to be stubborn or rigid, and may struggle to delegate tasks or work with others because they don’t believe others will do things to their high standards. OCPD is considered ego-syntonic, meaning that it is consistent with someone’s self-image, beliefs, and values. People with OCPD tend to feel validated in their patterns of rigidity and perfectionistic rules and schedules. Therefore, people with OCPD are less likely to seek treatment, unless their behavior begins to negatively impact those around them.

While Exposure and Response Prevention (ERP) is considered the “gold standard” treatment for OCD, there is no such definitive standard intervention for OCD. Exposure and Response Prevention (ERP) is a type of Cognitive-Behavior Therapy (CBT). Cognitive-Behavior Therapy varies from other types of talk therapy in that it is focused on changing thinking patterns and behaviors. It tends to be directed at the present, rather than the past and is goal-oriented and solution-focused. ERP aims to change behavioral patterns, allowing someone to confront their fears and therefore, reduce their OCD symptoms. Exposure refers to the direct confrontation of one’s fear through voluntarily taking steps towards their fears and triggers. Response Prevention refers to someone voluntarily agreeing to reduce their usual rituals and compulsions. It is very important for someone who is working on doing exposures to simultaneously refrain from engaging in compulsions. Without reducing or refraining from the related compulsions, the person cannot learn that they can tolerate the exposure or that the compulsion is unnecessary.

Treatment for OCPD tends to focus on the identification of rigid rules and lifestyle and how these things may be negatively impacting one’s life. Therapeutic intervention includes working on flexibility, willingness to make changes, and focusing on one’s values as motivation for change.

For those suffering from symptoms of OCD or OCPD, therapeutic intervention can be helpful. It is important to seek a specialized provider that can accurately diagnose and treat these disorders.

 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Grant, J. E., Pinto, A., & Chamberlain, S. R., (Eds.) (2020). Obsessive compulsive personality disorder.    American Psychiatric Association Publishing.

Hyman, B. M., & Pedrick, C. (2010). The OCD workbook: Your guide to breaking free from obsessive-compulsive disorder (3rd ed.). New Harbinger.

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By Peter White, M.A., LPCC, LICDC, Lindner Center of HOPE Outpatient Therapist

The problem during Bipolar Mood Disorders is a pattern of swings of the essential elements of mood between the two poles, like the North Pole and South Pole, of Mania and Depression. These swings are not moodiness, which are swings of mood throughout a day. A Bipolar swing is a distinct period of at least one week when the full spectrum of mood elements exhibits depressive and/or manic elements.

Although thought of as a subjective experience, mood deeply influences three areas. First is metabolism – sleep, appetite, libido and energy levels. Second, mood influences both motivation as well as the ability to experience pleasure and/or a sense of accomplishment. Thirdly, mood deeply influences interpretations within thoughts from positive to neutral to negative.

So, we can think of this first spectrum of mood disorder along an axis of depression to neutral to manic. Therefore, a depressed mood will depress metabolism. A person will have difficulty with sleep through either excessive or inadequate or disrupted sleep, loss of appetite or excessive eating despite disrupted appetite, loss of libido as well as loss of energy. Depression will hinder motivation making it difficult to experience the drive to initiate activities as well as hinder pleasure or the reward of activity. This is a very difficult cycle when it is hard to get active in the day compounded by not finding any pleasure or reward in the day’s activities. Lastly, depression will darken the flow of thoughts adding many themes of hopelessness, helplessness, worthlessness and guilt into our thought process.

Conversely, mania will elevate the same essentials. It will increase energy levels often in the face of declining sleep hours. It will increase libido, increase excessive and/or absence of appetite. It will increase motivation often leading to excessive engagement of plans or activities and will create a compounding loop of all activity feeling especially pleasurable or rewarding. Again, conversely is will paint thinking with elevated judgements of specialness, invulnerability, and inevitable positive outcomes.

The second spectrum of mood disorders, like most other behavioral health problems, is along the spectrum of severity – mild to moderate to severe. If you combine this spectrum of severity along with the first spectrum of depressive to manic, we see how varied and individualized any person’s experience with Bipolar Mood disorders can be.  Most people can relate to some degree of depression during periods of their life with perhaps a few weeks or month of low energy, noticing that they are not getting the same rewards in their regular activity as well as perhaps noticing they are thinking unusually negatively about themselves and their outlook on life. We might call this a mild, brief depressive episode. But the reality is that depression is one of the most disruptive and costly of all health conditions as recognized by the World Health Organization. This mean that depression is often moderate or severe to very severe and can disrupt functioning on every level for weeks to months if not years. A severe depression can make it difficult to get out or bed for days on end both from collapsed energy and motivation. It can destroy the pleasure and rewards of living so that all activity feels like a painful chore at best. Finally, it can turn thoughts dangerously dark with so much hopelessness, helplessness and worthless that suicidal thinking emerges nearly with a sense of relief.

Again conversely, though experienced less often by most people, Manic Episodes can present with mild, moderate, severe and very severe intensity. During a sever episode, a person with manic symptoms is often sleeping little but maintaining very high levels of energy. They are often talking very quickly and sometimes laughing excessively and outside the context of humorous things. Given the very high levels of motivation and the reinforcement of pleasure in all activities, they often initiate an excessive number of activities – starting multiple projects with little awareness of the ability to balance or complete them. They frequently initiate conversations or relationship in an open or disinhibited style very unusual for to their character. With elevated thought patterns, they might believe they have a unique or special purpose, and they are convinced that all their activities will be successful and rewarding. Give the excessive energy, motivation, pleasure and elevated sense of self and success, people in manic states will often engage in behavior patterns much riskier than typical – spending money well beyond their mean, unusually disinhibited sexual decision, reckless driving, shop lifting.

I hope it’s useful to review the way mood symptoms fluctuate along these two spectrums, because like all health care conditions, we are best off when we accurately identify what these behaviors are – symptoms. Mood symptoms are not moral challenges, personality traits or unconsciously desired behaviors. Mood symptoms are symptoms, and fortunately, there are many very effective treatments for all symptoms along both spectrums. Please know if you or a loved one or a client is experiencing any degree of Bipolar mood problems, there will be many ways to help and cope, and experience the satisfaction of effectively treating a behavioral health care condition.

 

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

 

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

What is Dieting

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

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

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

The Potential Harmful Effects of Dieting

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

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

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

 

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

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Danielle Johnson, MD, FAPA
Lindner Center of HOPE/Chief Medical Officer
University of Cincinnati College of Medicine Adjunct Assistant Professor of Psychiatry

Medications are undoubtedly an important tool in the treatment of mental illnesses. Expert application of psychopharmacology is a game changer in improving symptoms of mental illness and helping individuals achieve a manageable baseline. Complex co-morbidities and severe mental illness make prescribing even more complex.

Psychiatric medications can stabilize symptoms and prevent relapse. They work by affecting neurotransmitters in the brain. Serotonin is involved in mood, appetite, sensory perception, and pain pathways. Norepinephrine is part of the fight-or-flight response and regulates blood pressure and calmness. Dopamine produces feelings of pleasure when released by the brain reward system.

One in ten Americans takes an antidepressant, including almost one in four women in their 40s and 50s. Women are twice as likely to develop depression as men.

Selective Serotonin Reuptake Inhibitors (SSRIs) Side Effects

Selective serotonin reuptake inhibitors (SSRIs) increase levels of serotonin. Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) treat depression, anxiety disorders, premenstrual dysphoric disorder, eating disorders, and hot flashes. Potential side effects include jitteriness, nausea, diarrhea, insomnia, sedation, headaches, weight gain, and sexual dysfunction.

Zoloft Side Effects in Women

Zoloft, also known by its generic name sertraline, is an antidepressant medication that can cause a range of side effects in women. Some of the common side effects of Zoloft include nausea, diarrhea, headache, dizziness, dry mouth, drowsiness, and difficulty sleeping. Women may also experience sexual side effects such as decreased libido, difficulty reaching orgasm, and erectile dysfunction. In some cases, Zoloft may cause weight gain or weight loss, and it can also affect blood pressure and heart rate. Rare but serious side effects of Zoloft in women may include seizures, serotonin syndrome, and suicidal thoughts or behavior.

Prozac Side Effects in Women

Prozac, also known by its generic name fluoxetine, is an antidepressant medication that can cause a range of side effects in women. Some of the common side effects of Prozac include nausea, diarrhea, headache, dizziness, dry mouth, drowsiness, and difficulty sleeping. Women may also experience sexual side effects such as decreased libido and difficulty reaching orgasm. Prozac may also cause weight gain or weight loss, and it can affect blood pressure and heart rate. Rare but serious side effects of Prozac in women may include serotonin syndrome, suicidal thoughts or behavior, and seizures.

Lexapro Side Effects in Women

Lexapro, also known by its generic name escitalopram, is an antidepressant medication that can cause a range of side effects in women. Some of the common side effects of Lexapro include nausea, diarrhea, headache, dizziness, dry mouth, drowsiness, and difficulty sleeping. Women may also experience sexual side effects such as decreased libido and difficulty reaching orgasm. Lexapro may also cause weight gain or weight loss, and it can affect blood pressure and heart rate. Rare but serious side effects of Lexapro in women may include serotonin syndrome, suicidal thoughts or behavior, and seizures.

Serotonin-norepinephrine Reuptake Inhibitors (SNRIs) Side Effects

Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase levels of serotonin and norepinephrine. Venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq) are used to treat depression, anxiety disorders, diabetic neuropathy, chronic pain, and fibromyalgia. Potential side effects include nausea, dry mouth, sweating, headache, decreased appetite, insomnia, increased blood pressure, and sexual dysfunction.

Tricyclic Antidepressants Side Effects

Tricyclic antidepressants (TCAs) also increase serotonin and norepinephrine. Amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), nortriptyline (Pamelor), doxepin (Sinequan), trimipramine (Surmontil), protriptyline (Vivactil), and imipramine (Tofranil) are used to treat depression, anxiety disorders, chronic pain, irritable bowel syndrome, migraines, and insomnia. Possible side effects include sedation, forgetfulness, dry mouth, dry skin, constipation, blurred vision, difficulty urinating, dizziness, weight gain, sexual dysfunction, increased seizure risk, and cardiac complications.

Other Antidepressants Side Effects

Wellbutrin Side Effects in Women

Bupropion (Wellbutrin) increases levels of dopamine and norepinephrine. It treats depression, seasonal affective disorder, ADHD, and can be used for smoking cessation. It can also augment other antidepressants. Potential side effects include anxiety, dry mouth, insomnia, and tremor. It can lower the seizure threshold. There are minimal to no sexual side effects or weight gain.

Trazodone (Desyrel, Oleptro) affects serotonin and mirtazapine (Remeron) affects serotonin and norepinephrine. They are both used for depression and sleep. Mirtazapine has minimal sexual side effects.

Monoamine oxidase inhibitors (MAOIs) increase serotonin, norepinephrine, and dopamine. Isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and moclobemide are associated with more serious side effects than other antidepressants. There are dietary restrictions and numerous drug interactions. MAOIs are often used after other antidepressant classes have been tried. Other antidepressants need to be discontinued for a period of time prior to starting an MAOI.

Newer antidepressants include Viibryd (vilazodone) which affects serotonin, Fetzima (levomilnacipran) which affects serotonin and norepinephrine, and Brintellix (vortioxetine) which affects serotonin. Brintellix and Viibryd have mechanisms of action that make them unique from SSRIs. Viibryd is less likely to cause sexual side effects.

Excess serotonin can accumulate when antidepressants are used with other medications that effect serotonin (other antidepressants, triptans for migraines, certain muscle relaxers, certain pain medications, certain antinausea medications, dextromethorphan, St. John’s Wort, tryptophan, stimulants, LSD, cocaine, ecstasy, etc.) Symptoms of serotonin syndrome include anxiety, agitation, restlessness, easy startling, delirium, increased heart rate, increased blood pressure, increased temperature, profuse sweating, shivering, vomiting, diarrhea, tremor, and muscle rigidity or twitching. Life threatening symptoms include high fever, seizures, irregular heartbeat, and unconsciousness.

Estrogen Levels With Antidepressants in Females

Varying estrogen levels during the menstrual cycle, pregnancy, postpartum, perimenopause, and menopause raise issues with antidepressants and depression that are unique to women. Estrogen increases serotonin, so a decrease in estrogen at certain times in a woman’s reproductive life cycle can reduce serotonin levels and lead to symptoms of depression. Hormonal contraception and hormone replacement therapy can reduce or increase depressive symptoms; an increase in symptoms may be more likely in women who already had major depressive disorder. During pregnancy, antidepressants have a potential risk to the developing baby but there are also risks of untreated depression on the baby’s development. With breastfeeding, some antidepressants pass minimally into breast milk and may not affect the baby. The benefits of breastfeeding may outweigh the risks of taking these medications.   Antidepressant sexual side effects in women are vaginal dryness, decreased genital sensations, decreased libido, and difficulty achieving orgasm. Women should communicate with their psychiatrist and/or OB/GYN to discuss the risks and benefits of medication use vs. untreated illness during pregnancy and breastfeeding; the use of hormonal treatments to regulate symptoms associated with menses and menopause; and the treatment of sexual dysfunction caused by antidepressants.

It has been observed that some antidepressants can affect estrogen levels in women. The exact mechanisms behind these effects are not fully understood, but it is thought to be related to the interactions between the medication and the hypothalamic-pituitary-gonadal (HPG) axis, which is responsible for regulating estrogen production. It is important for women to discuss any potential effects of antidepressants on estrogen levels with their healthcare provider, especially if they have a history of hormonal imbalances or are taking hormonal therapies.

It is important for women to discuss any potential side effects with their healthcare provider before starting any depression medication.

Lindner Center of HOPE’s Approach

Lindner Center of HOPE’s residential services employ full-time psychiatrists with expertise in psychopharmacology. These prescribing physicians are designated members of each residential client’s treatment team. Medication management within Lindner Center of HOPE’s residential programs is also supported by 24/7 psychiatry and nursing staff, onsite pharmacy and an innovative Research Institute.

In some cases, patients over the course of treatment for mental illnesses accumulate many prescriptions. In cases like this, Lindner Center of HOPE’s residential units can offer a safe environment for medication assessment and adjustment. While the client participates in appropriate evaluation and treatment, their psychiatrist can also work with them on reaching rational polypharmacy — in other words, medication optimization.

For patients with more severe, treatment-resistant mental illness, Lindner Center’s psychiatrists can implement the most complicated, and often hard to use, treatments, in a safe environment, while under their observation.

If medication adjustments result in decompensation on the residential units, a patient can be temporarily stepped up to an acute inpatient unit on the same campus.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-Dr. Stephen Porges