Category: Stress

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

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

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

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

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

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

1) psychoeducation for both children and parents;

2) relaxation/stress reduction;

3) emotional expression and modulation;

4) cognitive coping and skills training;

5) creation of the trauma narrative (story);

6) cognitive processing of the trauma narrative; and

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

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

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

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

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

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

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

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

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

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

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By Jennifer Farley, PsyD
Associate Chief of Psychological Services, Lindner Center of Hope

 

 

 

In many areas, autumn’s colorful trees and darker mornings are reminders of the transition from summer to winter. Evening hours just don’t feel the same compared to the long days of summer when people are more active from sunrise to sunset. While it is common to experience life differently at different times of the year, approximately 10 to 20 percent of people in the United States experience a mild depression during the darker seasons, and 4 to 6 percent of Americans experience moderate or severe depression.

Seasonal Affective Disorder (SAD) is a clinical depression triggered by seasons of the year. SAD is believed to be associated with seasonal changes in the amount of daylight. For most people with SAD, symptom onset is in the fall or early winter, and relief starts in spring. Symptoms of SAD can last up to 5 months. SAD is more common in women than men and is typically not experienced prior to 20 years old. SAD is more common among young adults and the risks of developing SAD decrease with age. People with a depressive disorder or Bipolar Disorder and people with family members with SAD or other forms of depression raises the risk of having SAD. Living in sunnier regions and closer to the equator decreases the risk of SAD, validating why many people become “snow birds” and go south for the winter.

Because SAD is a depressive disorder, individuals experience at least some symptoms of Major Depressive Disorder. These can include feeling depressed most of the day, nearly every day, having less interest in enjoyable activities, sleep problems, feeling sluggish or agitated, having low energy, and feeling hopeless or worthless. Additional symptoms can include overeating, social withdrawal, and poor concentration. It is common for people with SAD to oversleep by going to bed earlier and/or waking later. A clinical diagnosis of SAD requires a full remission of symptoms when the season ends and 2 consecutive years of episodes in the same season.

Causes of SAD include lower levels of the neurotransmitter serotonin, disruption of the circadian rhythm, increased melatonin, and a deficiency in Vitamin D. SAD is most typically diagnosed by primary care physicians, but psychiatric clinicians (medication prescribers and therapists) can also identify SAD.

Though there is not much that can be done to avoid getting SAD, symptoms can be managed to reduce their intensity. Some people start treatment or interventions before SAD symptoms start or before the season changes. Methods of treatment include light therapy (i.e., light boxes), medication, cognitive-behavioral therapy, increased Vitamin D, and lifestyle changes. Taking care of one’s body by eating healthy and getting sufficient sleep, exercising, and avoiding alcohol and drugs can help. Managing stress is important, as is being around others. Isolation and loneliness may fuel depression. Planning pleasant daily or weekly indoor or outdoor activities can be helpful to help fight “hibernation”. People also benefit from planning a vacation somewhere warmer and sunnier during the winter, and the experience of anticipating something positive helps reduce depression. Though some people use tanning beds in the winter months, this is NOT recommended due to the harmful exposure of U/V rays.

Individual therapy and/or medication treatment can be quite helpful for those with SAD, and it is especially recommended when depression is at a moderate or severe intensity. Cognitive-Behavioral Therapy in particular helps by replacing negative thoughts about winter with more positive thoughts. Discussing ways to implement lifestyle changes and planning for enjoyable activities can be helpful. Therapy can also offer opportunities to learn and practice mindfulness and to explore how to radically accept the fall and winter by “leaning in” to its opportunities. People do not have to live through darker months with dark mood.

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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

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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.

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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

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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.

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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.

Sources:

https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder/index.shtml 

https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder 

https://www.yalemedicine.org/news/covid-19-seasonal-affective-disorder-sad 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302868/ 

https://www.sciencedirect.com/science/article/pii/S2215036620303072 

https://forge.medium.com/advice-for-coping-with-seasonal-depression-from-9-people-who-have-it-a5c04fdfe996

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Understanding Trauma

The sympathetic nervous system (SNS) is responsible for our “fight, flight or freeze” response and has been essential to our survival since the 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, increased 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).

Benefits of Yoga as a Practice

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.

Benefits of Yoga for Trauma Recovery

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 recommended 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:

  1. Chitta: the inner processes and capacity of attention and focus inward
  2. Samskaras: the storehouse of past actions, self-beliefs/messages

Yoga for Healing Emotional Trauma

In yoga the use of asanas, pranayama and 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 and emotional trauma can impact the body and leave scars of psychological destruction. Yoga offers a loving message of positivity, 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 people can benefit from the spiritual practice of Yoga.

Breathing Easier

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 will consider utilizing a yoga practice for yourself or recommending it to someone who could benefit. And remember, there is HOPE. For more information on other treatments for trauma recovery or information about the Lindner Center of HOPE’s services call (513) 536-4674 or click here.

 

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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.

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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.