Category: Mental Illness

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By Chris J. Tuell, EdD, LPCC-S, LICDC-CS
Lindner Center of HOPE, Clinical Director of Addiction Services; Assistant Professor, Department of Psychiatry & Behavioral Neuroscience
University of Cincinnati College of Medicine

At the end of the Vietnam War in 1975, 1 out of 5 soldiers (20%), returning to the United States from Southeast Asia, was addicted to heroin. It was estimated that approximately 100,000 American soldiers would be returning home, addicted to this destructive drug. Experts projected a drug epidemic, which would destroy countless lives and communities. It never happened.

Once soldiers returned home to families, friends and communities, the destructive nature of a hardcore drug, like heroin, failed to materialize. In fact, 95% of the soldiers who were once addicted to heroin, stopped using the drug almost immediately once they returned home.

For many years, our understanding of addiction was based on early research conducted in the first half of the 20th century. These studies involved rats and consisted of placing a rat in a solitary cage, providing the rat with a choice of water: plain water or water laced with cocaine or heroin. The study found that all the rats preferred the drug-laced water to the plain water. All the rats overdosed on the drug. The majority of the rats died in the study. This became our model of addiction for many years. The accepted belief became, if you are exposed to a drug, you will become addicted, and you may overdose and die.

Several years later, this original study was replicated, but with a significant difference. Researcher Bruce Alexander from the University of Vancouver, created, what was referred to as: a “rat park.” This park consisted of tunnels, multiple levels, toys, and other rat companions. Similar to the original study, all rats were given the same choice of water: plain water or water laced with heroin or cocaine. In Alexander’s study, rats preferred the plain water. Rates of overdose and death to the rats were significantly lower when compared to the initial study. How do we explain this difference in results? Perhaps, it is about the cage. Perhaps, it is about the environment.

Upon their return home, the soldiers from Vietnam who were struggling with a heroin addiction were able to re-connect with loved ones and community. A change in environment allowed for a change in connection, resulting in health, wellness and sobriety. Likewise, the environment of the rat in a solitary cage, as compared to the environment of the rat park, provided the rat with a “connection” with other rats, an environment which allowed the rat…to be a rat.

Individuals, who experience issues of mental illness and/or substance use disorders, have a natural tendency to withdraw and isolate from others. Depression, anxiety and addiction, greatly affect an individual’s ability to connect with others, let alone with one’s environment. This past year we have seen the devastating impact of COVID-19. We know that in order to maintain health and wellness, we need to maintain social distance and disconnect from one another. For now, this has and continues to be, what we need to do. It remains challenging for many of us to continue to avoid contact with loved ones and friends. We are separated from the very individuals who love us, support us, and are our sources of connection.

We have seen the rise of mental health issues during the past year. Nearly 20 percent of COVID-19 patients have developed a mental health issue (i.e., depression, anxiety) within three months of their diagnosis. During the past year, 4 in 10 adults in the U.S. have reported symptoms of anxiety or depression. Within the general population, rates of mental health issues and substance use have significantly increased across the board. In addition, the disconnection that we have witnessed has fragmented our society in general by harboring increased levels of fear, anger and animosity towards one another.

Hope on the horizon

Once “herd immunity” is achieved, the importance of re-connecting with one another becomes vital and essential to our health and mental wellness. We are social beings and need connection with one another. History has shown that the mental health impact of disasters outlasts the physical impact, suggesting today’s elevated mental health needs will continue well beyond the coronavirus outbreak.  Like the moth that needs to struggle out of the cocoon in order to develop the strength that it needs to survive in the world, we too are developing the strength that we need from the struggles we have endured.  Re-connecting with one another is an answer.  It gives us strength and it gives us hope.

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By Angela Couch, RN, MSN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE

Anxiety is a common symptom. Anxiety is a part of everyone’s lives, we have all experienced it to one degree or another. Believe it not, anxiety serves some useful purposes. Anxiety can help give you the drive to make a change, or complete task on time.Anxiety can activate the fight or flight instinct, in a “potentially” dangerous situation, giving you the drive to get out of there, or do something to prevent harm. Anxiety can occur when you are enduring multiple stressors, or there is uncertainty, and it’s not entirely unexpected.

For instance, say you hear layoffs are coming in the company, and you’re not sure if your department will be affected. You may experience physical symptoms of anxiety (which could include racing heart, nervous stomach, sweating, tremor, nausea, shortness of breath, and more), and you might also experience worry. COVID-19…yup, that can cause some anxiety, or worry, too! Situational anxiety is a part of life, and often can be managed by rational self-talk, problem-solving, and various positive self-care strategies. (For more on that, see some of our other recent blog articles, for lots of helpful ideas!) So how do we know when the anxiety is more than just “normal” or to be expected, and when to seek help?

According to the National Comorbidity Study Replication, about 19.1% of U.S. adults will have had an anxiety disorder in the past year, and 31.1% experience an anxiety disorder in their lifetime. In other words, it’s pretty common! There are various types of anxiety disorders, and most have an underlying common thread– difficulty in accepting uncertainty in some form. So how do you know if you may need to seek further assessment or help for anxiety, if it’s really so common? If everyone gets it, is it really a problem that requires treatment? The answer is yes, it might. Some symptoms that may indicate problematic anxiety include:

* Feeling “paralyzed” by fear.

* Anxiety is causing you to avoid things you used to be able to do without anxiety, or things that are important to you (this could include social activities, leaving your house, going to your job, driving, engaging in spiritual activities, etc.).

* You have difficulty staying present “in the moment”, which may repeatedly distract you from attending to conversations, being able to complete work or school tasks because of lack of focus.

* You are having difficulty with sleep or eating due to excessive worry or anxiety.

Anxiety is causing significant physical symptoms.

* You cannot determine a cause for the anxiety and the symptoms are persistent or very bothersome.

* You worry about “everything” or “all the time”.

* The anxiety/worry you are experiencing about situations seem excessive.

* You need to engage in compulsive or repetitive behaviors, or do things in a certain way, in order to avoid significant anxiety/worry.

* Anxiety is causing you to turn to self-medication with alcohol or substances.

So you’ve determined you should seek help, now what? Psychotherapy can be helpful for anxiety, and is a very important component of treatment. Psychotherapy may include several modalities such as cognitive behavioral therapy, addressing faulty beliefs contributing to anxiety, psychoeducation about anxiety and worry, problem-solving, exercise and wellness activities/lifestyle changes, addressing sleep hygiene, skills for time management and stress reduction, or exposure therapy, just to name a few.

How do you know if psychotherapy is enough to manage the symptoms? Medication can be a helpful component in treatment of anxiety, particularly if symptoms are not improving with other psychotherapeutic interventions mentioned above. Medications alone are rarely enough to treat anxiety disorders adequately. Medication can often make it easier to engage in meaningful psychotherapy, to make those helpful lifestyle changes, or try new ways of coping with the anxiety/worry. If you are experiencing suicidal thinking or significant depression, medication should be a consideration. If the anxiety symptoms are preventing you from being able to work or do other essential tasks, medication may be indicated. If your therapist suggests a medication consultation, you should consider it.

The important things to remember are, everyone has some anxiety, not all anxiety is bad, and when anxiety does become problematic or excessive, there are evidence-based treatments to help, so don’t be afraid to reach out for help!

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CBT and Psychosis

Many think that psychosis cannot be targeted with cognitive behavioral therapy, but that is not the case. There is a specific form of therapy that was developed for psychosis called CBTp. One important point to mention is that the symptoms are only targeted when they are distressing to the client and they interfere with their functioning or safety, not because one believes them to be untrue or abnormal. The main tenet is to join with the client and build rapport while not directly challenging their psychosis, which is referred to as working within their belief system. Once this is established, gradually helping them think differently about some of their experiences or beliefs is possible, but not in all cases. In some cases, the cognitive therapy is used to help them live their life and meet their goals in spite of their experiences or beliefs.

Combatting Stigmatization

One useful technique with this therapy is to help them feel less stigmatized and normalize some of their experiences. There are specific websites out there that detail stories and list famous people out there who have struggled with psychosis, which can be very helpful for the client to read about. One such website is intervoiceonline.org.

Effective Coping Strategies

Another very practical technique is helping them set smart and realistic goals. This can be done by asking what their goals are and developing a shared goal that can be accomplished. For example instead of “wanting the voices to stop” a smart goal could be “by the fourth session I will have learned and used two different coping strategies that reduce how much distress the voices cause from 100% to 75%”.

Other strategies that CBTp utilizes are coping strategy enhancement. First you figure out what they already are using to cope and figure out if they need to be refined or improved. Helping them figure out the time of day to use these strategies is important. They are likely to be most helpful when their voices are triggered, such as certain times of the day, a specific place, a certain smell, or certain feeling. Some strategies that can be useful to use before their voices are triggered include progressive muscle relaxation, deep breathing, and practicing mindfulness of the present moment such as identifying things in the room. Strategies that can be helpful once the voices are already triggered include: using an ipod and listening to a feel good songs playlist; playing the look, point and name; using sub vocal speech or singing under one’s breath which can interrupt the voices; focusing on voices (hearing out in order to change relationship with voice); entering into dialogue with them, and setting specific times for listening to voices.

CBTp Objectives and Techniques

When targeting voices in sessions, there are several main goals. One is to help the client understand how their beliefs and thoughts relate to the voices and influence their feelings, mood, and coping.  Another is to help them identify their beliefs about their voices. Helping them explore evidence for and against their distressing beliefs is important. One can also develop behavioral experiments to test out the reality of their belief. Helping them generate alternative explanations and thoughts about their voices is also helpful. Providing behavioral interventions to reduce distress associated with their voices is key as well. Lastly, helping them change their relationship to their voices is important.

As you can see, there are many strategies that can be useful in psychosis treatment for this presenting problem.
The key it to present it in a way that is collaborative with the client and doing so in a trusting professional relationship. Meeting the client where they are at is important. It is also helpful to keep in mind that these techniques take some time to work and for the client to be able to use them, so patience is key as well.

 

 Nicole Bosse, PsyD

Staff Psychologist, Lindner Center of HOPE

 

 

 

 

Established in 2008, Lindner Center of HOPE has stood as a beacon of support for countless individuals grappling with mental health issues or addiction. Contact the Lindner Center of HOPE today to learn more about our comprehensive suite of mental health treatments and services, our environment fosters enduring recovery. Powered by our dedicated psychologists, the Lindner Center of HOPE is wholly devoted to instilling hope and guiding you on your personal journey to wellness.

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Fortunately, our culture has recently seen a gradual erosion of the stigma regarding emotional disorders, along with an increased understanding of such conditions. However, a less well-understood aspect of emotional disorders is the impact that they have on the cognitive functioning of those who are afflicted. Disorders such as Major Depression, Bipolar Disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, and Schizophrenia all tend to interfere with one’s ability to access the full extent of their cognitive abilities, adding to the burden that these conditions create.

Regarding Major Depression, it is the one disorder that the DSM-V lists cognitive difficulties as one of the diagnostic criteria (diminished ability to think or concentrate, or indecisiveness, nearly every day). As a neuropsychologist, I routinely encounter patients who are all too aware that their depression impacts their ability to think clearly, to focus, and to recall everyday interactions. Part of the reason for this is that depression causes a reduction in processing speed, as well as the energy that it takes to attend to conversations and events. Difficulties with maintaining attention, and “keeping up” with things going on around them, these patients experience troubles recalling information, sometimes so profoundly that they begin to fear that they may have dementia. However, as their depression is more effectively treated, they regain full access to their cognitive skills and abilities.

Anxiety disorders also are accompanied by significant cognitive difficulties, for a couple of reasons. First, when the mind is anxious, most of the brain’s resources (blood flow, oxygen, glucose, etc.) are redirected to the emotional centers of the brain (the limbic system), and away from parts of our brain that mediate higher-level thinking and logic. Secondly, those who are anxious tend to be rather “internally-oriented” in their thinking, and so they are not as attentive to external events. In other words, because they become preoccupied with their fears and worries, the ordinary events of the external world can be largely overlooked. As a result, these ordinary events are not well-encoded into the memories of anxious patients, and therefore they cannot easily be recalled. As with depression, as anxiety becomes better managed, these cognitive issues largely resolve.

Two other diagnoses have profound implications for cognitive functioning. Bipolar disorder has a well-established pattern of cognitive difficulties, including diminished attention, verbal memory, and executive functioning abilities (planning, anticipating, problem-solving, emotional regulation, staying focused and attentive to personal goals, etc.) These difficulties, fortunately, are typically limited to times that these patients are actively experiencing a mood episode, whether it be depression or mania. Regarding those with schizophrenia, they experience similar cognitive difficulties. However, they often continue to experience such cognitive difficulties even when their symptoms of schizophrenia have been well-controlled with treatment. This is why the DSM-V lists “associated features” of schizophrenia specific to these difficulties, explaining that, “Cognitive deficits in schizophrenia are common and are strongly linked to vocational and functional impairments.”

Fortunately, over the past 20 years there have been treatments and interventions to address such cognitive difficulties. Cognitive Enhancement Therapy, or CET, has been developed and implemented for the mentally ill for whom cognitive problems are getting in the way of living independently, maintaining employment, and sustaining meaningful relationships. It has proven to be an effective means to address such difficulties, and for providing a much higher quality of life. It is anticipated that, as the benefits of CET become more evident to those working with the mentally ill, its positive impact will widen in both its breadth and depth.

Thomas A. Schweinberg, PsyD Staff Psychologist Lindner Center of HOPE

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In the United States, suicide is the 10th leading cause of death.  The rate increased 33% from 1999 through 2017 according to the Centers for Disease Control and Prevention.  The American Foundation for Suicide Prevention states that “suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair.” For some, the COVID-19 pandemic could create this experience. The pandemic has produced a condition that has increased many of the risk factors for suicide: feelings of depression and anxiety, increased alcohol and substance use, serious physical health conditions, unemployment, financial crisis, illness or death of a loved one, isolation, and decreased access to care.

Social distancing and isolating at home have limited access to coping skills and reduced suicide protective factors. People no longer have in person contact with behavioral health providers, there is decreased connectedness to support systems, and no access to gyms, art studios, massage therapy, beauty salons, barbers, etc.  With fewer physical and creative outlets, healing therapies, and self-care that improves self-esteem, people can feel lost. They also no longer have physical access to places of worship where the social connection was as important as the message or music.  It important to remember that we need to maintain physical distancing rather than social distancing – it is necessary to maintain physical separation to not contract the virus but other ways of maintaining social connections are still very important.

Another risk factor that staying at home can bring is closer proximity to abusers. Children of abusive parents who are no longer in school are now with their abusers all day and adults with abusive partners are also with their abusers more often. Adverse childhood experiences are associated with 2 to 3 times more suicide attempts later in life and victims of intimate partner violence are twice as likely to attempt suicide.

Staying at home also increases access to lethal means so it is imperative to either remove guns from the home or ensure they are locked securely and reduce access to other lethal means (such as large amounts of extra medications, excess amounts of alcohol, ropes/cords) in the home for people who are high risk for suicide.  For homes with large amounts of prescription medications due to multiple health conditions, a medication safe is recommended.

For people with loved ones who have risk factors for suicide, it is important to know the warning signs. Warning signs include talk of: killing themselves, feeling hopeless, having no reason to live, being a burden, feeling trapped, and unbearable pain; behavior: increase use of alcohol and drugs, looking for a way to end their lives (including internet searches), withdrawing from activities, isolation from family and friends, too much or too little sleep, saying goodbye to people, giving away possessions, aggression, and fatigue; and mood: depression, anxiety, loss of interest, irritability, humiliation/shame, agitation/anger, and relief/sudden improvement.  If you notice these warning signs, it is important to ask a person directly if they are having thoughts of suicide and if they are, get them help by contacting their mental health providers, calling a crisis line, taking them to an emergency department, or calling 911. Visit take5tosavelives.org or bethe1to.com to learn how to talk to your loved ones about suicide. Due to COVID-19, people have tried to avoid emergency departments and hospitals but if someone you love is unsafe do not hesitate to get them the help they need.

What are ways to increase coping skills and protective factors in our current climate? Take advantage of telephone or video appointments offered by your mental health providers. If you do not already have mental health providers, now is a good time to seek treatment – practices are still accepting new patients and insurances are covering telephone and video appointments. To reduce worry and fear, limit media consumption about COVID-19. Stick to a routine, stay physically active, get outside with appropriate physical distancing, get enough sleep, limit alcohol, and eat healthy. If you feel you have a problem with alcohol, substances, overeating, or other addictive behaviors – there are online support groups. Connect with loved ones by phone, social media apps, video apps, or writing. Consider safe altruistic ways to connect with others – making masks, running errands for vulnerable loved ones, donations, etc.

How can you get help?  Crisis Text Line: text HOME to 741741, they can also be messaged on Facebook messenger.

National Suicide Prevention Lifeline 1-800-273-8255

YouthLine answered by trained teen peer support from 4 pm – 10 pm and by adults from NSPL during other hours 877-968-8491 or text teen2teen to 839863

Childhelp National Child Abuse Hotline text or call 1-800-422-4453

National Domestic Violence Hotline 1-800-799-7233 or text LOVEIS to 22522

Mental Health America Support Group Directory www.mhanational.org/find-support-groups

Lindner Center of HOPE 513-536-HOPE

 

Danielle J. Johnson, MD, FAPA Lindner Center of HOPE, Chief Medical Officer

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Times are uncertain. The world feels scary. Our normal day to day life has been turned upside down. Let me just start by saying this, if you are feeling anxious, scared, overwhelmed, frustrated… you are allowed to feel these emotions, it makes total sense why you feel this way, you are not alone, and you are not weak. Remember, pain in life is unavoidable, but suffering is a choice. Meaning, we are going to experience stress in our life, every person on this planet will, but it is ultimately how we respond to that stress that influences exactly how much pain we will experience. Let’s walk through some ways we can live with anxiety during times of stress.

Mindfulness of Emotions. When it comes to managing our anxiety during times of stress, an important first step that we tend to overlook is mindfulness. In order to reduce anxiety, we must first acknowledge that it is there. Allow yourself to pause and put a name on what you are feeling, notice if you feel it physically in your body, observe what thoughts are running through your mind. Try using the stem “I am aware of the emotion of ______, I am aware of the thought that _______.”  By bringing mindful awareness to our anxiety in this way, we are bravely choosing to face our discomfort while also seeing it as something that we are experiencing in that given moment, not who we are or the way things will always be.

Self-Compassion. Now that you are observing your anxious mind in action, practice some self-compassion by normalizing the experience, validating its’ presence, being “kind to your mind.” We tend to create more suffering for ourselves when we judge ourselves for our emotions, when we tell ourselves we should not be feeling that way, or try to just “suck it up.” You are an amazing human doing the best you can with some really hard human things right now!

Changing Emotional Response. While part of our goal is accepting the anxiety through mindfulness and self-compassion, we also have the ability to create change in our emotional state and our response to it. First, we need to “check the facts” and get a good look at what our mind is telling us. Our minds tend to be great storytellers, mind readers, and fortune tellers. While these seem like super powers, these are actually mind tricks and traps that create more suffering. Checking the facts is seeing if your emotion and its’ intensity actually match reality (i.e., are valid), or if you are responding to a mind trick.

Next, ask yourself if the action urge associated with the emotion you are feeling is effective? For example, is being angry with your partner because they did not clean the house then throwing a shoe at them actually helpful here??  If the emotion is invalid and/or ineffective, we want to act opposite to what the emotion is telling us to do. So instead of avoiding work responsibilities because we are stressed, make a specific schedule to complete tasks. Instead of spending hours reading the news because we are scared, watch one news program then spend the rest of the day playing with the kids or watching movies.

Acceptance. Consider what is and what is not in your control. If there is a stressor that is in your control, practice problem solving. For stressors we cannot control, accept that we cannot change that reality and focus instead on what in the here and now is in your power. Remember, rejecting reality does not change reality. Instead of dwelling on how terrible it is to be stuck at home, make plans for a game night, clean out that room you have been avoiding, soak up the springtime outdoors.

Practice Gratitude. Lastly, practice gratitude every day. Spend some time thinking about what you have that you are grateful for rather than hyper-focusing on what you don’t have or what has been taken away, which tends to just create more stress. Be specific, instead of just saying you are grateful for your family, say “I am grateful that today my kids helped clean the kitchen and cuddled with me on the couch.”

We as humans are under an incredible amount of stress right now, but remember, as humans we are also incredibly strong and resilient.  Importantly, please know you do not have to struggle with this alone. Sometimes the strongest thing we can do is ask for help. If your anxiety is persistent and intense and/or is significantly interfering with your life, please reach out to a mental health therapist. Telehealth services are being offered across the region, including at the Lindner Center of HOPE, who has a whole team of providers eager to help guide you through this.

By Allison Mecca, PsyD
Lindner Center of HOPE, Staff Psychologist, Harold C. Schott Foundation Eating Disorders Program

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Quarantine.Isolation . Lockdown.

Who could have ever predicted that these words – so often associated with scary movies or rare, brief safety emergencies – would become so commonplace in our social language? The terms, themselves, being so casually thrown around that we’ve nearly become numb to their actual magnitude? The concept of loneliness is a broad one: certainly, this can describe distance or literal, geographical separation from others; however, it is also quite possible to experience loneliness while physically surrounded by people. This often arises in response to feeling misunderstood or “different” from those around us, or through a belief that we are truly alone in our struggles and suffering.

 

When in this state of mind, it’s easy to inadvertently fall into self-destructive patterns and habits that further worsen the depth of isolation we experience. This tends to be easier to “catch” in the “normal” world – someone is missing days at work or school, not showing up to family events, skipping appointments. However, in the midst of the COVID19 pandemic, this has become more difficult to identify, both in ourselves and in family members or friends. In this strange new reality, maladaptive coping might present through symptoms of depression:

– Withdrawing from others by declining phone calls or choosing not to respond to text messages
– Staying in bed during times when you’re not sleeping or physically in need of rest
– Deferring school assignments or work deadlines in favor of binging on Netflix series for extended periods of time
– Not leaving the house for fresh air when weather permits
– Declining hygiene practices and decreased attention to nutritional needs and physical activity
– Self-medicating through alcohol or drug use

In contrast, some individuals experience severe levels of anxiety when facing loneliness or isolation. Those with pre-existing obsessive-compulsive disorder, anxiety or impulse-control disorders, eating disorders, or traits of perfectionism may attempt to cope with isolation by trying to gain a sense of control over specific aspects of their lives. This could present as:

– Excessive cleaning, organizing, list-making in the home without clear need to do so
– Catastrophic thought processes with over-indulgence in news reports and social media
– Difficulty sleeping or resting due to racing thoughts
– Flare-ups of previous OCD rituals or disordered eating patterns
– Difficulty concentrating on school assignments or work due to preoccupation with above concerns

One of my favorite, go-to methods for combating these negative impulses is an emotion regulation technique called “opposite action,” a concept originating from the skill sets taught in dialectical behavioral therapy (DBT). This technique forces us to identify our emotion and the urges or impulses that go along with it, and to assess their degree of helpfulness or harmfulness by challenging them with facts. If found to be irrational or maladaptive, then we aim to implement the opposite of our emotion-driven impulse. We actually implement opposite action frequently through our lives without necessarily naming it as such. By identifying the technique, though, we
can consciously choose to use this skill when our level of motivation to change is low. Consider this example
(modified content courtesy of PsychPoint.com):

STEP ONE: Identify the emotion you’re looking to change. You’re really anxious about leaving home to go
on vacation.
STEP TWO: Identify the urges/impulses associated with the emotion. You actively avoid booking the
vacation by burying yourself in work and household tasks to subconsciously convince yourself that you simply
do not have the time to take a vacation.
STEP THREE: Assess whether the urge or behavior fits the facts of the situation. You have plenty of unused
vacation time and recognize that your year-end productivity will not be negatively impacted by taking the break.
You’ve taken vacations before and your family has benefited from the escape each time.
STEP FOUR: If the emotion and behavior does not fit the situation, then apply the opposite action.
Create a manageable schedule / timetable to take the steps necessary to search for and secure the logistics
required for booking the trip.
STEP FIVE: Experience the opposite emotion. Experience the excitement involved with planning activities
and excursions or buying a new outfit for the occasion. Go on the trip and enjoy the time with your family while
allowing others at work to keep things running smoothly until you return.

Used consistently, opposite action can help us to change our emotional response to stressors over time. It’s
important, though, to commit to the technique so that you can experience the full benefits of taking control of
your mood and behaviors rather than allowing them to be in control of you.

For a quick video explanation of opposite action, view the following:

If you’re experiencing the above symptoms associated with loneliness and have tried methods for self-help
without benefit, or if you’ve been previously diagnosed with a psychiatric illness or substance use disorder
that has begun to flare up in the midst of these extraordinary times, please know that psychiatric treatment
providers are still open, available, and ready to help you through this – at all levels of care.

Clinicians at the Lindner Center of HOPE are seeing patients every day through Telehealth, with options for
telephone or video sessions for both therapy and medication management. Additionally, our services are open
for emergency intake assessments and inpatient hospitalization, partial hospitalization, intensive outpatient,
residential, and treatment for substance use disorders.

If you or a loved one could benefit from professional help, call the Lindner Center of HOPE at 513-536-
4673 to start the conversation and take the next steps toward healing.

Jen Milau, APRN, PMHNP-BC
Lindner Center of HOPE , Psychiatric Mental-Health Nurse Practitioner

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Many who struggle with OCD are probably noticing a spike in their symptoms during these unprecedented times. Stress and uncertainty can often make OCD symptoms flare. Those who struggle with specific types of OCD may be having an even harder time: specifically those with contamination concerns and those concerned with harming others. Another symptom of OCD that may be particularly hard currently are perfectionism tendencies. While it may be harder to fight back against OCD with everything going on right now, it is more important than ever to not give in to compulsions and let them take over your life. One simple step you can take is to stay connected to your therapist, likely via telehealth at the moment. Having regular sessions during this time is key, especially as symptoms flare. Staying connected to others online or through social media options is also important, as the more you are connected to others the less stress you will notice. Another key piece is to continue to do things you enjoy and that bring you pleasure, as this will help lessen stress as well. Keeping a structured routine can be helpful and can help make things to continue to feel more normal. It can be important to try to continue with whatever routine you had going before that you are still able to do, for instance still getting at the same time in the morning and getting ready for work even if you are working from home. Adding consistent exercise into that routine will also be helpful, as this helps create endorphins and naturally lessens anxiety. Lastly, avoid reading the news all day, which will only lead to more stress and anxiety. It is important to limit access to only a couple of trusted sites and not get carried away with reading up on everything all day long.

Some specific OCD related steps you can take will vary depending on the type of OCD you have. For those who struggle with contamination concerns, get familiar with the CDC guidelines for the current pandemic and do not add other steps that are not recommended. For instance, they are recommending only washing hands for 20 seconds after being outside or in public, before eating, after going to the bathroom, and after you’ve coughed/sneezed/blown your nose. If soap and water are not available, they recommend you use hand sanitizer that contains at least 60% alcohol. They also only recommend disinfecting surfaces once per day. This should only take a few minutes per day and they suggest only focusing on the surfaces in your home that are frequently touched. It is also important to think about whether this is truly needed (for example, if you stayed home all day and had no visitors, do you really need to disinfect that doorknob?). It is also important to avoid some news sources that might not offer expert recommendations but rather their own opinions.

For those who struggle with fears of harming others, these symptoms might tackle the current pandemic and cause you to obsess about whether or not you might have infected someone or whether or not you might infect someone in the future. This might be a similar theme to past fears of contamination concerns, but it will still be helpful to alert your therapist to the new content so that new exposures can developed.

For those who struggle with perfectionism tendencies, this might be an especially trying time. The perfectionism could target all of the changes going on and adaptations people are having to make to conduct
their jobs, manage their families etc. It is important to give yourself a break and realize that it is impossible to be perfect in anything we do, but especially now during all of this change and uncertainty. Practice doing one or two things imperfectly on purpose as an exposure.

One important exercise I make sure to encourage all of my patients to do is to keep track of their victories against OCD, whether the victories are big or small. Keeping track of successes and not dwelling on everything that is going wrong is a helpful way to stay on track and to realize everything that you are doing to fight OCD, which is likely a lot. It can sometimes be hard to pick out the successes and often others only notice the failures or slips, but there are victories in there as well that deserve your attention and that can help give you confidence to fight back even harder next time

Nicole Bosse, PsyD
Lindner Center of HOPE, Staff Psychologist

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Peter White, M.A., LPCC
Lindner Center of HOPE, Addictions Counselor

Due to the COVID-19 pandemic, this is a period of unprecedented changes marked by great uncertainty shared by literally everyone. One of the complex realities of dealing with this much uncertainty is that we should feel a wide variety of difficult emotions – confusion, fear, disorientation, sadness, and anger to name a few. In a way, it is healthy to not feel okay at this time. But at the same time, it is important for us to acknowledge that we want to manage these difficult emotions in a healthy way. One common vulnerability in managing difficult emotions is depression. Although challenging, we can get good at identifying and countering the presence of depression during difficult times. We can effectively treat and manage depression so that it does not make our coping less effective.

Depression is a condition involving thoughts, emotions and physical reactions. It is opportunistic in periods of uncertainty expanding its ability to disempower and disquiet ourselves and our relationships. Depression’s biggest advantage is its negative judgement – hopelessness, helplessness, worthlessness and guilt are all hallmarks of depressive thought process. “It’s not going to get better. There is nothing I can do to make it better. I don’t deserve to have it be better,” are all examples of depressive distortions that can plague the mind and divorce us from our natural capacities to endure and thrive. In a way, depression fills the mind with judgements that are fundamentally untrue. There is always hope. Things can always improve. We always have some options to improve our situations, or at least find how to endure with as much forbearance and gratitude as possible. And of course, we all deserve to have our suffering relieved. They may seem like simple reframes, but they are the fundamental effort of successfully countering depression so that we can move forward with all our strengths and resources. Fear is appropriate and understandable in times like this with major uncertainties and potential pending losses of security and predictability. I always encourage clients to honor their fear, comfort themselves with the many blessings of their lives that help them endure and rebound from loss, and resist the power of depression to convince them that they are alone and without options

As noted, depression infects both the mind and the body. Depression disrupts our metabolism, so we might experience fatigue, sleep disruption, changes in our appetites, difficulty in concentrating and decision making. Given that depression has a corrosive effect on body, mind and spirit, it is most effective to counter it with body, mind and spirit. Keep moving, maintain a wholesome routine mixing both work and pleasure. An easy acronym to remember is GRAPES. G. stands for gentleness and gratitude in thought. R. stands for relaxation, even for brief moments. A. stands for the recognition of our accomplishments, especially the simple ones-caring for ourselves and our loved ones is always an accomplishment. P. stands for pleasure, again especially the simple ones- food, music, reading, nature, or whatever there is that reminds you that life has its joys. E. stand for exercise, or if not rigorous physical activity, any movement that brings the reward of the body moving through space. And S. stands for remaining social. All of the above are anti-depressive activities – effective reminders that hopelessness, helplessness and especially worthlessness are untruths to be dispelled during our moments of fear and doubt.

Let me end just highlighting the social. All humans, especially so right now, share the experience of fear and doubt related to uncertainty. Near invariably, we are all comforted when these fears are shared amongst our loved ones and our fellows in a spirit of honor and trust. Nearly all of us have experienced a darkness of spirit that is quickly dispelled by kind words from friends. If nothing else, resist the power of depression to convince you that you are alone and do not deserve the fellowship of loved ones and peers. Clearly now, our experience of uncertainty is a deeply shared experience. I encourage you to become robustly social, so that within the shared uncertainty, we can all experience the power of ourselves and others to endure and overcome this frightening time strengthened in our spirit of togetherness.

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

As feelings of anxiety, depression, or sheer boredom mount due to the growing pandemic of the coronavirus, the desire to turn to drugs and alcohol as a coping mechanism could become more problematic. Experts warn against self-medicating during these stressful times for a multitude of reasons. For many people who struggle with mental illness and/or substance use disorders, there is an unfortunate tendency to withdraw or isolate from others. So when we are told to practice social distancing, remain in our homes, isolate from one another, this can feed into a further deepening of an individual’s struggles and isolation with depression, anxiety, trauma or loss.

According to SAMHSA, (Substance Abuse Mental Health Services Administration), 84% of individuals who experience a substance use disorder, also experience a co-occurring mental health issue as well. During times of stress, many of us seek relief, in any way we can find it. The use of substances is not a healthy way of coping. Substance use is frequently used as a means to escape or numb-out from life’s problems. Substance use will often exacerbate a previous existing problem, making it worse.

In cities across the country, people are increasingly living under “shelter-in-place” or lockdown mandates that have closed businesses, limited social gatherings, and urged self-quarantine. These added stressors have resulted in increased levels of alcohol consumption. According to the Republic National Distributing Company, a wine and spirits distribution company, sales of spirits jumped by 50% for the week ending March 21, 2020. Nationally, the overall increase for the week according to Nielsen data, saw a 55% spike in alcohol sales.

Each of us experiences stress from time to time. However, recent events of the past few months have been unprecedented. Stress can feel overwhelming. There are different types of stress – all of which carry physical and mental health risks. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Some people may cope with stress more effectively and recover from stressful events more quickly than others. Unfortunately for some, substance use becomes an unhealthy way to self-medicate one’s stress, mood and/or anxiety.

Coping with the impact of chronic stress can be challenging. Because the source of long-term stress is more constant than acute stress, the body never receives a clear signal to return to normal functioning. With chronic stress, those same lifesaving reactions in the body can disturb the immune, digestive, cardiovascular, sleep, and reproductive systems. Some people may experience mainly digestive symptoms, while others may have headaches, sleeplessness, sadness, anger, or irritability. Over time, continued strain on the body from stress may contribute to serious health problems, such as heart disease, high blood pressure, diabetes, and other illnesses, including mental health issues such as depression or anxiety. For some, substance abuse only adds insult to injury.

When does one’s consumption of a substance (i.e., alcohol, drugs, gambling, Internet, gaming) become
problematic? Addictive behaviors consists of the following three behavioral questions (The Three C’s).
• Is there a loss of Control? (I am unable to manage the behavior.)
• Is the behavior Compulsive? (I cannot stop doing the behavior.)
• Do I continue to engage in the behavior, despite the negative Consequences?

Coping with life stressors by the use of alcohol or any other substance, is a bad idea. If you take practical
steps to manage your stress, you may reduce the risk of negative mental and physical health effects. Rather
than reaching for that adult beverage, below are tips that may be helpful in coping with stress:

Be observant. Recognize the signs of your body’s response to stress, such as increased alcohol and other
substance use, difficulty sleeping, , being easily angered, feeling depressed, and having low energy.

Talk to a health professional. Don’t wait for your health care provider to ask about your stress. Start the
conversation and get proper health care for existing or new health problems. Effective treatments can help
if your stress is affecting your relationships or ability to work.

Get regular exercise. Just 30 minutes per day of walking can help boost your mood and improve your
health.

Pursue calming activities. Explore relaxation or wellness programs which may incorporate meditation,
imagery, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy and
relaxing activities.

Set goals and priorities. Decide what must get done now and what can wait. Learn to say “no” to new
tasks if you start to feel like you are taking on too much. Try to be mindful of what you have accomplished at
the end of the day, not what you have been unable to do.

Stay connected. Even though this may be a challenge, given our current social distancing, we need to remain
connected with one another. You are not alone. Keep in touch with people who can provide emotional
support and practical help. To reduce stress, ask for help from friends, family, and community or religious
organizations. Many community support groups (AA, NA, GA, SMART Recovery) are available online. Stay
healthy, stay connected.