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The following articles are written by BHI clinicians and others to provide education and information about various topics. Check back with us frequently for more articles.

We also invite you to read our BHI BLOG for timely and informative posts: www.HealthyBehavior.blogspot.com.

Disclaimer:
The information in these articles is for informational purposes only. It is not intended to be psychological advice and should not be considered a substitute for consultation with a licensed mental health professional.


ADD: Evaluation, Treatment and Prognosis
By Frederick M. Kravitz, Ph. D., Licensed Psychologist
Behavioral Health Institute

While there has been a lot of publicity in the past few years about children being diagnosed and treated for Attention Deficit Disorder, there still seems to be much confusion over the nature of the disorder, how we evaluate and treat it and the long-term prognosis for ADD kids.

ADD is a neurological disorder that negatively affects many aspects of a child's life. The disorder causes problems in a child's ability to control his behavior, leading to difficulties attending to tasks, completing work and organizing as well as others his age. These children are impulsive, easily distracted and quite disorganized. While there is no one cause, heredity, perinatal factors and head injuries have been cited. Some theories postulate an insufficiency of neurotransmitters, chemicals in the brain that regulate the flow of messages between brain cells. Regardless of cause, ADD is a group of behaviors including difficulty paying attention, focusing, staying on task and regulating one's own behavior. Some ADD children are hyperactive; some are inattentive. The latter are often times harder to recognize since they may appear attentive and focused while they are in fact daydreaming and not with the program. When called upon in class they may have no idea what's being asked of them. Whether a child is hyperactive or inattentive, these kids bore easily and often engage in self-stimulative behaviors.

Evaluating a child for ADD requires the input of parents, teachers and other caregivers. While it is normal for children to become restless and inattentive at one time or another, ADD should be considered only if these symptoms interfere with functioning at home and at school. The ADD evaluation typically includes a developmental history, teacher ratings of classroom behaviors, parent ratings of behavior at home, and psychological testing and observations. While there is no single test for ADD, psychologists typically administer a continuous performance test to see how a child's ability to sustain his attention on a tedious task compares with their same-age peers. Often times an intelligence test and/or an achievement test are administered to assess the child's ability to stay on task and to rule out other learning difficulties that may be contributing to the child's misbehavior and poor academic performance.

Once a diagnosis is made, treatment options may include the following:

The physician's decision to recommend medication is typically based on the data presented by the treating psychologist. Specific stimulant medications are estimated to each have a 75% positive response rate. Overall, more than 90% of children respond well to one of the available stimulants. These medications control the ADD; they do not cure it. These medications are considered safe. Side effects are usually manageable: decreased appetite at lunchtime and a small delay in falling asleep at night.

As far as prognosis goes, we used to think that ADD children outgrew the disorder in adolescence. We now know that many of the symptoms persist throughout the life-cycle. However we also find that many children learn to compensate as they get older; they acquire new skills and may no longer need medication to function adequately in their later schooling or in their adult life. The career choices made by ADD adults may also reduce the need for treatment by providing stimulation with a minimum of tedium. ADD's effects are most apparent when an individual is in a classroom with the passive role of listening and learning. Once these individuals are out in the world working the effects are very different.

While some people have questioned whether we are over diagnosing ADD, scholars remind us that the world we live in is increasingly complex and requires that we stop and focus and try to keep up. The demands of modern life are clearly beyond the demands made on previous generations. The complexities of modern life have not caused ADD, but have revealed it.


10 (Low Cost) Ways to Maintain Your Psychological Health
By Todd D. Giardina, Ph. D., Licensed Psychologist
Behavioral Health Institute

Sometimes life can feel overwhelming. Whether it’s due to the loss of a job, family problems, or ”too much to do with too little time,” stress can build and problems can appear insurmountable. It’s easy to lose perspective. Here are some simple, low-cost ways to maintain your psychological health in these times of trouble

  1. Prioritize. Ask yourself, “What is essential and what can I take off my list?” When stress mounts, you’ll find yourself with less time and energy. To avoid unnecessary frustration and conflict, decide on your priorities and make decisions accordingly. For instance, maybe until the big project at work is finished you could make career and family your focus, and the bowling league will have to make do without you for now.
  2. Exercise. While physical limitations may be an issue for some, being physically active in whatever way you can has several psychological benefits. Not only does physical activity produce a feeling of accomplishment, but it also causes chemical reactions in your body, which can have natural antidepressant and anti-anxiety effects. And, you recognize that you can escape your thoughts and feelings and just BE for a while.
  3. Keep talking. Don’t keep your feelings pent up. When you find yourself worrying, it’s better to talk with someone you trust – close friend, family member, or clergy. This can help you define the problem and develop ideas for possible solutions.
  4. Seek happiness. It is important to utilize the resources that are already within your grasp but that you may have failed to recognize or forgotten about. Schedule hobbies, social activities, and activities you enjoy into your routine. Why wait for happiness to come to you if you can seek it out?
  5. Set Goals. Consider reasonable and achievable goals, steps to attain them, and then work consistently in that direction. Whether you are working on saving money by packing lunches and eating out less, or controlling your anger by increasing your physical exercise and taking time outs when your tension starts to build, it is possible to change your behavior.
  6. Draw on past successes. Think back to difficult times you have experienced in the past – how did you get through? What did you do to cope? These answers may help you formulate a plan for weathering the current storm. If your faith helped you survive a rough divorce, then maybe meditation and prayer will help you manage your work-related anxiety now.
  7. Work on changing one thing at a time. If you are already stretched thin in other areas, adding the stress of major lifestyle change may not be a good idea. This is why Alcoholics Anonymous advises participants to wait until they have achieved sobriety before starting a new relationship. You end up adding to your burden and setting yourself up for failure if you lack the psychological energy to commit to such a task. Sometimes you need to give yourself a pass on some bad habits and focus on changing just one thing at a time.
  8. Avoid unhealthy comparisons. Just because your friends or co-workers seem to be handling life stress better than you doesn’t mean they are; they might just be better at hiding it (and that can be a stressor in itself). Stress is very relative, and how you manage it all depends on your personality, life history, coping resources, belief system, and so on. Life is not an apples to apples comparison, and you’ll only make yourself more upset by trying to keep up with the Joneses.
  9. Take a breath and count to 10. Long, slow breathing into your diaphragm (stomach) has a relaxing effect on the body and mind. Combine this with counting slowly to ten and you have tools that help manage anxiety, stress, anger, pain, insomnia, and even depression. You end up calming yourself instead of dwelling on your thoughts/emotions, allowing you to regain a feeling of self-control and greatly reduce reacting impulsively.
  10. Be realistic. Don’t expect too much of yourself or other people. Give in occasionally when something is just not that important, and use your sense of humor whenever possible. Sometimes it’s best to try to accept what you cannot change and just keep working toward changing what you can.

Depression: A Patient Guide to Treatment
By E. Nelson-Wernick, Ph. D., Licensed Psychologist
Behavioral Health Institute

Everyone feels “down” or “blue” once in a while, and these moods are often a normal reaction to stress or some disappointment or loss in life. But when this mood lingers on for weeks, it begins to impact different aspects of day-to-day functioning. It is impossible to “just snap out of it.”

Clinical depression is a common medical illness, affecting 1 in 10 adults in any given year. Also, depression is known to weaken the immune system, making the individual more vulnerable to other health problems.

Signs of depression include:

Some people believe that depression is a sign of personal weakness, and that the best thing to do is just “pull yourself up by the bootstraps and get over it.” This is not true. In fact, this type of thinking leads people to feel ashamed of seeking treatment.

Depression is very treatable. 80 % of people respond well to treatment, and nearly all experience some level of improvement.

It is important to see a health professional in order to evaluate the possible causes of depression, including certain illnesses and the side effects of prescription medications. If these factors are found to be causing your symptoms, your physician will address them. Depression can also occur along with other medical illnesses, and if this is the case, both conditions may require treatment.

How is depression treated?

Treatments for depression include psychological interventions and antidepressant medications. Often a combination of the two treatments is most effective.

Cognitive and behavioral therapies are the most effective psychological treatments for depression. These therapies can help change negative styles of thinking and behaving that may contribute to depression. It can help you to develop good decision-making skills, learn to deal more effectively with others, and improve your relationships. A licensed mental health professional can help you set realistic goals for yourself and work with you toward achieving them. Sometimes family members are involved in treatment in order to learn effective ways to provide support.

Today there is a wide range of antidepressant medications used to treat depression. These medications help to alleviate symptoms of depression. It is important to be aware that regular physical exercise can also help manage symptoms.

Not everyone with depression requires medication. The decision to start antidepressant medication often depends upon the nature and severity of symptoms. Your physician and/or a licensed mental health professional can help you make that decision, and if you do start medication, they will work together to treat your depression.

If you are being treated with antidepressant medication, it is important to remember the following:

  1. Take the medication just as it is prescribed. Ask questions if you are unsure of the instructions, and write them down.
  2. If you experience any side effects, they will usually be mild and pass within a few days. If this is not the case, notify your physician.
  3. Because it takes a while for these medications to build up in your bloodstream, it may take several weeks before you can expect to feel positive effects.
  4. Do not stop taking your medication without first discussing this with your physician.

Conclusion:
Depression is a common medical illness that results in changes in one’s thoughts, emotions, behaviors and physical functioning. It is impossible to “just snap out of it.” Cognitive and behavioral therapies as well as antidepressant medication have been shown to be effective treatments for depression. By being an active participant in your treatment you can help yourself move through the depression more quickly, and return to a healthier life.

For more information about depression and its treatment, please contact Behavioral Health Institute at 954-340-0888.


Dollars and Sense:
Talking to your Children about the Economy

In this time of extreme economic stress, it is difficult to leave the problems of the economy off the kitchen table. Fears about mortgages, college tuition, retirement, and day-to-day expenses haunt the halls of many family homes. Children are no doubt noticing the increased stress of their parents during the financial crisis and may be experiencing their own stress as a result.

“Children are extremely resilient,” says psychologist Dr. David Palmiter, “However, they are keenly aware of tension in the household, whether it is from the financial situation or from other familial problems. It is important to be honest with your children, yet only share information that you think they can handle.”

While open communication between parents and their children is the foundation of a healthy relationship, parents should not overburden their children. Instead, address problems at age-appropriate levels. For example, what a parent might tell a younger child about the family’s financial situation is different then what they might tell an adolescent; young children may interpret the situation as more dire than it actually is. Older children and teens will be more exposed to the news--discussing their understanding of the economy and its implication on the family can be reassuring.

How parents phrase their worries about the financial situation influences a child’s interpretation. Younger children may take overheard statements such as “we’re going to the poor house” literally and thus internalize fears about losing their home. Talking to your children and asking them their thoughts and ideas will help clear up any misunderstandings, ease their anxieties, and reduce their stress.

Families can also use their financial situation as an opportunity to manage their children’s expectations for material goods. Teaching your children about budgeting, perhaps by setting up a “savings account” for their pocket money, or by allocating a certain amount for charity, will help them better understand that an Xbox or an iPod might not be feasible for the holidays this year. Furthermore, these times offer an opportunity to focus on the positive aspects, and prioritizing what’s important—relationships with loved ones and friends, the family’s health—can lessen children’s fears and reinforce family values.

Pay attention to signals that your child may experience: sleep and appetite changes, nightmares or avoidance of situations or people. Parents who use healthy stress-relieving behaviors set a good example for children. Taking a family walk after dinner or playing a board game in the evening are not only positive alternatives to distract oneself from the news, but also inexpensive activities that foster bonding time.

Being proactive about managing your family’s stress and continuing life as usual, despite what’s happening on Wall Street or Main Street, will help make a psychologically healthy home even in a time of economic unrest.

Special thanks to APA members Dr. David Palmiter, Dr. Mary Alvord, and Dr. Nabil Hassan El Ghoroury for their help with this article.


Many People Suffer from Chronic Pain:
How Psychology Can Help
by Todd D. Giardina, Ph. D.

Originally published in the July 2010 edition of the BHI E-newsletter.

A recent article in The Journal of Pain (Miller & Cano, 2009) reported that as many as 22% of people in the community may be suffering from chronic pain, i.e., pain lasting more than several months. While this figure may be surprising, what is even more noteworthy is that 35% of those chronic pain sufferers are likely to be depressed.

In addition, while we don't know how to account for this, the current research indicates some individuals are at greater risk for developing chronic pain: females, African-Americans, those who are middle-aged, or who are in a lower income or education bracket. Also, if you are already depressed or distressed you are likely to experience your pain more often, more intensely, or with a more debilitating effect.

Pain is a complicated phenomenon. While someone may say, "I feel your pain," in actuality, pain is subjective - no one but you can know what your pain feels like. Pain is also relative - meaning, stubbing your toe may rate a 3 out of 10 on a pain scale, but for another person it might feel like a 5 out of 10 - same injury, but a different experience of pain.

Perhaps the most complex aspect of pain is how it affects, and is affected by, your emotions. With acute pain -- the kind that passes in a short time -- it is common to feel anxiety. When the pain becomes chronic, with no clear end in sight, it can lead to feelings of frustration, helplessness, hopelessness, and eventually depression.

So how can psychologists help? Using cognitive-behavioral therapy we can teach you to change your psychological perspective and thus lessen your distress. For instance, we know that the types of thoughts we have influence how we feel and behave. If you are thinking, "This couldn't possibly be worse. My pain completely incapacitates me and I am worthless," there is a greater chance that you will feel more hopeless and depressed, experience higher levels of pain, and be less active and functional. We can help you recognize that although chronic pain may have caused some dramatic changes in your life, the reality is you still have many strengths, abilities, and means to contribute to your family. By learning to change the way you think, you can begin to improve your mood and your ability to manage your pain.

Other pain management strategies, such as breathing exercises and relaxation techniques, can help relieve physical tension and release endorphins, which are like natural antidepressants or painkillers. You can regain a sense of control over your body and your pain.

Comprehensive pain management usually involves a team approach, including the patient, psychologist, physicians, and physical therapists. Also, for a pain management protocol to be most effective it needs to be tailored to the individual patient. Family members are also involved at times.

Reference

Miller, L. R. & Cano, A. (2009). Comorbid chronic pain and depression: Who is at risk? The Journal of Pain, 10, 619-627


When Your Anxiety Level Goes Above “Normal”
By Monica Pedemonte, Psy. D.

Originally published in the November 2010 edition of the BHI E-newsletter.

Anxiety is a natural occurring emotional state that allows us to maintain alertness and awareness of our surroundings. When anxiety is maintained at a normal level it allows for effective problem solving and safety. Our signal that anxiety is going above normal is that we begin to feel uncomfortable, overwhelmed or unsafe. What triggers this discomfort? Typically, we become more anxious when we encounter a situation or event that we feel ill equipped to manage or solve effectively. At this point, we may experience the following: physical tension, aches, pains, excessive worries, self-doubts, restlessness, feeling on edge, apprehension, fearfulness, and/or irritability. As these symptoms persist, our feeling of efficiency is diminished. To restore a sense of competence, safety and comfort the following are recommended:

  1. Stay focused on the present.
  2. Quiet down the 'what if' thoughts.
  3. Take a long shower or bath.
  4. Listen to melodious music; move your body gently to the rhythm.
  5. Take a walk; take in the beauty of your surroundings.
  6. Confide in and seek support in a trusted friend or family member.
  7. Maintain healthy habits.
  8. Reassess the situation. Remind yourself that there is always something that you can do to make a situation better.

The Engaged Parent: Preventing and Dealing with Adolescent Drug and Alcohol Use
By: Anne Davies, Psy.D

Originally published in the August 2011 edition of the BHI E-newsletter.

Over the summer we've likely been able to spend more time with our families, whether on vacation, visiting relatives, or attending local events. With the school year just around the corner it's the perfect time to reflect on ways we can stay engaged with our families and as "hands -on" as possible once our schedules get more hectic. Why is parental engagement so important? Children of hands-on parents not only tend to have higher levels of self-confidence and more success in school, but they are far less likely to smoke, drink, or use other drugs

Knowledge is Power
If you are a parent or guardian of middle school or high school children, it's important to plan how you will handle potential situations with regard to alcohol and other drugs. The first step is to make sure you as the parent are educated about the recent research on adolescent drug use.

Discard the Fiction, Learn the Facts:

The Science Behind It All
Many people are aware of the research findings that the teen brain is still in the process of developing. Human brains are at about 95 percent of adult volume by age five. Around the age of eleven and continuing into one's early twenties the brain undergoes significant reorganization and maturation. What you may not know is that drug use during adolescence can have permanent effects on brain development.

Understanding the Developing Brain:

Constructively "Dealing with it"
There is also a myth that treatment for adolescent substance abuse does not work unless the teen is ready for it. In fact, research has shown that adolescents who are coerced into treatment are just as successful in treatment and recovery as adolescents who willingly enter treatment. Maybe one in twenty kids actually wants to go to treatment. For parents asking, "How bad does it have to get before I ask for help?" The answer is clear: Get help now. Don't wait until the problem is so obvious that your friends or neighbors have to work up the courage to tell you they are concerned. Treatment works--but it takes time.

References:

  1. How to Raise a Drug Free Kid by Joseph A. Califano, Jr. (Simon & Schuster, Inc. , 2009)
  2. Teens Under the Influence by Katherine Ketchum and Nicholas A. Pace, M.D. (Ballantine Books, 2003)

6 Tips to Achieving Your New Year's Resolutions
by Todd D. Giardina, Ph. D.

Originally published in the January 2012 edition of the BHI E-newsletter.

For many, the New Year signifies the birth of a "new you" with fresh resolutions to accomplish. Some goals may be lofty, while others can be simple fixes to everyday issues. Here are tips to reaching a lasting change in YOUR life THIS YEAR!

Define a WHO:

Recognize a WHAT:

Find a WHY:

Determine a WHEN:

Create a HOW:

Map out a WHERE:


Avoiding Burnout By Finding Your Flow
by Todd D. Giardina, Ph. D.

Originally published in the June 2012 edition of the BHI E-newsletter.

“I feel burned out!” This can describe the end of a long day at work, taking care of kids, keeping up with exercise routines or maintaining relationships. Most people can relate, but you may not know that psychologists actually study burnout as a phenomenon. Burnout has most often been studied in work settings, but it can be experienced in all areas of endeavor. It’s been defined as that crossroads of feeling worn out, not caring about work or people anymore, and feeling like your voice is not heard or your efforts don’t matter (Maslach & Jackson, 1981).

On the flip side, “flow” is a term coined by psychologist, Mihaly Csikszentmihalyi, in 1990. Dr. Csikszentmihalyi and others working in the field of positive psychology study what leads people to feel true happiness, contentment and joy. Usually, psychology and the medical field in general is thought of as a place to turn when things are broken; however, positive psychology seeks to “find and nurture genius and talent", and "to make normal life more fulfilling." (Compton, 2005) Not intending to replace traditional psychology, but to complement it, positive psychology emphasizes the importance of not only studying how things go wrong, but seeks to determine how things go right.

Flow is a feeling state described as the meeting place of challenge and ability. For instance, you may become depressed or feel defeated if you take on a job, task, or activity that you question you have the ability to do (e.g., first job out of school, new parenting role, etc). On the other hand, you can become bored or frustrated if you feel you are in a place in life where things are too routine or easy, and there is no challenge, no goal to achieve, no mountain to climb (e.g., stalled out in your hierarchy at work, lost your hobbies along the way of parenting, etc.).

Professional athletes are most often used as the example of flow – that balance of confidence and risk that leads to many of the play of the day highlights on ESPN. But it’s not just athletes who can achieve flow – the businessperson who closes a big but challenging deal, the parent who successfully juggles the kids’ school/activity schedules and still makes time for charity work, the carpenter who takes on a job that could go overbudget and comes in underbudget and earlier than planned, the yoga instructor who keeps trying a certain pose until its mastered. In any aspect of life, you can find your flow – heck, even if you knit all day - if you challenge yourself to finish knitting your new granddaughter’s outfit before she is born, and it seems unlikely but you press on anyway – that can be flow too!

What should you be looking for?

  1. challenge or opportunity
  2. passion for the task
  3. the ability to change the situation via your actions

Simply put, too little of any of these 3 and you are likely to burnout (or grow depressed/stagnant), but just enough and you find your flow.

It’s that feeling of “maybe I can and maybe I can’t, but I won’t know unless I try.” There may be defeats before the victory is achieved. But the thrill of the chase and the passion for the challenge are what keep you going – that’s the difference between exhaustion and burnout, work and flow.

References:

Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New York: HarperCollins.

Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behavior, 2, 99-113.

Compton, William C. (2005). An Introduction to Positive Psychology. Belmont, CA: Wadsworth Publishing.


Happy Holidays After a Loss?
by E. Nelson-Wernick, Ph. D

Originally published in the December 2013 edition of the BHI E-newsletter.

You may ask, "Is it even possible to be happy?" When someone special is no longer with you, either due to the ending of a relationship, divorce or death, the holidays can be a very difficult time. You may long for the Happy Holidays of the past and feel a deep sense of loss. This is a normal reaction to losing someone who was important to you. Letting yourself feel the sadness is part of grieving and healing, but if you are feeling overwhelmed by your emotions, these are some ideas that may help.


For more information about coping with different kinds of loss, check out these websites:

Loss in general --
Grief: Coping with the loss of your loved one
Coping with Grief and Loss - Understanding the Grieving Process
Grief: Coping with reminders after a loss

Loss due to suicide --
Coping with Suicide Loss

Loss due to divorce --
Surviving the Holidays While You’re Surviving Divorce

Loss of a pet --
Coping With the Death of Your Pet