Articles & Trainings

Trauma-Specific Self-Care: Part 2

We know that self-care is important for everyone. But how do you practice self-compassion and personal wellness when you have been through trauma or are trying to help someone through a traumatic life event? In the first part of a two-part series on trauma-specific self-care, we looked at how your body responds to stress and trauma and what individuals can do to begin healing. Now, in part two, we’ll explore how mental health professionals can take care of themselves while they take care of their clients.

How Does Treating Clients with Traumatic Experiences Affect Me?

The reality is that treating clients who have experienced trauma can have impact. This “inevitable secondary stress,” as Trauma expert and Simmons College Graduate School of Social Work professor Julia Colpitts, MSW, calls it, is natural. We evolved to connect with our pack to survive. When we see or hear other people’s trauma, the areas in our brain that are activated are the same ones that would be activated if it was primary trauma—our own trauma. Mirror neurons are engaged in the trauma’s retelling, and our bodies respond to the story and mimic the survivor’s physiological response. Trauma is, in a sense, contagious. So, what can we do about it?

What Is Secondary Stress?

“Vicarious or secondary stress is empathy in action,” Colpitts states, and it is unavoidable. We are social animals, and we respond naturally to others. The impact ranges from mild to clinically symptomatic, but all responses on the continuum can have a long-term effect. We can get stuck in arousal mode from the continuous retelling of traumatic life events if we don’t actively manage our secondary stress and its impact on us as therapists and mental health providers. It doesn’t have to lead to professional burnout; viewed and managed differently, it can even become an invitation to grow personally and professionally.

Secondary traumatic stress often causes muted arousal responses, either hyper (flood of anxiety, fear, and anger) or hypo (distancing from emotion). Over time, cognitive distortions can develop, altering one’s focus, the content of their thoughts, and even their worldview. Unacknowledged vicarious stress also has a negativity bias, which can obscure our compassion satisfaction and real accomplishments. For therapists who hear traumatic stories that resonate with their own prior life trauma, the arousal response can deepen—and our professional dissociation and burnout, historical and/or cultural trauma, and traumatized organizations can serve to further deepen that response.

Some mental health professionals, like others in the population, cope with secondary stress and trauma by employing short-term relief strategies to manage their state of arousal, such as food and alcohol issues, inactivity or “mindless” (dissociative) activities, and overwork. These primitive defense mechanisms may appear to help for a few hours, but ultimately they all have long-term negative consequences.

Unhealthy coping behaviors such as substance use may have the same effect as ignoring the secondary stress altogether: illness, including serious chronic conditions such as heart disease. Women who are social workers, for instance, are 36% more likely to have heart problems than women in other professions (American Heart Association scientific session, November 2019). And “community and social services” is number one of the top ten professions correlated to cardiac arrest (gender-neutral) (CDC Morbidity and Mortality Weekly Report, 2016). It is therefore crucial that we develop positive coping methods for secondary traumatic stress.

A therapist’s self-care involves acknowledging the continuous stress you are under and allowing yourself a release. We need to proactively prepare for secondhand stress and its impact on us through daily doses of calm interspersed through our days.

Which Tools Should Therapists Use for Secondary Stress?

How do we turn off the arousal response? We activate the care system.

“Self-care is not just what we do after work. Self-care is how we do the work itself.” –Julia Colpitts, MSW

 

First of all, guard against the tendency to overcommit, to overwork in an effort to soothe. Like the proverbial oxygen mask on an airplane, you are ill equipped to help others if you’re not functioning well yourself.

Then, create a resilience menu. Choose from an array of simple, self-care actions to calm the body and calm the mind—a personal relaxation practice that can radically reframe how you go about your day. As though you are selecting a dish from a restaurant menu, choose the one(s) that sound best to you that day, at that time. And just as we are advised to “eat the rainbow” when it comes to dietary health, your resiliency menu or toolkit works best when you layer soothing actions across the spectrum, and use self-care well not just when there’s a personal crisis, but proactively and intentionally, every day. Some examples of what relaxing options might be on your resiliency menu [link “resiliency menu” to October blog] include:

  • Breathwork, such as box breathing
  • Being kind to yourself—kick out the inner critic
  • Muscle tension release using progressive relaxation techniques
  • Guided meditation, such as those offered by Kristen Neff
  • Sensory stimulation (e.g., aromatherapy, calming visuals, nature sounds, savory tastes, touch, water, sexual activity, massage, Reiki bodywork, and grounding strategies)
  • Acupressure and acupuncture
  • Yoga, tai chi, and other mind-body centering work
  • Conjuring up images of love and connection
  • Self-compassionate meditation and activities, such as bilateral stimulation like the butterfly hug, and affirmations
  • Interacting with animals, including equine-facilitated therapy
  • Mindfulness and related physical practices, such as walking meditation and forest bathing
  • Body scans
  • Expressing gratitude and love

Your resiliency tools not only help to heal the impact of secondary traumatic stress by releasing stored arousal responses and reestablishing a peaceful baseline, they also help strengthen your capacity for joy and presence and prepare you for future sources of stress.

How Can I Support Other Mental Health Professionals’ Well-being?

To journey to wellness together, we need to support positive attachments to ourselves, to others, and to community coregulation. As mental health providers, we can:

  • Talk openly about secondary trauma and its impact.
  • Add moments to meetings that emphasize compassion satisfaction.
  • Practice personal relaxation techniques openly, as appropriate, to model calm.
  • Notice and address when organizations are traumatized.
  • Support setting realistic workloads.

Thank you to Julia Colpitts, MSW, for sharing her keynote presentation and ideas on this subject.

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Posted on by Author Rachael Severancein Categories Tips for Healthy Living, Understanding Mental Illness, WellnessTagged ,

Frederic G. Reamer

Ethics and Risk Management Challenges in Behavioral Health

This webinar will provide participants with an overview and in-depth examination of compelling ethical challenges in behavioral health.

Thu, November 10, 2022
Wed, November 30, 2022
8:30 AM – 4:00 PM EST

Refund Policy

No Refunds

About this event

About the Training:

This webinar will provide participants with an overview and in-depth examination of compelling ethical challenges in behavioral health. Dr. Frederic Reamer will explore complex and challenging ethical issues and practical strategies designed to protect clients and practitioners. The webinar will include a series of challenging cases and discuss practical steps professionals can take to manage ethical issues skillfully. Key topics will include boundary issues, dual relationships, conflicts of interest, confidentiality, privileged communication, informed consent, clients’ rights, delivery of services remotely, termination of services, and impaired professionals, among others. Dr. Reamer will discuss relevant ethical standards; national practice standards; and statutes, regulations, and case law. The webinar will focus especially on complex documentation issues. The presenter will make extensive use of case material and provide ample opportunity for audience participation.

This training is worth six (6) contact hours.

By the end of this workshop, participants will be able to:

  • Identify challenging ethical issues and dilemmas in behavioral health
  • Apply practical ethical decision-making frameworks and protocols
  • Identify ethical issues that pose malpractice and liability risks
  • Design strategies to protect clients and practitioners

Agenda for the Day:

  • Difficult ethics cases in behavioral health: The anatomy of ethical dilemmas (8:30-9:30 a.m.)
  • Compelling ethical challenges: boundary issues, dual relationships, conflicts of interest, confidentiality, privileged communication, informed consent, clients’ rights, delivery of remote services, termination of services, and impaired professionals (9:30-10:15 a.m.)
  • Break: 10:15-10:30 a.m.
  • Compelling ethical challenges in behavioral health (continued) (10:30 a.m. to noon)
  • Lunch (Noon to 1:00 p.m.)
  • Risk-management strategies to protect clients and prevent ethics complaints and litigation (1:00-2:30 p.m.)
  • Break: 2:30-2:45 p.m.
  • Ethical decision-making strategies (decision-making protocols; codes of ethics; ethics literature; ethics committees; practice standards; relevant regulations, statutes, and case law) (2:45-3:40 p.m.)
  • Questions/answers (3:40-4:00 p.m.)

***This training has been approved for LADCs and CADCs by the Maine Board of Drug and Alcohol Counselors.***

About the presenter:

Frederic G. Reamer is Professor in the graduate program of the School of Social Work, Rhode Island College, where he has been on the faculty since 1983. His research and teaching have addressed a wide range of human service issues, including mental health, health care, criminal justice, public welfare, and professional ethics. Dr. Reamer received his Ph.D. from the University of Chicago (1978) and has served as a social worker in correctional and mental health settings. He has also taught at the University of Chicago, School of Social Service Administration (1978-1981), and the University of Missouri-Columbia, School of Social Work (1981-1983).

Dr. Reamer has served as Director of the National Juvenile Justice Assessment Center of the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention (1979-1981); as Senior Policy Advisor to the Governor of Rhode Island (1987-1990); and as a Commissioner of the Rhode Island Housing and Mortgage Finance Corporation, the state housing finance agency (1987-1995). Dr. Reamer served on the State of Rhode Island Parole Board from 1992 to 2016. He also served as Editor-in-Chief of the Journal of Social Work Education (1990-1994). He serves as Associate Editor of the National Association of Social Workers Encyclopedia of Social Work (Oxford University Press and National Association of Social Workers). Since 2012, Dr. Reamer has served as the ethics instructor in the Providence (RI) Police Department Training Academy.

Dr. Reamer has conducted extensive research on professional ethics. He has been involved in national research projects sponsored by The Hastings Center, the Carnegie Corporation, the Haas Foundation, and the Scattergood Program for the Applied Ethics of Behavioral Healthcare at the Center for Bioethics, University of Pennsylvania. He has published 24 books and 175 journal articles, book chapters, and encyclopedia articles. His books include:

  • Moral Distress and Injury in Human Services: Cases, Causes, and Strategies for Prevention (NASW Press)
  • On the Parole Board: Reflections on Crime, Punishment, Redemption, and Justice (Columbia University Press)
  • Ethics and Risk Management in Online and Distance Behavioral Health (Cognella Academic Publishing)
  • Ethics and Risk Management in Online and Distance Social Work (Cognella Academic Publishing)
  • Risk Management in Social Work: Preventing Professional Malpractice, Liability, and Disciplinary Action (Columbia University Press)
  • Boundary Issues and Dual Relationships in the Human Services (Columbia University Press)
  • Heinous Crime: Cases, Causes, and Consequences (Columbia University Press)
  • The Social Work Ethics Casebook: Cases and Commentary (NASW Press)
  • A Guide to Essential Human Services (NASW Press)
  • Criminal Lessons: Case Studies and Commentary on Crime and Justice (Columbia University Press)
  • Social Work Values and Ethics (Columbia University Press)
  • Tangled Relationships: Managing Boundary Issues in the Human Services (Columbia University Press)
  • Ethical Standards in Social Work: A Review of the NASW Code of Ethics (NASW Press)
  • The Social Work Ethics Audit: A Risk Management Tool (NASW Press)
  • Ethics Education in Social Work (Council on Social Work Education)
  • The Foundations of Social Work Knowledge (Columbia University Press; editor and contributor)
  • Social Work Malpractice and Liability (Columbia University Press)
  • Social Work Research and Evaluation Skills (Columbia University Press)
  • The Philosophical Foundations of Social Work (Columbia University Press)
  • AIDS and Ethics (Columbia University Press; editor and contributor)
  • Ethical Dilemmas in Social Service (Columbia University Press)
  • Rehabilitating Juvenile Justice (Columbia University Press; co-author, Charles H. Shireman)
  • The Teaching of Social Work Ethics (The Hastings Center; co-author, Marcia Abramson).
  • Finding Help for Struggling Teens: A Guide for Parents and the Professionals Who Work with Them (NASW Press; co-author, Deborah H. Siegel)
  • Teens in Crisis: How the Industry Serving Struggling Teens Helps and Hurts Our Kids (Columbia University Press; co-author, Deborah H. Siegel)

Dr. Reamer is also the author of chapters on professional ethics in the Encyclopedia of Social Work, Encyclopedia of Bioethics, Encyclopedia of Global Ethics, Encyclopedia of Applied Ethics, Encyclopedia of Lifespan Human Development, Encyclopedia of Higher Education, and Encyclopedia of Primary Prevention and Health Promotion. He has been an essayist on National Public Radio’s Morning Edition (“This I Believe” series), a commentator on National Public Radio’s All Things Considered, and a guest on various radio and television broadcasts. From 2007 to 2021 Dr. Reamer served as host and producer of the National Public Radio series This I Believe—New England, broadcast weekly. He is featured in the podcast series Trapped in Treatment produced by Paris Hilton, Warner Brothers, and iHeart Media; Yahoo News national series Unfiltered; and as a commentator in the video documentaries America’s Serial Killers: Portraits in Evil and Rampage: Killing without Reason. He is also a featured expert on the PBS (Public Broadcasting Service) series This Emotional Life.

Dr. Reamer has lectured extensively nationally and internationally (including India, China, Singapore, South Korea, Japan, Taiwan, Sweden, Germany, Italy, Portugal, Djibouti, Bahrain, Indonesia, Diego Garcia, Spain, Romania, Poland, Greece, and Canada) on the subjects of professional ethics and professional malpractice and liability. He has served as an adjunct professor and visiting scholar at the University of Pennsylvania, Tulane University, Simmons University, Smith College, University of Oklahoma, and Augsburg University. Dr. Reamer chaired the national task force that wrote the National Association of Social Workers Code of Ethics and served on the code revision task force. He chaired the international commission sponsored by the Association of Social Work Boards to develop Model Regulatory Standards for Technology and Social Work Practice. Dr. Reamer also chaired the national task force sponsored jointly by the National Association of Social Workers, Association of Social Work Boards, Council on Social Work Education, and Clinical Social Work Association to develop Technology Standards in Social Work Practice. He has served as an expert witness and consultant in 130 court and licensing board cases addressing professional ethics.

Dr. Reamer received the “Distinguished Contributions to Social Work Education” award from the Council on Social Work Education (1995); Presidential Award from the National Association of Social Workers (1997); Richard Lodge Prize from Adelphi University for “outstanding contributions to the development of social work theory” (2005); Edith Abbott Award from the University of Chicago for “distinguished service to society and outstanding contributions at the local, national or international levels” (2005); Neil J. Houston, Jr. Memorial Award for “dedicated service and citizen contribution toward the criminal justice profession and the public interest” (2009); International Rhoda G. Sarnat Award from the National Association of Social Workers for significantly advancing “the public image of social work” (2012); Excellence in Ethics Award from the National Association of Social Workers (2015); and inaugural Contributor Award from the Association of Social Work Boards (2019). In 2016 Dr. Reamer was named a Social Work Pioneer by the National Association of Social Workers for his “commitment and dedication to the social work profession and to the improvement of social and human conditions at the local, state, national, and international levels.”

Register here for the Tuesday, November 10 session!
Register here for the Wednesday, November 30 session!

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Posted on by Author Randy Runnelsin Categories Events

Trauma-Specific Self-Care: Part 1

Self-care is important for everyone. But how do you practice self-care and self-compassion when you have been through or are currently experiencing a traumatic life event? In this first of a two-part series on trauma-specific self-care, we look at how your body responds to stress and trauma and what individuals can do to begin healing.

What Determines my Level of Tolerance?

We all have different ranges of tolerance to life’s stressors. The ideal state of being in which you have the ability to deal with life’s ups and downs to a reasonable extent is what the National Institute for the Clinical Application of Behavioral Medicine refers to as your “window of tolerance.” Stress and trauma affect your window of tolerance, shrinking it and disturbing what stresses you’re able to handle. You may become hyperaroused—anxious, angry, overwhelmed—or hypoaroused—zoned out, numb, frozen. These reactions aren’t something you choose; it’s simply how your body reacts. Working with a mental health provider can help you by expanding your window of tolerance, so you have a wider range of situations and challenges you are able to cope with.

How Is my Body Affected by Stress?

Traumatic stress is experienced in the body. Upon noticing something novel, you become alert. You then move into threat identification, seeking social cues to evaluate the extent of the threat. Both the alert and the subsequent shift into threat identification are instinctual responses to your environment, and you may not even be conscious of them. If you perceive the novel event as a threat, whether real or imagined, your body is then aroused—your lower, reptilian brain takes over, and your threat-defense system is activated. This process sends adrenaline, cortisol, and oxytocin into your body. You then experience a defense response: fight, flight, freeze, or tend and befriend. If your defense response works, your body calms down and your upper or cortex brain begins processing the experience.

In a state of alert, your body becomes hypersensitive, with a particular heightened awareness of the real or perceived threat. You can experience hyperarousal when trauma associations are triggered, feeling a flood of emotions such as anxiety, fear, anger, and grief. Trauma expert and Simmons College Graduate School of Social Work professor Julia Colpitts, MSW, calls this state “stuck on.” Or, you can experience hypoarousal, where you distance yourself from emotions to quiet the state of hyperarousal, which can lead to numbness and a disconnection. Colpitts calls this state “stuck off.” Your arousal responses highjack your higher brain functions and create physical reactions.

When stress and trauma are complex or ongoing, your body does not return to its baseline, and this sort of constant hypervigilance and arousal flood your body with stress hormones, which can impact health. Physical reactions can range from simple tension to chronic illness. Often, those who experience trauma will develop behavioral patterns to manage traumatic arousal. These behaviors often involve food, alcohol, inactivity, or overwork, which can provide short-term relief but cause long-term negative consequences.

How Can I Heal from Stress and Trauma?

Calm the body, calm the mind. Self-compassion involves enacting a lesser-used cycle of emotional regulation, which Paul Gilbert calls the “soothing system” in his book The Compassionate Mind: A New Approach to Life’s Challenges. The soothing system, which manages functions to slow down, soothe, rest and digest, safeness, kindness, and care, can be underdeveloped in an individual. With practice, you can build upon it to better manage your emotions and expand your window of tolerance.

What is a Resiliency Toolkit?

To strengthen your soothing system, spend more time in self-compassionate practices that center physiological and mind-body relaxation. Focus on creating a personalized relaxation practice from a menu of soothing options, Colpitts advises. Some soothing strategies to add to your resiliency toolkit include:

  • Breathwork, such as box breathing
  • Muscle tension release using progressive relaxation techniques
  • Guided meditation, such as those offered by Kristen Neff
  • Sensory stimulation (e.g., aromatherapy, calming visuals, nature sounds, savory tastes, touch, water, sexual activity, massage, Reiki bodywork, and grounding strategies)
  • Acupressure and acupuncture
  • Yoga, tai chi, and other mind-body centering work
  • Self-compassionate meditation and activities, such as bilateral stimulation like the butterfly hug, and affirmations
  • Interacting with animals, including equine-facilitated therapy
  • Mindfulness and related physical practices, such as walking meditation and forest bathing
  • Body scans
  • Expressing gratitude and love

Try to maintain a regular practice of your chosen relaxation techniques. You can form healthy habits by starting small and attaching a technique to part of your regular routine, such as breathwork after brushing your teeth each day. Take note of the improvements you feel, which will help you continue and build upon your emotional resiliency menu of options. By regularly employing direct body and other relaxation strategies, your body will calm down and your mind will follow suit. This will create patterns of calm that serve to “release stored arousal and reestablish a peaceful baseline,” according to Colpitts. “The more strategies you use,” she states, “the more difference it will make.”

What Else Can I Do to Take Care of Myself after Trauma?

In addition to using tools in your resiliency toolkit, you can also “burn off” the stress in your body from traumatic experiences by engaging in physical activity. This can include energetic pursuits, such as dancing and working out, and/or more soothing activities like hiking and listening to music.

You may also need strategies to depower your threat defense system, which for those who have experienced or are experiencing trauma is overactive. You can do this by partnering with a mental health professional to learn new patterns and activate the care system. We also advise working with a practitioner on cognitive behavioral work and to engage with trauma success factors, including taking reparative action, interrupting the trauma flow, managing arousal, bringing attention to cognitive adaptive patterns, cultivating positive attachment and experiences, and attending to context.

“Being kind to ourselves releases energy to move forward,” Colpitts says. And it “soothes body, mind, and spirit.”

Thank you to Julia Colpitts, MSW, for sharing her keynote presentation and ideas on this subject.

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Posted on by Author Rachael Severancein Categories News

How Do I Help Students Concerned about School Violence?

As summer comes to a close, parents and students across America start preparing to head back to school. Some students understandably have anxiety about returning to the classroom in light of the school shooting in Uvalde, Texas, and other recent incidents of school shootings. How can we help children who feel anxious about school violence? Let’s look at ways back-to-school anxiety is expressed and examine strategies for helping students with concerns about school violence.

What are Signs of Anxiety in Children?

Anxiety over school shootings has become common in America. Even when children aren’t directly involved in episodes of school violence, they are deeply affected by these traumatic experiences. Exposure to violence can cause learning and behavioral problems in students. Children may feel anxious or fearful, and they may not express the distress they are feeling in a way that adults can easily recognize.

If a child isn’t directly communicating their worries about returning to school, look for symptoms that may indicate anxiety is present. These signs can include:

  • Excessive worry
  • Seeks constant reassurance from teachers and caregivers
  • Avoids school or summer camp
  • Sadness/depression
  • Withdrawn
  • Difficulty enjoying activities that were previously pleasurable
  • Irritability/anger
  • Argumentative
  • Negative thinking patterns
  • Hypervigilance
  • Difficulty concentrating
  • Poor or declining school performance
  • Poor appetite
  • Headaches
  • Nightmares

How Can I Help Anxious Students?

The most important way you can help school-age children coping with anxiety around school violence is to talk to them. Do not avoid the scary topic—that makes it scarier. Ask them what they are thinking and feeling. Listen attentively, and use the information you gather as a basis for how much information they need and can handle, in addition to the child’s age and whether or not they have experienced trauma before.

Children’s concerns and questions tend to be different than adults’. Kids often want to know who is to blame, what could be done to prevent the tragedy, or whether it could happen at their school. Being truthful in your response—while keeping in mind developmental appropriateness—is crucial to building and maintaining trust and open communication with the child.

Validate the child’s feelings. Avoid downplaying their concerns or fears. And keep the conversation going—this is not a one and done talk, and it might be best to handle in smaller doses, especially for younger children. An open-door policy and a continued dialogue encourage children to share their concerns at any time.

Anxious kids also benefit from routines. Keep schedules predictable to the extent you are able. The consistency of their daily routine will help them feel secure and safe.

Limit their exposure to violence. While we want to keep an open, honest dialogue, seeing the same event televised or in the papers repeatedly is not helpful and may in fact be harmful. This can mean developing new household rules to limit screen time or access to newspapers and/or social media, especially after a school shooting or other traumatic event.

For parents, caregivers, and therapists of older kids, such as those in middle school or high school, we can help them convert anxious or angry feelings into plans for action. Older students may find that becoming an advocate for school safety helps them channel their anxiety into action, creating a helpful, healthy coping strategy for dealing with feelings around school violence. Also encourage them to report specific incidents that concern them, such as bullying or threats, and occasionally check in about how they are feeling or what they are experiencing at school.

Finally, as an adult, manage your own anxiety around school shootings. Kids are very adept at picking up on their parents’ fears, which can contribute to increasing the intensity of their own fears. To reassure a child, you need to be taking care of yourself, too. Ensure you have another adult to talk to about how you feel, de-stress, and engage in regular acts of self-care. When you model healthy ways to cope with stress and fear, children will learn from that behavior. Ultimately, we want to teach children skills for self-soothing and effective, lifelong coping mechanisms in dealing with stressful events to develop their resiliency for all they might encounter.

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Posted on by Author Rachael Severancein Categories NewsTagged , ,

How to Identify and Treat Summer Depression

Summertime… and the living isn’t easy for everyone. Depression in the summer is more common than you might guess. While many equate summer with school vacation, outdoor camps, water fun, and blooming gardens, others can and do feel depressed during the sunny season—and the social expectation that you’re supposed to have fun can make that depression feel even lonelier and more isolating.

How to Identify Summer Depression

While summer depression shares common symptoms with depression (feeling depressed most of the day, having low energy levels, losing interest in activities you used to enjoy, difficulty concentrating on tasks, and feeling hopeless or worthless), summer depression has specific symptoms that include:

  • agitation and restlessness
  • loss of appetite
  • trouble sleeping (insomnia)
  • weight loss
  • anxiety

If you feel depressed come June each year and it seems to improve around September, you may be experiencing summer depression. The National Institute of Mental Health indicates a patient may be diagnosed with summertime seasonal affective disorder if they have symptoms of major depression, have lived with depressive episodes in the summer months for two consecutive years, and have a tendency to have depressive periods more frequently in the summer than in than in other times of the year.

Symptoms of summertime blues, by contrast, are similar (low mood and a lack of energy) but less debilitating.

Where Does Summer Depression Come From?

Like all forms of depression, summertime depression can have biological, psychological, and/or environmental causes. Summer schedules are often disruptive to our usual schedules, and this sudden, big change can be hard to handle, especially for people who are vulnerable to depression.

Biologically, some studies suggest that, like other forms of major depressive disorder (MDD), summer depression may be linked to the brain chemical serotonin. The risk of developing summer depression is higher for women, those with relatives with a mental illness, or those who have major depressive disorder, bipolar disorder, or another mental illness.

More than 3 million American adults experience seasonal affective disorder, or SAD. Of those, about 10% of people who have a MDD with a seasonal pattern, such as SAD, have their depression symptoms begin at the onset of summer, not winter. It’s unclear why this happens to a subset of those with MDD or SAD. Some experts point to too much sunlight, heat, and humidity as possible culprits.

How to Help Your Clients Cope with Summertime Depression

A number of tools and strategies can be employed by mental health practitioners to help their clients cope with summer depression.

  • Change dosage. If you are licensed to prescribe medications, consider temporarily increasing the dosage of your client’s medication for depression. Or, if you are not, encourage your client to speak to their medication prescriber about gradually increasing their dosage in late spring and easing off slowly in the fall.
  • Respect the worry your client may be feeling. With summer depression in particular, people who are struggling with their mental health are apt to feel something is wrong with them: Why does it seem like everyone else is having fun and I’m not? What’s wrong with me? While this is a typical response, it is not helpful to compare how we’re feeling with how we think we’re supposed to feel. Instead, gently encourage your client to focus on the causes of their summertime depression and how it can be resolved.
  • Evaluate triggers. Consider what past experiences your client may be associating with summer, whether it’s the death of a loved one, an important anniversary, or another traumatic event. Working through triggers may lessen or release some of these associations.
  • Experiment with darkened rooms. Following some mental health professionals’ theory that too much sunlight could be causing summer-onset MDD, spending more time in darkened rooms—the opposite of light therapy—may be advisable. For similar reasons, wearing sunglasses may help.
  • Advocate for regular exercise. Numerous studies demonstrate that regular physical activity can help depression and mood disorders.
  • Recommend a good night’s sleep. Insufficient sleep can trigger depression. Rule out this cause by ensuring your client is getting enough ZZZs (generally 7 to 9 hours a night for adults).
  • Engage in mindfulness. Yes, there’s that oft-mentioned recommendation to develop a meditation and mindfulness practice again! Evidence shows mindfulness has a significant impact on mental wellbeing, combating fatigue and naturally bolstering one’s defenses against depression.

Get Help

If you or someone you know thinks they might be depressed, regardless of the time of year, please get help. Do not take summer depression lightly or downplay its symptoms. Talk to a mental health practitioner. We are here to help, and there are effective treatments available. You do not need to suffer in the summer.

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Posted on by Author Rachael Severancein Categories #EndTheStigma, Understanding Mental Illness, WellnessTagged , , ,

John M. O’Brien, Ph.D. ACC, NBC-HWC

Best Practices for Treating Clients with Co-occurring Disorders

We explore the common co-occurrence of mental health and substance use conditions in this six-hour training for clinicians.

Fri, September 16, 2022
Fri, September 30, 2022
9:00 AM – 4:15 PM EDT

About this event

About the Training:

This highly interactive six-hour training will review best practices for working with clients who have addictions as well as comorbid psychiatric disorders. The presenter and participants will explore various treatments and treatment issues for clients with addictions and mental health disorders. In addition, participants will learn skills to manage their own reactions to clients who present challenging behavior patterns. Case examples, surveys and group discussion will be used to illustrate key points.

This training is worth six (6) contact hours.

By the end of this workshop, participants will be able to:

1. Identify major diagnoses and diagnostic categories of addictions.

2. Discuss treatment approaches to addiction and psychological disorders.

3. Categorize ethical issues that emerge in working with clients with co-morbid addiction and mental health issues.

4. Increase empathy and personal ability to manage countertransference in dealing with clients who present challenging interpersonal behaviors.

 

Agenda for the Day:

9:00-10:30:

Empathy/sympathy/pity/compassion

Countertransference

Self-care

Neuroscience and addiction

Stages of Change

10:30-10:45: Break

10:45-12:15:

Assessment

Evidence-based treatment Medication-assisted treatment (MAT)

Case #1

12:15-1:00: Lunch on your own

1:00-2:30:

Treatment dilemmas

Who is the client?

Documentation

“Manipulation”/Triangulation

Communication/Collaboration

Scope of practice/expertise

Case #2

2:30-2:45: Break

2:45-4:00:

Ethical issues

Telehealth

Case #3

4:00- 4:15: Discussion/Question/Wrap-up

 

About the presenter:

John M. O’Brien, Ph.D. ACC, NBC-HWC earned his doctorate in Counseling Psychology from Michigan State University in 1996. Since 1998, he has been in private practice in Portland, Maine, providing psychotherapy and consultation services with specialties in addition, trauma, grief and LGBTQ+ clients. He is an adjunct faculty member at the University of Maine at Augusta, teaching courses in psychology and addictions. He served as president of the Maine Psychological Association and is currently co-chair of Continuing Education for the APA Society of Consulting Psychologists.

John is an ICF ACC Certified Coach and NBHWC Certified Health and Wellness Coach. He coaches leaders in a variety of fields, including business, health care and the law.

In his spare time, John enjoys motorcycling, skiing, biking and furthering his ability in German.

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Posted on by Author Randy Runnelsin Categories Events

Together for Mental Health

More than 52 million American adults—or one in five—live with a mental health issue. Despite its prevalence, we hold an unhealthy stigma of mental illness. As a result, some individuals who live with mental health issues experience challenges accessing quality care and coverage, a challenge that can be exacerbated by their backgrounds and identities. This needs to change.

Reducing the stigma associated with mental illness is central to Health Affiliates Maine’s vision. By recognizing that we are all affected by mental health and substance issues, we reduce the stigma associated with accessing care, and in doing so, we increase the opportunity for everyone to participate in their own journey to wellness.

That’s why we’re proud to raise awareness for the Bebe Moore Campbell National Minority Mental Health Awareness Month this July. “Together for Mental Health,” we proudly stand up for a shared vision of a nation where anyone affected by mental illness—no matter their class, culture, ethnicity, or identity—can get the appropriate, quality care and support they need to live healthy lives.

“We need a national campaign to destigmatize mental illness, especially one targeted toward African Americans…It’s not shameful to have a mental illness. Get treatment. Recovery is possible.” –Bebe Moore Campbell, 2005

 

Anyone can experience the challenges of mental illness. Mental health conditions do not discriminate based on race, color, gender, class, sexual orientation, or any other elements of our identity. While BIPOC have rates of mental health disorders similar to white people, people in the BIPOC community are disproportionately affected by a lack of access to quality healthcare and cultural stigma, according to US News.

Of the 52 million+ Americans who live with a mental health condition, nearly 5 million are black people—and yet only 33% of those seek appropriate treatment, such as regularly meeting with a mental health professional, compared to nearly half of white people. As writer and policy analyst Brakeyshia R. Samms describes, there are many factors that contribute to whether or not a person with a mental illness receives treatment, including under/misdiagnosis, lack of access to quality care, and community stigma. We all experience these factors, but some communities experience them to a disproportionate degree—and suffer as a result. Bebe Moore Campbell summarized the issue: “No one wants to say, ‘I’m not in control of my mind.’ But people of color really don’t want to say it because we already feel stigmatized by virtue of skin color or eye shape or accent, and we don’t want any more reasons for anyone to say, ‘You’re not good enough.’”

How to Help

Samms suggests four activities we can all engage in to take action against the stigma around mental illness: gather information to counter “negative preconceived notions,” speak up, remain open, and believe people. “Stigma stems from a lack of knowledge,” Samms writes, “and the best way to fight a gap in information is by educating others in our community.” To this end, understanding and then communicating the complex issues at play helps spread acceptance and inclusivity, which in turn fights the inequities and stigma we have developed and now need to unlearn as a culture.

 

Sources: www.nimh.nih.gov, nami.org, rtor.org, mhanational.org

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Posted on by Author Rachael Severancein Categories #EndTheStigma, Understanding Mental IllnessTagged , ,

Restore Your Mental Health: Forest Bathing in Maine

You’re in the middle of a forest on a beautiful day in Maine. Sunshine peeks through the leaves and scatters in fascinating, eye-catching patterns on the moss-covered ground, soft under your feet. You breathe in the scent of pine and become aware of the stillness and the small sounds of scurrying chipmunks and birdsong echoing across the land. Green leaves, brown soil, and glimpses of blue sky fill your vision for as far as you can see. Warmth from the sun spreads across your face. You can feel your whole body relax as you walk slowly through the woods, breathing and sensing each moment fully.

Immersing ourselves in nature cultivates a sense of mindfulness, a practice that is now widely known for promoting mental wellbeing. What is it about being outside that restores us so?

Many workers spend hours indoors in a busy state of focused concentration, and one of the results can be mental and physical fatigue. Fatigue and stress are risk factors for depression, as is the lack of vitamin D many of us experience during Maine’s long winters. Treatment for mild to moderate depression may include cognitive behavior therapy (CBT) and other interpersonal therapies. Many also find strategies such as aerobic exercise, yoga, and the Japanese practice of forest bathing helpful, whether they are experiencing mild depressive symptoms or simply daily stressors.

In addition to sometimes leading to depression, fatigue can result in reduced attention, and forest bathing seems to provide a respite from the long hours of concentration that typical workdays require. Screentime, a modern near-requisite, can exacerbate the problem, as can urban living and spending much of our time indoors.

In psychological parlance, Stephen Kaplan’s theory of attention restoration proposes that when we use quite a bit of directed attention, or effortful attention employed to focus on a task we’re choosing to pay attention to, we need to exercise involuntary attention, which naturally occurs in nature, to restore our balance. Directed attention, in other words, such as you employ during the workday, can cause fatigue and mental exhaustion (even if you enjoy the work you are doing), and you need regular breaks to offset the effects.

Research has demonstrated that the Japanese practice of Shinrin-yoku, or “forest bathing,” has positive physiological and psychological benefits, including a reduction in blood pressure, an improved immune system, and improved mental health—and one study in particular, published in Environmental Health and Preventive Medicine in 2019, found the improved state of mental health especially pronounced for those with depressive tendencies. This natural remedy for mild depressive symptoms can alleviate negative emotions and moods such as anxiety, fear, anger, and disgust, and increase positive emotions such as joy.

Since a number of studies in the 1980s touting the benefits of Shinrin-yoku, Japanese doctors have included the practice, which they often describe as preventative medicine, in what is called “social prescribing.” Other social prescriptions include gardening, mountain walking, exercise and sports, swimming, caring for animals, and cooking—all activities, you may note, which engage our senses.

To practice forest bathing, we can fully immerse ourselves and our senses in a walk in the forest. Put away your phone. Slow down. Quiet your mind. Notice the details from all of your senses. It is not as simple as taking a walk outside; “immersion” is precisely the right word to truly experience all of Shinrin-yoku’s benefits. And if you don’t have access to a forest, parks can serve as a substitute space.

More research is needed to fully explore the therapeutic aspects of Shinrin-yoku, including studying whether its effects apply to those with high stress and depressive tendencies. In the meantime, forest bathing can be a stress-reducing, preventative, healthy outdoor activity for everyone to enjoy—and summer in Maine is a great time to try it out.

 

Sources: psychologytoday.com, ncbi.nlm.nih.gov, mentalhealthtoday.co.uk

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Posted on by Author Rachael Severancein Categories Tips for Healthy Living, WellnessTagged , , ,

Psychological Flexibility: Flexing Your Thinking to Improve Your Wellbeing

Many things happen in our lives that we cannot control or predict. Unexpected, large-scale traumatic events like the COVID-19 pandemic and the invasion of Ukraine can be sources of stress, as can daily life stressors, such as conflicts in relationships, money troubles, or an upsetting interaction. Psychological flexibility, or the ability to adapt our thinking and behavior when new or unexpected events arise, is an important skill we can use to increase individual wellbeing now and in the future.

Let’s say you are being tailgated by an aggressive driver on a two-lane highway. You feel scared and worried about what will happen if you need to use your brakes. No one is around to help.

Employing psychological flexibility in a given situation can be seen as a three-stage sequence of events:

  1. Evaluating the needs and demands of the situation or context;
  2. Selecting a response or coping strategy; and
  3. Monitoring the success of the approach you employ and modifying it as needed.

In the example we illustrated above, where the stressor was a tailgater, this sequence might look like:
Context sensitivity = There is potential for danger here. You need to remove yourself from its threat. The other driver may not react quickly enough if you brake.
Repertoire = Continue going the exact same speed and be extra alert for the possibility of needing to brake.
Feedback = You feel stressed and scared. You still don’t feel safe. They have not stopped driving too closely to your car.

You may then decide, from the feedback loop, to modify your approach and select a new behavior in your repertoire. Perhaps you can use your right turn signal to indicate you would like them to pass you, for instance. The feedback loop can continue until you have met your goals for the situation.

This sort of flexible thinking, as you might imagine, is a predictor of resiliency and creativity. Research shows psychological flexibility is associated with a better quality of life, particularly in older adults. In the workplace, exercising flexible thinking tends to lead to better job performance, improved learning on the job, innovation, and better overall mental health, including lower levels of stress and emotional exhaustion. In clinical settings, psychological flexibility training has been shown as effective in treating a myriad of disorders, such as anxiety, depression, and substance use, and this training works whether it is delivered in person or online.

The great news is psychological flexibility can be practiced and improved. But how?

Create optimal conditions for being flexible. By practicing mindfulness, doing yoga and aerobics, and engaging in relaxation techniques, we give ourselves a solid foundation to deal with stress in a purposeful, thoughtful manner.

Cultivate optimism. Rather than focusing on what the pandemic has negatively impacted in our lives, for instance, we can reframe our thinking and consider what has made us change for the better. Choose to view your struggles as part of being human, rather than something that happens to you.

Pause. Focus on your reactions and attitudes. What are you feeling? Why might you be
feeling this way? Allow yourself the space you need for an intentional response.

Exercise creative thinking. Consider unusual solutions. Seek outside perspectives. Frame issues from different angles. Challenge your own beliefs. By utilizing divergent thinking, we can overcome embedded thought patterns and see the situation from a new angle, which could provide a fresh perspective on the matter.

Keep your decisions aligned with your values. When you use your core values to guide your decisions, you gain peace of mind by keeping your integrity intact. At the same time, our values can change over time, and some situations present an opportunity to reflect on and evaluate which values are true for us and which may need to be reconsidered.

In clinical settings, we can employ cognitive behavioral therapy (CBT) as well as structure learning, or the ability to extract information about the structure of a complex environment and decipher streams of sensory information, to promote psychological flexibility.

Psychological flexibility helps us see that what we’re doing in response to a given stressor is not leading to a successful outcome, and it shows us how to make the appropriate changes to our behavior to achieve our goal. It is a handy tool in our kit to cope with stress. The more we exercise flexible thinking, the stronger it gets, providing us with a protective buffer between everyday stressors and possible negative outcomes.

 

 

Sources: ethicalsystems.org, psychologytoday.com, weforum.org

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Posted on by Author Rachael Severancein Categories Tips for Healthy Living, Wellness

Motivational Interviewing for Substance Use Treatment

As a compassionate behavioral and mental health care provider, you incorporate many modalities to treat your clients. For those clients seeking recovery from addiction or substance use, one lesser-known, relatively new model is Motivational Interviewing (MI). Developed in the early 1980s, MI requires an approach based on collaboration, understanding, and empathy. 

What is Motivational Interviewing?
Motivational Interviewing (MI) is a technique commonly used in the treatment of clients with addiction or substance use. This style of treatment can be thought of as an evidence-based conversation that truly encourages behavior change from within and guides clients toward a specific end goal (in this case recovery from addition). 

Motivational Interviewing is highly collaborative. Through approachable dialogue, the client is encouraged to explore their desire for change, receiving kindness, compassion, and acceptance both from their counselor and from themselves. 

This style of treatment is not meant to manipulate, coerce, or “get people to change” as in an intervention. Motivational Interviewing is an on-going conversation between clinician and client that takes time, practice, and the client’s own self-awareness.

Essential Processes of Motivational Interviewing
There are four main processes to successful Motivational Interviewing or “keeping the conversation going.” During the “conversation” (Motivational Interviewing treatment), the clinician must always be: 

  • Engaging. The foundation to MI: actively listening, reflecting on, and affirming a client’s experience and perspective. 
  • Focusing. Steering dialogue toward the end goal of positive change.
  • Evoking. Helping clients build on their “why.”
  • Planning. The “how” to the process of change for a client.

Signs Motivational Interviewing May Benefit a Client 
Although not an exhaustive list, a client may benefit from MI if the following is present:

  • Ambivalence: having mixed feelings about change
  • Low confidence: doubting their ability to change
  • Apathy: low desire or uncertain if they want to change 

Is this tool aligned with my treatment style and will it be beneficial to my clients?
Be honest with yourself if this tool may be right for you, your clients, and your practice. Not every clinician or behavioral health provider is a good fit for motivational interviewing, just like not every client will be a good fit for this type of treatment.

The following are important characteristics in clinicians for the success of Motivational Interviewing:

  • Partnership and collaboration. Clinicians guide toward change, not force it.
  • Acceptance. Clinicians are non-judgmental and actively seek to understand their client’s perspective and life experiences. 
  • Compassion. Clinicians express unending empathy and promote their client’s wellbeing in a selfless way.
  • Patience and understanding. Clinicians actively listen, ask meaningful questions, and provide affirmations to build up client confidence

Behavioral and mental health providers should consider if Motivational Interviewing would be an impactful approach for those clients who are willing and wanting to change. It is proven to be a successful, client-centered approach to encouraging change, promoting resilience, and building confidence particularly in those seeking recovery. 

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Posted on by Author Kayla Quesnelin Categories #EndTheStigma, Advice for Affiliates, Understanding Mental Illness

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