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

By: Anna Guerdjikova, PhD, LISW, CCRC, Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program, Lindner Center of HOPE 






Spring is in the air. More often than not during this time of year, we find ourselves determined to clean, declutter and organize. In a way, spring cleaning is very similar to New Year resolutions and the big hurray at the beginning of the school year in August when everything is new and fresh, big decisions of how we will be better are made…but not for long. We find ourselves hyper-focused on new goals and behaviors to quickly abandon them soon after as it is too hard, too slow, too boring, or life comes in the way of our good intentions. Then the guilt of “look at this mess, I should be decluttering” sets in, we continue to buy things to organize the many things we already have and this cycle continues to perpetuate both the mental anguish and the physical clutter.

To be able to consistently change a behavior, it is helpful to understand why we are resistant to the change, even if we know it will make us feel better in the end. Digging into the barriers and the reasons for our self-sabotage can help us be more self-compassionate and to get us a step closer to actually making the changes we intend and hope for.

Decluttering can be difficult and anxiety provoking. Below we summarize some of the issues and possible ideas on how to approach the solutions to avoid self-blame and feelings of failure and to finally get the ball rolling.

Issue: The job is too huge and you don’t know where to start. It gets to be too overwhelming too quickly. 

Solution: Decide on decluttering small bites – a time period to declutter daily/weekly or one surface, drawer, rack, 1/3 closet at a time and don’t overdo it. Keep a very open mind and avoid rigid agenda (ex. be done with the kitchen by Sunday) no matter how tempting this is, as when the job does not get done for some reason as we have planned, we tend to abandon the whole project.

Issue: What if I need this later?

Solution: If you have not used it in 6 months, you are most probably not going to use it now. Most things in our households can be replaced quickly, thus giving yourself the permission to buy new if needed is the “get out of jail free card” that can help battle this problem. In most cases than not you will not have to use the card/buy the item again.

Issue: The guilt of life not lived. Textbooks we bought to study something we never got to, the hiking shoes to walk the Appalachian trail, the super expensive multicooker and many others representing the life we hoped to have or wished to live but never actually implemented.

Solution: Consider radically accepting yourself for who youare truly at the present moment in life instead of who you wished you were. Get rid of the expensive hiking shoes you have never put on. If you decide to hike the Appalachian trail, you will have to start by hiking the local parks and this can be done in regular sneakers for a while, then if needed you can buy some new fancy hiking shoes.

Issue: Change is hard and decluttering does not solveother issues.

Solution: Take it slow and give your brain and body time to process the change. If you get rid of a rug, the room will feel empty and sad and the most common reaction is to go buy another rug immediately. Try to give the new look time to settle, this will allow you to see the space with new eyes and can spark creativity and true change. If in a while you still feel you need the rug, go for it.

Give approaching decluttering with curiosity and self-compassion a try this spring. It is not fatal if it does not get done and beating yourself over what “should be finished” is not helpful in moving forward. Finally, decluttering our physical and digital spaces might make us more aware and mindful of our habits, but is not the “fix for our lives”. Clutter can be seen as a result of some struggles that we deal with and starting to tackle it might bring to light a plethora of challenges and this is one of the reasons why this process can be so anxiety provoking. Kindness to self, giving it all time and space to unfold and paying attention to the mental load behind the physical possessions might be helpful in promoting sustainable change.

Anna I. Guerdjikova, PhD, LISW, CCRC
Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program
Lindner Center of HOPE





Emotion regulation refers to the process of generating and maintaining an emotion, as well as the ability to modulate its’ intensity and frequency in order to achieve socioemotional competence and sustain mental health. In modern society, from early age, we learn inhibition to downregulate our emotions (for example, to not cry in public or to not say anything when angry) which often results in emotional restraint. True emotional regulation is reached through focused monitoring, evaluating, and modifying of our emotional reactions and depends on the person’s age, temperamental characteristics and environmental circumstances. Some examples of successfully practicing emotional regulation include being able to calm self-down after something exciting or upsetting happens, sustaining focus on repetitive tasks, refocusing attention on a new task and controlling impulsive behaviors. The skill to emotionally regulate depends significantly on the persons’ age and brain maturity and thus understanding that some of the time the individual is not difficult or spoiled, but developmentally or circumstantially unable to control their emotions can help build empathy and strengthen family systems and relationships.

DOs in Emotional regulation

  • Do create safe space for all emotions- the good, the bad and the ugly. Being happy should be equally accepted in the family as being angry or sad.
  • Do model emotional regulation for your children and peers every time you can. Work on naming your emotion (ex.” I am very upset with you now..”), the reasons for it/ the trigger, if you know it (..”because you hit your sister..”) and the solution you have (..”so I will take a moment to regroup and then we will talk about how I am feeling and what helps me go through it”)
  • Do practice awareness of your reaction to the emotional dysregulation in others. The goal it to learn to respond to their outburst (observe, acknowledge, empathize and work through it) rather than react (yell back or slam the door and leave).
  • Do prepare and reflect. When a challenging situation lays ahead, take the time to prepare yourself and the child for it and afterwards reflect on how preparation and having a rescue plan had helped to minimize emotional outbursts.

DON’Ts in Emotional regulation

  • Don’t expect emotional regulation if the person is hungry, thirsty, tired, lonely or in other way physically unsettled. Emotions are felt in the body and learning how the body reacts to them is a crucial step in recognizing and further regulating them.
  • Don’t ignore or minimize kids’ emotions. They might see overly dramatic, or unnecessary, or inconvenient (airport tantrums, anyone?) but for the child they are real and often intense. Work on acceptance that even if we don’t get it, it is real for them and our job is to validate their struggle/excitement and teach them how to better self-regulate.
  • Don’t pretend you “feel it for them” if you do not. It is ok to state that “I don’t know what you are going through but I am here for you and I am willing to help you out in any way I can”.
  • Don’t try to “fix it” or make it go away or focus on it for too long. Emotions are fleeting, they can feel very intense when they occur, but most of them resolve or lose their overpowering force if the person “stays with it” (recognizes it, tolerates the distress for negative emotions and responds, rather than reacts) for long enough. Learning this skill early on can be truly helpful in adulthood

Practical skills to help with emotional regulation

Mindfulness techniques. There are many ways to focus on the “now” to help tame an emotional outburst. A simple example is the 5-4-3-2-1 Grounding Exercise. It can distract from the anxiety trigger, focus the person on the present moment, and help them relax in their body. Ask the person to : name 5 things they can SEE in the room (have them list them out loud) ; name 4 things they can FEEL (sock on my feet, knots in my belly) ; name 3 things they can HEAR (my voice, radio); name 2 things they can SMELL right now (my coffee) ; name 1 thing they can TASTE (if not in the moment, what did they taste last night) . This can be shortened to 4-3-2-1 or even 3-2-1, depending on the circumstances.

Relaxation techniques– teach yourself and your young ones deep breathing. Yoga Dragon breath and the Camel pose can be a fun quick way to release tension.  Explode like a volcano/ Balloon technique can be practiced anywhere and most children under 10 years of age find is helpful (pretend you explode like a volcano/popped balloon- you can jump up and model the eruption with your hands and make a lot of loud dramatic volcano sounds). Using movement, music and sensory activities can help further relax and refocus one’s brain.

Diligent self-care – emotional regulation is impossible in a body with unmet basic needs, namely being tired, hungry, thirsty, lonely or sick. Daily self-care, particularly getting enough rest depending on the person’s age, should be encouraged and taught by parents, especially to teens and young adults who have more autonomy and can make the connection between being overly tired and overly emotional and further

Kristy L. Hardwick, EdD, LPCC-S Lindner Center of HOPE, Outpatient Therapist









The sun is shining; the days are longer. Summer is approaching. For some, summer is a break from study or work. For others, it may be an opportunity to take a week of vacation to relax and rejuvenate. Whether it is a two-to-three-month break, or simply more time in the evening to enjoy the sunshine, it is a time for which most look forward. It is often a time of joy, laughter, and reprieve. Summer is associated with rest and play, all of which can promote positive well-being. And I embrace all of it.

However, I am also keenly aware of the various tragedies we have collectively experienced over the recent months. With the “last day of school” and the “first vacation of the summer” pictures also come news of mass shootings, war, and other difficult events. There is exposure to pain and suffering on multiple levels, whether indirectly or directly.

Thus, I get the sense “the sun is shining, but it is also dark!” I find it necessary to acknowledge the current conflicting duality of our reality and the distress which many are experiencing, while sharing a few reminders to help us navigate through.

First, during times like this, it is crucial to recognize it is normal to have a plethora of intense thoughts and feelings, as well as an urge to act. It is also expected there will be differing viewpoints and ways these events affect individuals based on a variety of factors.

Second, it is important to highlight there are times when words are insufficient to convey the depth and intensity of feelings or to comfort adequately. Perhaps we don’t know anyone personally who has been directly affected by one of the current tragedies. Yet, we have been impacted. We may find ourselves juggling varying thoughts and feelings and struggling to put these into words. I would invite us to lean into what we are experiencing in our bodies. Accept there may not be “right words.” However, we can give space for our thoughts and feelings, accepting them as we experience them.  Sitting in silence might be necessary. It might also be helpful to focus on possible actions. For example, if we are feeling helpless, we might brainstorm a way we can make a difference or identify an area where we do have control. We can also find ways to show care, concern, support, and express meaningful presence with others amid the current tragedies.

Perhaps we do know someone who has been directly affected by one of the various tragedies or observe others being more deeply impacted by our current shared experiences. Again, we may not know the “right words” to say to those who have suffered directly from a tragedy or are in more distress. That is okay. There is a reason why words fall short; it is because ultimately, they often do. Thus, instead of getting caught up in “saying the right words,” we can focus on embracing being a meaningful presence. We offer authentic support through honest connection. Even saying, “I don’t know what to say; however, I am here for you,” or “I don’t understand or know the solution, but I am here to listen.” Offering just to be with someone is powerful.

Next, we may experience discomfort when we feel “caught in the middle” of opposing circumstances or even opposing feelings. On the one hand, it is summer. We have plans to relax, find joy, rejuvenate. Yet, we find ourselves surrounded by various tragedies. The degree of impact may vary. We are both impacted and aware of the suffering; yet also are navigating daily lives. We are both excited about summer plans, but also angry and sad about world events. Or we may be struggling with different stressors or difficult life circumstances, but also must continue to function. In these situations, it can be powerful to embrace “both/and.” Often we are influenced to exist in an “either/or” mindset. Either we are happy, or we are sad. Either we are fulfilled, or we are discontent. Yet this negates the complexity of both the outer world, and our inner worlds. Joy and pain can coexist; celebration and grief may show up hand in hand. Vacations are happening in the middle of world conflict. We are both celebrating our young adults graduating college and mourning for those killed in a mass shooting. Embrace and hold space for “both/and.” Multiple, often conflicting, thoughts and feelings can be true at the same time. It is necessary to accept all of them.

Lastly, we can utilize healthy coping skills to navigate these “distressing-at-a-loss-for-words-embracing-both-and” times. Consider strategies which have been helpful in the past, as well as those we may not have utilized previously.

Find ways to express our thoughts and feelings, giving ourselves permission to hold several thoughts and feelings simultaneously, while also releasing them. (Allow time for “both/and.”) Resist the urge to hold them in. Even if we have moments of “no words,” we must find ways to release them in nonverbal ways and then be willing to let words flow when they do come, without judgment. Releasing feelings is an important skill to practice.

Get moving, be active. We cannot separate the various parts of our bodies; they are all interconnected. Moving is good for all areas of our health, increasing endorphins. Research also supports various activities such as yoga, which activates the parasympathetic nervous system, decreasing stress and muscle tension. We can engage in physical activities we love, whether it be swimming, kayaking, or biking.

Be creative. Engaging in novel and creative activities increases dopamine. Make art; write, create music. Simply listening to music has been found to decrease anxiety and stress. (We can even combine the coping skill of releasing and expressing feelings with this one!)

Seek social support. Make connections. We increase the oxytocin (the “love hormone”) in our brains by spending time with family, friends, and pets. We are inherently built to be in relationship with others.

Stick to routine; take the vacations we have planned. Routine helps us stay motivated and organized.

Maintain healthy habits. Sleep/rest. Eat well, hydrate.

Limit social media/news exposure when current events become too distressing.

Seek ways to advocate and get involved in organizations created to assist survivors of events or those which support issues we find important.

And lastly, let us not hesitate in seeking professional help if levels of distress increase, we are unable to function or fulfil roles, unhealthy coping has increased (drug/alcohol use), there is difficulty sleeping or change in appetite, and if experiencing severe hopelessness and suicidal thoughts. We are here to help when the sun is shining but it is also dark.

By: Jessica Kraft, APRN, PMHNP-BC
Lindner Center of HOPE, Psychiatric Nurse Practitioner

Seasonal affective disorder (SAD) is a type of depression that is more isolated to the changing of the seasons. It can happen in the spring and summer but occurs most commonly in the fall and winter months. We know that everyone is going to have a bad day from time to time, and it’s not uncommon for some to face more challenges in the winter months when the weather is colder and the days are shorter. But when does this become a problem that requires intervention?

What are some of the common symptoms of SAD? 

  • Feeling down or depressed for most of the day, almost every day
  • Less interest in hobbies, social activities, or things that have brought you joy in the past
  • Decreased concentration at home and at work
  • Fatigue, sluggishness, or low energy
  • Sleeping too much or too little
  • Changes in appetite (increased craving for carbohydrates) or changes in weight
  • A general feeling of hopelessness
  • Low self-esteem
  • Thoughts of self-harm or suicide

It is hard to estimate the number of people who have SAD, as many do not know they have it. It’s also thought that the number in recent years has been higher due to the COVID-19 pandemic. Women can be at higher risk for developing SAD as well as those who live further north. SAD most commonly develops in young adulthood, it often runs in families, and can often be co-morbid with other mental health conditions including depression, bipolar, anxiety, ADHD, and eating disorders.

It is not entirely understood what causes SAD, but research indicates that people with SAD may have reduced activity of serotonin, too much melatonin production, or even vitamin D deficiency. Changes in these areas may impact the body’s daily rhythm that is tied to the seasonal night-day cycle. Negative thoughts and feelings about the winter and its associated limitations and stresses are common among people with SAD, as well as others. It is unclear whether these are “causes” or “effects” of the mood disorder, but they can be a useful focus of treatment especially when seeking therapy.

If the above symptoms start to interfere with day-to-day life, it may be beneficial to seek out care for SAD. For some it may be ideal to start with their primary care provider in order to rule out other medical conditions that could be responsible for symptoms of SAD including alterations in thyroid hormones, low blood sugar, anemia, or viral infections like mono. If there is not an identifiable medical cause, seeking psychiatric help may be beneficial.

What are some of the common symptoms of SAD?

  • Light therapy – a common approach to SAD since the 1980s. The thought is that exposure of bright light every day can supplement the lack of natural sunlight/sun exposure in the winter months. Sitting in front of a light box of 10,000 lux daily during the winter months in the morning can be a helpful intervention.
  • Talk therapy – the most common type of talk therapy for SAD is cognitive behavioral therapy (CBT).
  • Vitamin D supplementation – there is mixed research on how helpful supplementation of Vitamin D is for SAD but some find it helpful and a good option to try prior to trying a psychiatric medication.
  • Psychiatric medication – for those who haven’t seen much improvement with light therapy or CBT, psychiatric medication can be an option including SSRIs (Prozac, Zoloft, Lexapro, etc.) or Wellbutrin. It is important to keep in mind that treatment with one of these medications may take several weeks in order to be efficacious, for some up to 6-8 weeks.
  • When doing research on this topic I came across many anecdotal stories from those struggling with SAD and what interventions they tried and found helpful. Some examples included going outside more often, taking a trip, caring for something like a plant or a pet, finding a new hobby or interest, staying social, creating new rituals, consistent exercise, quality nutrition, good sleep, and maintaining a consistent schedule.

What are some of the common symptoms of SAD?

One of the helpful things about treating SAD is the predictability of when symptoms set in compared to other sub-types of depression that are much more variable. Unfortunately there is little research answering the question of whether or not this can be prevented or if there is a significant benefit to starting treatment early. Of the limited data available the medication Wellbutrin was found to be the most helpful intervention to start early.


The sympathetic nervous system (SNS) is responsible for our “fight, flight or freeze” response and has been essential to our survival since beginning of our existence. In the case of traumatic, threatening emotional, mental and physical experiences, this fear response can become altered.  Connection between the amygdala and hypothalamus causes change to the hypothalamic-pituitary-adrenal axis (HPA), increasing cortisol levels and increased HR, increase respiratory rate, hypervigilance, and sleep disturbance. There are several neural connections and neurotransmitters acting on the amygdala contributing to fear response, and medication management has its risks. In hopes to improve overall outcomes of patients, many people and practitioners have utilized complementary and alternative medicines (CAM).

Yoga is probably the most known and utilized form of CAM in the united states. Yoga has been practiced for thousands of years to heal both physical and mental ailments. Philosophically, Yoga is defined as “Union”, and often interpreted as “union to the divine within”. Union is achieved through pranayama- breathing and asanas- postures.  This ancient Eastern tradition has gained popularity due to the awareness of the mind-body-spirit, holistic approaches in America and Europe. There is now a fair scientific understanding and body of research validating its potential benefit as an integrative intervention.

There are several benefits to incorporating yoga that could benefit people with trauma. It is important to assess one’s state of stability prior to introducing yoga therapy. In yoga philosophy, the concept of krama means “in the correct order” and can reduce risk of additional pain and suffering caused by the treatment. Just as establishing a sense of safety prior to other trauma therapies is essential, it is also to do so with yoga.

Controlling the length of inhale and exhale and manipulating the diaphragm stimulates the Vagus nerve or CN X and parasympathetic response to “rest and digest”. This effectively promotes cardiac relaxation, decreases contractility in the atria and ventricles (less-so). Primarily, it reduces conduction speed through the atrioventricular node. CN X can lower cortisol levels via modulating the hypothalamic-pituitary-adrenal-axis. Which is thought to be hyperactive in people with trauma and stress disorders.

Vagal tone is the body’s ability to successfully respond to stress. One study, by a team in Boston University School of Medicine (Streeter et al, 2012), hypothesized that Yoga effected the autonomic nervous system to improve stress response in PTSD. Using ujjayi pranayama (form of resistance breathing popular in Hatha yoga)  they found “increased relaxation response and increased heart rate variability” thus resilience to effects of stressors It is well understood that yoga has a calming action on the nervous system and is valuable as an adjunct treatment for those with trauma and stress related disorders.

In yoga there are two major concepts that can have psychological benefit. Chitta is the inner processes and capacity of attention and focus inward; and samskaras- the storehouse of past actions, self-beliefs/messages. In yoga the use of asanas, pranayamaand meditative practice- one works towards awareness and letting go of these unhelpful attachments that are stuck in the mind and body. As we know in people who have survived trauma, emotional scars can be felt throughout the body and leave scars of psychological destruction. Yoga offers a loving message of positive, self-compassion and promotes a gentle, non-judgmental environment.  Letting go of negative self-beliefs has many benefits psychologically.

After a trauma, in my experience and in DSM V criteria, one’s self-perception of negativity as well as negative beliefs about the world can damage spirituality or connection to a power greater than oneself.  In yoga the common ending to a practice is to bow in honor and say “Namaste”. Which translates into “the Divine light within me sees, honors and respects the Divine light within you”. For those with trauma, believing there is light within them that can shine again, can be the key to transformational healing. Yoga is not a religion, and it does not promote worship of any deity, instead “God” is expressed as truth, light, love and energy that is flowing through the universe.  Religious and non-religious can benefit from the spiritual practice of Yoga.

Yoga has proven its place in the holistic approach to mental health treatment, and because the only requirement is to be able to breathe, it is accessible to anyone who can breathe.  It has been said about yoga, by a great teacher… the breath is a wonder drug! I hope you consider utilizing a yoga practice for yourself or recommending it to someone who could benefit.

Jennifer L. Farley, PsyD
Lindner Center of HOPE, Associate Chief of Psychological Services

Congratulations! Your child graduated from high school!  And now…   what?

Many are busy selecting their fall semester college courses and buying necessities for their dorm room. Others have chosen to delay college and work instead, using time to consider their future. Some opted to focus on a career trade and are doing apprenticeship work. No matter their course, these newly-minted adults can now do 3 main things in America: vote, go to jail for their own actions, and enter into contracts on their own accord.  Yet, there are some contracts for which 18-year-olds are too young, and many lack the financial independence many contracts require. Bottom line: young adults still need support. But things are different, they’re high school graduates now. And most still live at home, at least for a little while.

The length of time it takes for one’s emancipation from home is entirely dependent on the path they’ve chosen and their success with it. For college students, the biggest first leap is when they move into their college dorm. It’s their first space outside of home to call their own.  Yet, the college dorm is still a contained bubble, where rules still dictate what’s expected and complete freedom is not given. Even dorms typically shut down during extended or holiday breaks. Freshman year represents the first of a graduated series of “bubble” expansions, when by their 3rd or 4th year, students have learned how to cook some of their own meals (instead of relying on cafeteria meal plans), they have to navigate roommate tensions without the aid of a dorm resident advisor, and they’ve (hopefully) learned to be self-disciplined and self-accountable. Most college students aren’t fully emancipated from their parents until they function completely independently on their own – when they get a job and make enough money to support themselves. That stage doesn’t mean “without support” of parents, it’s just that the adult child no longer requires parents’ resources to live on their own. For any young adult, this takes time:  time to get a job, time invested in working, and time spent saving money.

Even among the healthiest of families, any young adult’s process of emancipating from home comes with tension. This is par for the course… it’s how young adults develop self-confidence and gumption.  Without “tests” involving interactions with family, without the development of gumption, young adults risk a poor transition into their independent years. Imagine going away to college, working a full-time job, or moving out feeling insecure about yourself, not being able to trust that you can assert yourself or make good decisions. Without gumption, one may be so comfortable at home that they don’t seek more independence. Gumption fuels self-decision-making and serves as a foundation towards independence. Gumption often brings tension, and tension is experienced before big changes or transitions. The changes involved with emancipation are experienced by young adults and their families, alike.

During the months leading up to one’s emancipation from home, tension is often experienced in waves. Parents, realizing the borrowed time they have with their child, may seek more time to spend together with their child. Other times, parents may engage in more activities without their child to prepare themselves for their child to leave home. Adult children do a similar dance; sometimes they may seek their parents in anticipation of being away from them, while much of the time they want to spend time with friends. You can imagine the conflicts that arise when an adult child wants freedom with friends during a time when parents seek quality time with their child. This is all natural, it’s just a matter of recognizing and understanding it. Time spent together can involve some creativity with lessons in laundry, basic cooking, and how to manage money – while times of tension make it easier for everyone to prepare to say “goodbye” and to face the changes ahead.

No matter the transition ahead, practice the cycle of a “submarine parent” – stay offshore, come up for air sometimes to check in with your young adult child, and retreat back down in the water when you see your child is doing just fine.

Thirteen months ago, the world was experiencing the onset of a shared trauma … a pandemic was sweeping over the globe. The actions that were taken to keep people safe included community shut downs, stay at home orders and mandated isolation. Lindner Center of HOPE, like mental health providers around the world, began to see spikes in mental illness and addiction. Individuals who were already struggling with mental illness or a pre-disposition, saw exacerbated symptoms and an increase in severity of illness. People who were managing, saw new onset at higher levels of acuity. As time has passed since the beginning of the pandemic, the trauma has been sustained with higher percentages of people still struggling with mental illnesses and addictions. Additionally, data shows people who have experienced COVID-19 infection are also suffering with co-occurring psychiatric symptoms.

Dr. Paul Crosby, Lindner Center of HOPE

Fortunately, vaccines have been released to protect the population from the physical health threats of COVID-19. However, Lindner Center of HOPE’s President and Chief Operating Officer, Paul R. Crosby, MD, states the vaccine also offers mental health benefits as well.

“The first mental health benefit of the vaccine is simple,” Dr. Crosby said, “since the risk of COVID-19 infection diminishes significantly with vaccination, receiving the vaccine would also protect individuals from co-occurring mental illness that has proven to manifest with COVID-19 infection.”

“The second mental health benefit of the vaccine is the reduction in overall anxiety and stress, as risk and fear of infection is reduced. Vaccinated individuals can lift their isolation from other vaccinated individuals, can begin to see a return to other activities that improve mental health, like more exercise, improved sleep, new experiences through travel and more. A return to these healthier activities can hopefully also lead to a reduction in substance use, overeating or lack of participation in other things that bring joy.”

“The COVID-19 vaccine has significant potential in improving your mental health.”

For individuals experiencing symptoms of mental illness, it is critical to access help. Mental illnesses are common and treatable and no one should struggle alone.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic services for all ages and short-term residential services for adults, and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.


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!

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 or 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

Lindner Center of HOPE 513-536-HOPE


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