Cyndi Turner's Blog, page 19

SMART Recovery Celebrates its 25th Anniversary

Congratulations to SMART Recovery® for celebrating its 25thanniversary this year. SMART Recovery started back in 1994 and was founded by Joe Gerstein and Tom Horvath. It was established as an alternative path to recovery, utilizing principles of self-empowerment, based on motivational and cognitive therapies.

What is Smart Recovery?

SMART Recovery stands for Self-Management and Recovery Training
It utilizes peer support groups in-personand onlineas well as tools based on the following four goal areas:

Building and Maintaining Motivation
Coping with Urges
Managing Thoughts, Feelings and Behaviors
Living a Balanced Life




The program aims to help those with both substance use and process addictions
SMART is based on abstinence, but welcomes individuals attempting moderation

How is it incorporated in therapy?

SMART Recovery can be incorporated in therapy in many ways when working with a therapist that has been trained in the Smart Recovery Model. The therapeutic experience can be enhanced by utilizing the tools provided in the Smart Recovery toolbox such as The Change Plan Worksheet or the Bost-Benefit-Analysis. The therapist can process online or in-person meeting experiences with a client as it relates to increasing support systems. SMART Recovery is a helpful tool to augment the therapeutic experience by offering additional supports both in and out of sessions for the client’s journey through recovery. It provides an alternative to traditional 12- step approaches, especially for clients looking for more tangible treatment tools and for those who struggle with the concept of powerlessness.

Angie Harris, LCSW, LSATP, MAC, MA, is a therapist with Insight Into Action Therapy in Ashburn, VA. She is trained in SMART Recovery and is a moderation friendly therapist. She works with clients to establish and work toward individualized goals related to substance use. She enjoys helping people uncover the reason for their substance use as well as identifying ways to maintain healthy balance in their lives. Reach out to Angie at aharris@insightactiontherapy.comor (703) 646-7664 to schedule an appointment.

It’s Day 10 of DRYUARY™ Challenge: Am I Ready To Change?

 

“Yesterday I was clever, so I wanted to change the world.

Today I am wise, so I am changing myself.”

– Jalal Ad-Din Rumi, Persian poet & mystic

Are you ready to do something about your drinking? The following Stages of Change model can be very helpful in determining where you are with your readiness to address your concerns about alcohol use. It can help to have an idea of where you are before you can move forward. Once you figure this out, you will have a better idea of how to achieve success.

James Prochaska and Carlo DiClemente developed the Stages of Change Model in the late 1970s. They were studying how smokers were able to give up their habit, but the model is widely used addiction treatment industry for anyone trying to change a behavior. The two observed that change occurs through an individualized process of stages.

So, where are you?

Precontemplation: I’m not ready or willing to change 

If you are in the Precontemplation Stage, you may not consider your alcohol use a problem. You may not yet have experienced any negative consequences, or you may not be ready to acknowledge the severity of consequences that have already occurred. You are not prepared to admit that there is a problem or behavior that needs to change.

The goal in the Precontemplation Stage would be to explore the impact of drinking on your life and those around you, not necessarily to make changes. If you are here, it can be helpful to ask what the people closest to you think about your drinking. Take a look at the way your choices might affect your major role functions, such as keeping commitments, parenting, or performing at work.

At this stage, forcing someone to do something against his or her will often backfire because they may not see that there is a problem or that one could be developing. They may fight back, becoming more entrenched in their belief that nothing is wrong. In therapy, I ask a lot of questions without judgement, taking an exploratory approach. Sometimes people need time to see different perspectives before they can apply it to their own life. The Precontemplation Stage is about gathering information and getting honest about your alcohol use.

Sometimes more negative consequences occur or you see an unpleasant reality and move into the next stage.

Contemplation:  I’m thinking about making some changes 

If you are in the Contemplation Stage, you may be worried that you have a problem with your drinking. You may be thinking about doing things differently. Although you may have tried to cut down or modify your drinking patterns, you still may not yet be ready to make substantial changes. 

You may be ambivalent about taking any steps. A good friend or therapist can help you weigh the pros and cons of any modifications and develop a plan of how to deal with each. Consider these questions: “What am I worried about if I decide to change how I drink?”, “If I was to going to modify my drinking, what would it look like?”, and “What situations do I need to prepare for?”

People transition from the Contemplation Stage when they make a conscious decision to change their actions.

Preparation:  I am ready

If you are in the Preparation Stage, you are gearing up to alter your drinking and preparing to take action. Identify why you drink and have a plan to manage the reasons. Recognize risky situations and the necessary changes that need to occur. Will you cut down or stop drinking completely? When will you start?  How long will you keep it up?

In this stage, you should seek a support system and resources. Some of them may include scheduling an appointment with a therapist, learning about alcohol moderation, going to a mutual support meeting, talking with your doctor about medications, going to treatment, or finding a support and accountability person. 

The goal here is to identify obstacles to the change process and problem solve each one.  Identify your supports. And when you make positive steps, like cutting back on your amount of alcohol or going several days without drinking explore how you were able to do it. Then repeat it.

Action:  I’m doing it

You are making the necessary lifestyle changes when you are in the Action Stage. Great job! Your willpower and motivation will wax and wane. This is totally normal. I find that people who have the most success are the ones who add enjoyable activities and people to their lives, not just focus on taking away the alcohol. It is hard to live in a state of deprivation so I recommend having something to look forward to each day.

Over a lifetime, you may cycle through many of these stages. The coping skills that worked in the past may cease to help as new life challenges arise. Sometimes you may have the best intentions yet still struggle with maintaining new behaviors. The maintenance phase focuses on how to keep the changes going.

Maintenance:  I’m Persevering

The Maintenance Stage is when you have made the appropriate lifestyle changes for your goal. You will have consistently changed your drinking patterns. The goal now is to keep the healthy behavior going to prevent a relapse to the old behavior. Identify triggers and a plan to deal with them.  Keep doing what works and stop doing what does not.

Many of my most successful clients schedule regular check-in appointments with me. These people have worked long and hard to get to where they are in their recovery process and do not want to go back to where they were. Some of them have chosen complete abstinence, and some are working on drinking in moderation. Each person will have a different goal but it helps to have a support and accountability partner to maintain your progress and ward off any future problems.

Which stage of change are you are in? What would it take to get you to the next stage? Who and what can help you?

Post Submitted By: Cyndi Turner LCSW, LSATP, MAC

Cyndi Turner LCSW, LSATP, MAC is the co-founder and clinical director of Insight into Action Therapy in Fairfax, Virginia. She is the author of the book “Can I Keep Drinking? How You Can Decide When Enough is Enough” which challenges the traditional belief that all drinkers experiencing problems are alcoholics who must quit drinking forever.

Day 10: Am I Ready To Change?

Out and About (Fall 2018)

Dr. Danielle Rothman was named 2018 Loudoun’s Favorite Psychologist by Loudoun Now. She offers play therapy and psychological testing.

 

Craig James, LCSW, LSATP, MAC participated as a panelist on September 18, 2018 in Ashburn. The event was focused on breaking the stigma of mental illness and was provided to the community to raise awareness of mental health issues. The event was sponsored by the Loudoun County Chamber of Commerce.

 

On September 24, 2018 Cyndi Turner, LCSW, LSATP, MAC and Craig James, LCSW, LSATP, MAC partnered with Dominion Hospital to provide a training on adolescent substance use and dual diagnosis issues. The training was hosted at the Chantilly outpatient services location for Dominion Hospital. The training was a great opportunity to help education local providers on teen specific issues when treating substance use and dual diagnosis. The event showcased Insight’s ability to collaborate with other local providers, such as Dominion Hospital, as a step-down option for treatment for kids and teens following more acute inpatient services.

 

Insight Into Action Therapy sponsored a screening of the movie Angst, a documentary about teen anxiety on September 27, 2018. The movie raises awareness about the stressors our kids face and the resources that are available. The movie was shown in partnership with Loudoun County Public Schools at the Administration Building in Ashburn. Afterwards, Angie Harris, LCSW, MAC, MA participated on an expert panel along with a LCPS psychologist, social worker, counselor and homebound coordinator to identify community supports from the private provider community as well as options available through LCPS to help alleviate youth stress and anxiety.

 

Matt Christian, MSW represented Insight at the 5thannual Mental Health and Wellness Conference hosted by the Fairfax County Public Schools at Fairfax High School in Fairfax. Matt was able to connect with many local parents looking for resources in the Fairfax-area to help support their children and adolescent’s mental health needs.

Insight Into Action Therapy was named as a finalist for the 2018 Health and Wellness Business of the Year by the Loudoun County Chamber of Commerce. They celebrated with almost 600 guests at the prestigious Small Business Awards ceremony on November 1, 2018.

 

Cyndi Turner, LCSW, LSATP, MAC and Craig James, LCSW, LSATP and MAC attended the 17th Annual Pathways to Wellness Conference in Fairfax, Virginia on October 12, 2018. The theme of the event was Embracing Our Best Selves. Cyndi and Craig provided resources to the local community to highlight substance use and dual diagnosis treatment options available at Insight offices in Fairfax and Ashburn.

 

Angie Harris, LCSW, MAC, MA presented “Raising a Responsible Adult: Tips for Increasing Your Child’s Success” for Loudoun County Public Schools at the Mental Health and Wellness Event at Briar Woods High School in Ashburn. The event was held on October 13, 2018 to connect parents with local providers and experts in helping children and adolescents manage their mental well-being.

 

Angie Harris, LCSW, MAC, MA co-presented with Matt Christian, MSW on “Mindful Parenting” for LCPS on the 13th. The event effectively introduced parents to the concept of integrating mindfulness into their parenting strategies to become more fully present in the lives of their children as well as themselves. Both trainings were well-attended by local parents of elementary, middle and high schoolers.

 

Insight Into Action Therapy joined other Loudoun County Chamber of Commerce members on January 25, 2019 at the Community Leadership Awards. Insight was a finalist for 2019 Outstanding Community Leader of the Year in the Small business category. Although we did not take home the award this year, it was an honor to be a part of this amazing event and be recognized by Loudoun County Chamber of Commerce and the local community members for our efforts. We love living and working in our own community in Loudoun County and look forward to many years of service to come. 

 

 

 

The Basics of Mindfulness

Over the years mindfulness has become more common in our society. There are apps to guide us through the practice and it is even being integrated in schools to help teach kids how to manage emotions and stress. But what is mindfulness?

Mindfulness is the practice of being both aware of the present and simultaneously accepting the present circumstances.

Many times we find ourselves lost in thought as we carry out other activities throughout our day, such as driving a car and not realizing which way we took home or making lunch and not realizing what ingredients were on the sandwich. This is known as “mindlessness” because we are checked out of the present. Just because we are able to do things without paying attention to them does not mean this serves our best interest. Mindlessness is a short distraction from our feelings but often does not allow us to work through the thoughts causing us distress, anxiety, or sadness.

The goal of mindfulness is to recognize what is happening in the present and slow down our awareness to understand our thoughts.

Understand what we are doing by becoming aware
Understand why we are doing it

Overall, this can enhance our life experiences and help us remain presently focus based on reality, not the distortions where anxiety lives. Over time, we become aware of our thoughts, are able to confront them in a more rational and wise way as well as learn to be less judgmental of ourselves.

Mindfulness originated in ancient Buddhist meditative techniques. It became more integrated in the field of healthcare in the 1980s when treating chronic pain patients and trauma victims. Here are some additional benefits that have been found:

Lowered stress and emotional reactivity
Reduced anxiety and negative emotions
Reduced likelihood of substance-related relapse
Enhanced relaxation and overall sense of well-being
Lowered perception of chronic pain
Increased immune system response

If you are interested in exploring how mindfulness can help you improve your overall functioning or target specific problems in your life, find a therapist that integrates mindfulness into treatment. Angie Harris, LCSW, MAC, MA is certified in Mindfulness Based Stress Reduction. She incorporates mindfulness with other evidenced-based approaches, such as Cognitive Behavioral Therapy (CBT) or Distress Tolerance, to help manage overwhelming emotions and manage anxiety and stress. Learn more about her at http://www.insightactiontherapy.com/therapists/angie-harris/or contact her directly at aharris@insightactiontherapy.comor (703) 646-7664.

 

 

Three Play Therapy Techniques You Can Use at Home

This week is National Play Therapy Week. If your child is struggling emotionally or behaviorally, play therapycan provide them with an opportunity to express themselvesin their natural language – the language of play – and allow the therapist to support you in better understanding and meeting your child’s needs. Even if your child is thriving, there are play therapy strategies you can use at home that can give your child more opportunities for self-expression and help strengthen your bond with your child.

Let Your Child Take the Lead

As a parent, it is natural that you want to ensure that your child is learning and growing. You may often find yourself directing your child toward activities or encouraging them to use their toys in certain ways. Change things up by following your child’s lead in play, even if they do not want to use their toys in expected ways. Perhaps your child wants to fill their dollhouse with toy soldiers instead of furniture. Maybe they want to make interesting patterns using Connect Four pieces rather than trying to line up four pieces in a row. Whatever they are doing, join in their play and follow along. There is no one “right” way to play. Your child is learning from all the many ways they play. Allowing your child to lead in play in a judgment-free environment will give them increased opportunity for self-expression, hone decision-making skills, help them to build confidence in their own ideas, and increase their connection to you by helping them to see that you are genuinely interested in them and their thoughts.

Provide Access to a Variety of Toys

It can be tempting to fill your house with the latest and greatest electronic toys. It is important to give your child regular access to toys that more readily lend themselves to emotional expression. Dr. Garry Landreth, author of Play Therapy: The Art of the Relationship, discusses the following three categories of toys:

Real-Life Toys: these are toys that represent the objects and situations that your child encounters in daily life. Examples are dolls, toy cars, pretend medical kit, play money, and pretend food.

Aggressive-Release Toys: these are toys that allow your child to safely express angry and aggressive tendencies in an appropriately contained manner. Examples are toy soldiers, aggressive animal figures (dinosaurs, dragons, sharks, etc.), and a “bop bag.”

Creative Expression Toys: these are toys and materials that give you child the opportunity for free expression of feelings and creative thought. Examples are art supplies, play dough, dress up clothes, and kinetic sand.

Providing your child with a few toys in each of these categories will give them opportunities to express their thoughts and emotions through play, reducing the need to act out or engage in other undesirable behaviors. 

Goodbye Questions & Criticisms, Hello PRIDE 

If you are like most parents, when you play with your child you probably ask them lots of questions about what they are doing and also offer the occasional criticism. It makes perfect sense that you want to ask your child whythey chose to color that cow blue or tell them that they’ll waste that glitter if they dump it all out. There are plenty of times when questions and corrections should be part of your interactions with your child. However, these are both interjections that can interrupt the flow of your child’s play. Even the most well-intentioned question can cause your child to second-guess their choices. Try setting aside a few play sessions each week with your child where you avoid questions and critiques and instead focus on using PRIDE skills. PRIDE skills are a component of Parent-Child Interaction Therapy (PCIT),  a form of therapy for young children with behavioral problems, and are as follows:

Praise: Give your child specific praise when they are engaging in a desirable behavior (“I love that you shared that with me”; “You worked so hard on building that tower!”). This lets your child know that they will receive attention for positive actions and clarifies what desirable behaviors are.

Reflection: Repeat what your child says to you. For example, if they say, “I colored this whole page!” you might say, “You colored the whole thing!” This lets your child know that you are listening to them and paying attention.

Imitation: Copy your child’s play. If they tell you they are making cupcakes with their playdough, you let them know that you are making cupcakes, too. This will show your child that they are leading the play, that you value their ideas, and that you are actively engaged with them.

Description: Tell your child what you see them doing (“You are putting the red block on top of the blue one.”) This will let your child know that you are interested in what they are doing and can provide opportunities for conversation without relying on questions.

Enthusiasm: Let your child know that you are excited about playing with them. (“I’m having so much fun with you!”) Showing enthusiasm lets your child know that you enjoy your time with them and will increase their connection to you as well as their desire to engage in behavior that is pleasing to you.

As your child gets older, certain PRIDE skills may no longer be a good fit.  But children of all ages will be thrilled to have opportunities to engage in enthusiastic, nonjudgmental play with you and to soak up praise and positive language.

 

Danielle Rothman, Psy.D., is a licensed clinical psychologist at Insight Into Action Therapy, where she provides therapy and psychological testing. She can be contacted at (703) 646-7664 ext. 11.

Are You SAD?

Do any of these sound like you during the winter months?

Have a depressed mood more days than not
Loss of interest or pleasure in activities you once enjoyed
Increase in appetite, especially for carbohydrates
Increased sleep
Loss of energy or increased fatigue despite extra sleep
Increase in restlessness or slowed movements
Feeling worthless or guilty
Trouble concentrating or making decisions
Thoughts of death or suicide

You may be experiencing SAD—Seasonal Affective Disorder. Nearly 70% of people who struggle with depression will experience SAD during the winter months. About 5% of the general population also may deal with this type of depression. Symptoms typically resolve themselves starting in March.

There is a combination of factors for why SAD occurs. One has to do with the overproduction of melatonin. This is a hormone that increases drowsinessin response to darkness. During the months of December, January, and February we have shorter daylight hours as well as decreased levels of sunlight because the sun is lower on the horizon. Exposure to the sun helps our skin produce vitamin D. We need vitamin D to absorb calcium which promotes bone growth. Low levels increase fatigue, muscle pain, ability to fight infection, and depression. Additionallypeople with SAD may have difficulty in regulating serotonin, a neurotransmitter that affects our mood, appetite, and sleep. During the winter months, people with SAD overproduce SERT, a protein that transports serotonin. Increased SERT levels diminish serotonin activity, increasing depression. Some also believe that we are not as aware of these effects in December as we are often preoccupied with the holiday season.

To reduce and cope with the symptoms, try the following:

Sit near a full spectrum light also known as a lightbox or SAD light. This is not an ordinary lightbulb, but one that has at least 10,000 lux. It’s best to sit close to it for about 30 minutes a day, preferably in the morning hours.
Get at least 15 minutes a day of natural sunlight. Do not put on sunscreen, it will block the production of Vitamin D. While dermatologists warm us about the damaging effects of the sun’s ultraviolet rays, most agree that this amount is therapeutic.
Try therapy. A trained professional can teach you coping skills and help keep you accountable when your motivation is low.
Talk to your doctor. If you are already taking an antidepressant, it may make sense for him or her to increase your dose or add another medication during the winter months.
Get your Vitamin D levels checked. As we spend less time outdoors and often wear sunscreen regularly, many of us are deficient. If your levels are deficient, your doctor can prescribe a high dose of it. Vitamin D is also available over the counter as a supplement.
Rule out any medical issues. Hypothyroidism, anemia, infections, and mononucleosis are all conditions marked by the symptoms listed above. A medical doctor can make an accurate diagnosis and treat these conditions.
Take your vacation in the winter instead of the summertime. Head south. The closer to the equator, the more exposure to the sun.
Increase your intake of foods rich inVitamin D. These include fatty fish like salmon, tuna, and mackerel, almonds, cheese, egg yolks, mushrooms, and fortified foods like milk, yogurt, cereal, and orange juice.

Realize that the winter solstice occurs on December 21. This is the shortest day of the year when we have the longest hours of darkness. Every day after we add a few more minutes of daylight.

Remember that Spring and Summer always come. Winter is just a season. You will get through it!

Insight Into Action Therapy offers therapy to help you learn strategies to deal with your depressive symptoms. Learn more about our services and how we can help by visiting insightactiontherapy.com or give us a call at (703) 646-7664.

 

Suicide: A Psychiatrist’s Perspective

We have recently heard news of high profile celebrities completing suicide. As tragic and eye opening as such news is, this psychiatrist’s opinion is that the discussion has been superficial and speculative. It also, rather unsatisfyingly, concludes by only offering up the national suicide hotline.

What appears to missing from the discussions is not the term mental illness, which has acquired its own negative connotation because of its repeated association with mass shootings over the years, it’s actually the more appropriate terms: depression and mood disorder.

This is important because more than 90% of completed suicides are associated with mood disorders. These are also among the most readily treatable of mental illnesses, with early warning signs of worsening mood that would usually be recognizable by loved ones, allowing them and professionals to intervene earlier. Herein lies the silver lining to such dark clouds surrounding suicides.

What makes people want to plan their own death? The reasons are varied, but among the common symptoms that many find unbearable are: persistent anxiety, insomnia, hopelessness, helplessness, and chronic pain. Not surprisingly, many individuals turn to alcohol or drugs to ease the burden of such symptoms. We know that such substances can end up exacerbating the very symptoms they are trying to cope with. Most concerningly, they can also powerfully influence judgment during such states, making the person think there are no alternatives and making them act upon their anxiety and hopelessness in self-destructive ways.

We also know that the negative thinking patterns intrinsic to depression can make a person simply not want to seek help or to write off the effectiveness. It is such thinking and decision-making that needs to be recognized and addressed to halt the descent of the person into ever worsening and destructive patterns of thinking and behavior that end up only feeding each other.

Thus, what the person chooses to do about their symptoms can either help, perpetuate or even worsen depression. Individuals naturally vary in what is often referred to as their coping style. Certainly, withdrawal and avoidance of treatment can be important factors in the downward descent toward suicide. On the other hand, physical activity, reaching out and regular structured activity (such as work) can help prevent such a decline.

There’s more to the story than just symptoms and how individuals cope with them: feelings. Oftentimes there are deep-seated and painful ones that are truly difficult for most human beings to share. These include shame, guilt, regret, and inner turmoil, mostly at feeling unable to cope or having let themselves or others down. Such emotional reasoning also tends to worsen depression and can itself generate another terrible cascade of negative, self-berating thoughts. Or to put it more basically: beating oneself up.

So, what can we do to prevent suicides? The answer is not a simple or easy one. It involves recognizing and exploring the person’s feelings as well as associated symptoms of depression. Depression can be manifest either in what the person says and does. There may be a significant change from their usual level of functioning. It is important to pay attention to the person’s demeanor: hunched posture, limited eye contact, poor self-care and a monotone voice can be obvious clues. Finally, persistent rumination about the past or present, pessimism about the future, and negative thinking can also be signs of a major depressive disorder.

When physicians are assessing the severity of depression, they are not just confirming a depressed mood, they are looking for other associated symptoms to confirm the diagnosis and its severity. This includes changes in what is referred to as biological functioning. These are disturbances in basic bodily functions such as appetite, sleep, activity, and interest in hobbies, socializing or sex. In some depressions, people may end up sleeping more, in others, less. In melancholic depression, weight goes down by more than 10%, along with a worse mood in the mornings. In more atypical depressions, people may end up eating more and gaining weight, together with an unusually sensitive and fragile sense of self and a very heavy feeling in the arms or legs.

Once a mood disorder has been diagnosed, it needs to be treated as soon as possible. Most depressions are treated in the outpatient setting, with more severe symptoms requiring hospitalization to ensure the person’s safety.

Some depressions, if mild in severity may not require antidepressant treatment. Instead they may benefit from a specific kind of therapy called CBT that helps a person recognize and challenge the tendency toward negative thinking. However, the decision to start medication should be made in consultation with a physician familiar with such treatment. The most severe depression might also benefit from a specialized medical treatment called ECT (Electroconvulsive Therapy).

Suicide should be assessed at every appointment. Proper assessment is more than just asking if suicide is present or not. Some patients fear disclosing such thoughts for fear of being hospitalized against their will or because of shame. In truth, physicians are encouraged to ask patients about suicide to help demystify the shame or guilt associated with such thoughts and to help normalize the experience of such thoughts when depression symptoms are worsening.

As a psychiatrist, when I ask about suicide, it is to get the proper context of such thoughts. Are they only in relation to the severity of symptoms at a time? Do they result in the patient stewing over ways to do it? Most importantly, what plans have or have not been made or attempted? Suicide needs to be assessed on a spectrum of thinking, ranging from fleeting thoughts that may last only seconds, to the other end involving actual planning and acting. Unfortunately, many patients just get a barrage of questions on a checklist that neither encourages honesty nor builds any meaningful rapport with the person asking about what kind of suffering has given rise to such thoughts.

Of course, the science of suicide risk assessment involves more than just asking the patient about it. Subjective reports are but one factor in such an assessment. As a psychiatrist, I must consider my patient’s whole history (including childhood traumas, family history, their own history of mood disorder, prior suicide attempts and their usual coping style) that would make them vulnerable to future suicide. In addition, I must make a judgment about how vulnerable they are right now, based upon how they look to me, the range and type of mood symptoms, and how much they rely on drugs or alcohol.

Then there is the person’s support network. Who do they live with? Who do they tend to confide in? Is there adequate structure and meaning in their life (work, children, family)? All these risk and protective factors must be considered in making a judgment about how high the risk of suicide is. Even with all this information, no physician can predict a suicide. However, if vulnerabilities and symptoms are addressed with proper, focused interventions and the right kind of support, this can go a long way to reducing the risk of suicide substantially.

As a practicing psychiatrist, my goal is first to build a trusting, solid and emotionally honest treatment relationship with my patient. That way, I can get the most accurate picture of what is going on and how I and others can help. Thus, I make a point of asking the patient to call me directly if they are having worsening or changing symptoms, issues or concerns about their medication or new stresses that make it hard for him or her to cope as before.

In addition, if I am concerned, I will see them more frequently, be in phone contact more often, change medication dosage or type, refer them to a therapist, or reach out (with the patient’s permission) to close family or friends. Only if I am convinced that the person is at foreseeably high risk will I facilitate hospitalization. The decision as to what to do is a highly individualized one, based upon the full range of information available to me and upon my patient’s current state of mind.

In my approach to reducing the risk of suicide, I emphasize patient education as a key aspect. This helps empower him or her. The patient will then know why the doctor is proposing a certain course of treatment, dosage etc., what therapy is supposed to address, and what crucial part the patient themselves can play in their own recovery. In addition, I try to instill hope by informing patients just how treatable most depression and mood disorders are with the right kind of medication, psychiatric follow up, and therapy.

If there is any silver lining to the cloud of suicide in our society it is that the causes can be  identified and addressed with a treatment alliance with your health care provider(s).

 

Is Smart the New Average?

You’ve heard it from friends, family, relatives, neighbors, other parents, teachers and you’ve possible said it yourself: “My kid is smart.” But what does smart mean?  What is it? How do you quantify it?  Depending on the context in which it is used, Merriam–Webster defines smart as an adjective, verb, and a noun; i.e. bright, knowledgeable, witty, clever.

So this smart thing, it sounds good but how is smart measured?  Too often it seems to relegated to the academic arena and specifically a standardized test score, grade(s), and/or the number of advanced placement classes. But with test corrections, test re-takes and rolling deadlines, should be we really consider these artificial and arbitrary indicators?  Unfortunately, too many parents do and with good reason.  The Loudoun-Times Mirror  sites that 81% of the high school grade distribution among Loudoun County Public Schools were As and Bs.   If this is the barometer for smart, then for parents and students alike, this is a trigger.  A trigger for panic and fear!  Fear that your daughter isn’t making the grade or THESE GRADES, and that she won’t get into college and she won’t be happy and that she won’t be successful.  This likely leads to parents incessantly checking the on-line portal for grades or missing assignments and contacting teachers.  Thereby creating a parent-child relationship void of independence, instead modeling one based more in anxiety and distress.  How parents so often forget what their formative years were like. It is said that age and experience provide us with wisdom.  But if grades are the measure of smart, then we are likely going to see more parents’ hysteria.  Where’s the wisdom in this?

This smart phenomenon had me thinking.  Is it supposed to be code for gifted?  Is it an indicator for exceptionalism or for proficiency?  When did grades become the measuring stick for tolerance? Is the use of the word smart now code for average? And if so, is average a bad thing?

Think back about twenty years, when education, learning, comprehension, and independent thinking were more the focus than the number of Honors and AP classes a kid took.Psychologist, Richard J. Herrnstein, and political scientist, Charles Murray, introduced the Bell Curve, the statistical analysis of how and where people measure against the norm.  While there was controversial use of the Bell Curve due to social agenda and stigma, within the academic arena its use was for probability and how to understand a student population on any given task.  In short, the Bell Curve determines that students are more similar than different with a small sample of outliers on either end of a continuum.  So, if students are more similar than different, is smart really the appropriate term? While it’s nice to identify someone as smart, should we actually say that most students are average? And that this is not disparaging in any way?

I contend that the word smart has been misused.  What if what is called smart is a person’s natural affinity or gift? That thing that comes easy and with little effort.  Calling it something that it is not could indirectly do more harm than good, thereby diminishing a student’s ability and undervaluing effort and work ethic.  Have we – parents and students – become unintended casualties of the standard-based education reform by focusing on labels, smart, and grades and not determination?  Just something to think about!

Over the Counter and Psychiatric Medications: Helpful or Dangerous Combination?

Over the counter medications (OTC’s): many of us have relied on them for day-to-day ailments. Be it for coughs, colds, headaches, fever, minor sprains, allergies, or aches and pains, we’ve all found ourselves meandering into our local pharmacy seeking relief from these minor but pesky symptoms. In fact, studies have revealed that around $116 Billion dollars was spent on OTC remedies in the United States in 2016.

The true question here though is: Is there anything wrong with managing our symptoms this way? The proper answer to this question is: Well, it depends. To give an oversimplified answer, there are two essential ways to address an illness: treat the symptoms or the underlying illness itself.

In reality, symptoms are what drive us to seek help. Symptoms like fever, nagging cough, sore throat or runny nose can be very troublesome and we simply want relief. That’s understandable and human. We just want the headache to go away, nose to stop running, or irritating cough to cease That’s where a pain reliever, cold syrup, or cough drops can help. We take it, feel better, get on with our day, or simply fall asleep easier. However, that doesn’t mean that we have treated the viral illness that gave rise to flu symptoms in the first place. This is where a prescription medicine may prove more effective by both shortening the duration of the flu symptoms and by making them less intense—because it is targeting the root cause.

Such an analogy would also apply to psychiatric symptoms. For example, the inability to fall asleep might be a sign of depression or anxiety. While an over the counter sedative might help you fall asleep, it won’t address the other symptoms of those disorders. If you are regularly resorting to a sleep aid for insomnia you may be treating the problem superficially, never really addressing the underlying causes. This is where it would probably be more helpful to seek professional advice and help.

Most physicians understand patients’ need for symptom relief and would likely prescribe something for this. In addition, what I do as a physician is educate my patient about what medication does, how it works, and the underlying nature of the problem/disorder. That way we can go about tackling the problem comprehensively, rather than just skimming the surface with use of OTC medications.

The other important issue I inform patients about is that OTCs are not totally harmless just because they can be obtained without a prescription. This is especially important to know if I plan to prescribe psychiatric medications that might interact dangerously with sedative medications such as Benadryl.  This interaction could either mean intensifying the effects of the existing prescription medication (including side effects) or undermining it by affecting the prescription medication’s metabolism by the liver.

Given the above, I get especially concerned as a physician when my patient tells me after that fact that they have resorted to an OTC medication. That usually tells me they are still trying to self-medicate a troubling symptom even with their existing prescribed medication. In such cases, I work with my patient to establish the full range of medications they should or shouldnot be taking. It also tells me whether I need to add or change their existing medication to address their ongoing symptoms.  I then ask them to inform me as soon as possible of any changes or additions to any of their othermedications or to inform me before they intend to take any other medications, supplements or herbs.

If chosen well, prescribed psychiatric medications should ideally address all ofthe symptoms of a patient’s psychiatric disorder so that a patient should not feel the need to reach for OTC symptom relief. If not, I always encourage my patient to tell me if a medication or dosage has not worked in the way that it was expected to. That way I can adjust or change their prescribed medications accordingly. I also then advise them of the time frames expected, so that they do not lose hope and again resort to OTC medication use.

Teaching patients about how brain receptors work helps people have a realistic understanding of medications’ effectiveness and what symptoms they can treat. Patients who are used to being on several medications or who have had histories of alcohol or drug use may require higher doses of their psychiatric medications. However, such increases should always be supervised by a physician who is familiarwith their medical and psychiatric history and never done by the patient of their own accord.

The most common cause of poor outcomes that has been repeatedly proven in healthcare studies is inadequate communication among healthcare professionals and patients. This is why I want to emphasize the importance of always telling your treating psychiatrist about allof your symptoms, what remedies—including OTC medications—and what doses you have tried thus far. That way he/she can make their best judgment as to the most appropriate and safest next step to help you achieve relief of your symptoms faster.

 

 

Parenting is Cruel

So your family and friends visit and tell you how sweet and precious they are, this little miracle, this bundle of joy, this beautiful child that depends on you for everything.  They tell you how luck you are and how you are going to embrace and love every moment as a parent, THEY lied they left out what it’s like when they get older. Read Cyndi’s blog post in Lose the Cape entitled, Parenting is Cruel