Behavioral Health Update

Building Your Resilience

2011-06-10T15:11:00.002-05:00

Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress – such as family and relationship problems, serious health problems, or workplace and financial stressors. Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that anyone can learn and develop.

Developing your resilience is a personal journey. An approach to building resilience that works well for one person might not work for another. People use varying strategies. Some variation may reflect cultural differences. For example, an individual’s culture might have an impact on whether and how he or she connects with others and communicates feelings.

The following pointers may be helpful to consider in developing your own strategy for building resilience.

Make connections
Good relationships with close family members, friends, or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need can also benefit the helper.

Avoid seeing crises as insurmountable problems
You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.

Accept that change is a part of living
Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.

Move toward your goals
Think about possible solutions to the problems you are facing and decide what realistic goals you want to achieve. Do something regularly – even if it seems like a small accomplishment – that enables you to move forward. Focus away from tasks that seem unachievable. Instead, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"

Many people find it helpful to track their progress by making a record of any accomplishment that moves them toward their goals. It is important to spend a moment reflecting on the fact that you are taking action and achieving what you believe you need to do.

Take decisive actions
Act on adverse situations as much as you can. Take decisive actions, rather than detaching from problems and stresses and wishing they would just go away. Being active instead of passive helps people more effectively manage adversity.

Find positive ways to reduce stress and negative feelings
Following a stressful event, many people feel they need to turn away from the negative thoughts and feelings they are experiencing. Positive distractions such as exercising, going to a movie or reading a book can help renew you so you can re-focus on meeting challenges in your life. Avoid numbing your unpleasant feelings with alcohol or drugs.

Look for opportunities for self-discovery
People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.

Nurture a positive view of yourself
Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.

Keep things in perspective
Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion. Strong emotional reactions to adversity are normal and typically lessen over time.

Maintain a hopeful outlook
An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear. Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing and that contribute to good health, including regular exercise and healthy eating. Taking care of yourself helps keep your mind and body primed to deal with situations that require resilience.

Additional ways of strengthening resilience may be helpful
For example, some people write about their deepest thoughts and feelings related to trauma or other stressful events in their life. Meditation and spiritual practices help some people build connections and restore hope. The key to developing an effective personal strategy is to identify ways of building your resilience that are likely to work well for you.

Where to look for help
Getting help when you need it is crucial to building your resilience. Many people turn to family members, friends and others who care about them for the support and encouragement they need.

Self-help and community support groups can aid people struggling with hardships, such as the death of a loved one. By sharing information, ideas and emotions, group participants can assist one another and find comfort in knowing that they are not alone in experiencing difficulty.

For many people, using their own resources and getting help from others may be sufficient for building resilience. At times, however, an individual might get stuck or have difficulty making progress on the road to resilience.

A licensed mental health professional such as a psychologist can assist people in developing an appropriate strategy for moving forward. It is important to get professional help if you feel like you are unable to function or perform basic activities of daily living as a result of a traumatic or otherwise stressful life experience.

Different people tend to be comfortable with different styles of interaction. A person should feel at ease and have a good rapport when working with a mental health professional or participating in a support group.

This fact sheet is adapted largely from “The Road to Resilience,”available on the Psychology Help Center, located online. The American Psychological Association Practice Directorate gratefully acknowledges the assistance of Rick Allen, PhD; Lillian Comas-Diaz, PhD; Suniya S. Luthar, PhD; Salvatore R. Maddi, PhD; H. Katherine (Kit) O’Neill, PhD; Karen W. Saakvitne, PhD; and Richard Glenn Tedeschi, PhD, in developing this material.

This publication is provided by the American Psychological Association, and may be reprinted in its entirety without modification.

Impulsive Self-Injurious Behaviors

2011-05-05T13:17:00.001-05:00

Paul Hill, PhD, LP

Few behaviors are more alarming than self-injurious behavior (SIB). SIB is commonly defined as deliberate infliction of physical injury to one’s body without intent to die. While there may be no intent to die, it is precisely the potential lethality of this behavior that creates alarm.

One of the most prevalent types of SIB is “Impulsive SIB”, which includes spontaneous and often symbolic acts such as skin cutting, skin burning, or self-hitting. These acts often start out as isolated incidents but can become habitual. This type of SIB is frequently associated with borderline personality disorder, eating disorders, posttraumatic stress disorder, or some form of trauma or abuse.

Why Do People Deliberately Injure Themselves?

Several factors help make sense of this seemingly baffling behavior. (a) Affect Regulation: Many people who engage in SIB react abnormally to negative feelings. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to settle. In theory, these people have learned to reduce their negative emotions through SIB. One-half to three-fourths of SIB patients report anesthesia or relief during the SIB. On a biological level, the anesthesia might be explained by an addiction hypothesis. This hypothesis suggests that the endogenous opioid system has been chronically over-stimulated for the purpose of alleviating negative feelings. The individual develops a tolerance to the influx of endogenous opioids, cyclically suffers a withdrawal reaction, and is driven to release more endogenous opioids through SIB. (b) Dissociation: For some people, stress leads them to disconnect from reality or dissociate. The pain associated with SIB may help them to break through their detachment, reconnect with reality, and feel again. Many people who engage in SIB report that the behavior helps them feel or that the pain.

On a biological level, the pain hypothesis suggests that stress or emotional pain triggers overproduction of opioids or a failed negative feedback loop does not “shut off” release of opioids. The increased levels of endogenous opioids leads to numbness and dissociation, a state that only SIB can break through. (c) Limited Problem-solving skills: While maladaptive, impulsive SIB tends to serve as a coping response for people with limited problem-solving skills. Like more adaptive coping responses, SIB influences others in ways that alleviate difficult circumstances or demands. SIB can also elicit assistance and support. The SIB is reinforced by a responsive environment. (d) Shame: More than other emotions, shame appears to be associated with SIB. Many people who engage in SIB learn to devalue and blame themselves through experiences of childhood trauma, including sexual and physical abuse, or an unempathic or invalidating environment. For some, SIB is described as concrete atonement for being bad, and an aggressive, impulsive response to self-directed hate. The relief they experience is akin to relief that follows completion of penance. On a biological level, a strong correlation exists between decreased serotonin function and increased impulsivity, aggression, and suicidality.

What Can Medical Providers and Educators Do?

1. Provide supportive communication. Maintain an accepting, open attitude about the person who self-mutilates. Don’t make judgmental statements, browbeat, or avoid the subject due to your own discomfort. Blame and attack only induce shame and continue the cycle of self-hatred and frustration that leads to SIB. Pay more attention to healthier things the individual does than to SIB. Inquire about any efforts to delay or avoid the act of SIB and praise and encourage any successes.

2. No medications have received U.S. Food and Drug Administration approval for treatment of impulsive SIB, nor have any double-blind placebo-controlled medication trials been performed. Selective Serotonin Reuptake Inhibitors (SSRIs) have been shown to decrease impulsive-aggressive behaviors and have received mixed support for reducing SIB. Because these medications are well-tolerated and pose a low risk for deliberate overdose, they are usually a good first choice in pharmacologic treatment. Sedative/hypnotic class drugs often are not helpful (i.e.,disinhibit in a negative way) and carry a high risk of abuse. Beyond this, medication strategies tend to focus on targeting symptoms that may be specifically associated with SIB (e.g., ß-blockers for dissociation).

3. Help your patient or student learn strategies to exert more control over their SIB. Have them develop a list of things they can do to distract or delay SIB (e.g., call a friend, write in a journal, go somewhere especially around people, watch a movie or listen to music, exercise). Help them set limits to the amount of time they spend focused on SIB. Help your patient or student learn strategies to cope with intense emotions. Sometimes the first step can be to replace lethal forms of SIB with behaviors that do not produce lasting results. The strategies that are most commonly suggested include squeezing an ice cube or snapping oneself with a rubber band.

4. The most effective treatment of impulsive SIB involves a combination of psychotherapy and psychopharmacology. A therapeutic alliance is a critical element of treatment given the problems commonly reported by patients who engage in SIB (e.g., problems with trust, mood regulation, self-soothing, and suicidal behavior).

Paul Hill, PhD, LP is a psychologist at Behavioral Health Services (BHSI) in Shakopee, Director of BHSI in North St Paul, and is BHSI’s Director of Operations.

Post-Traumatic Stress Disorder

2010-08-03T10:48:00.012-05:00

Posttraumatic stress disorder (PTSD) has been receiving greater attention in recent years because of the high incidence of the disorder among soldiers returning from deployment in Iraq and Afganistan. Additionally, soldiers are not the only people who can develop PTSD. PTSD affects approximately 8 percent of the United States population, with between a quarter and one-third of people who experience a significant trauma developing PTSD.

Significant trauma is considered any event that is dangerous or upsetting such as an assault or violent attack, combat, natural disaster, or vehicle crash (National Institute of Mental Health, 2008). Symptoms of PTSD, which can occur anytime after the event, include re-experiencing the event, such as having recurring nightmares, avoiding reminders of the event, being less responsive including feeling detached and less interested in life activities, and increased arousal, such as having angry outbursts or difficulty sleeping (Grinage, 2003).

The good news is if you or someone you know has been experiencing symptoms such as those described above, treatment is available. BHSI offers the opportunity to take an anonymous screening for PTSD as well as other common mental health conditions. The screenings are free and only take a few minutes. To take a creening visit: http://www.mentalhealthscreening.org/screening/BHSI

or you can visit the BHSI website at http://www.bhsiclinics.com/

Bell, S. (2007, January 17). The Invisible Injury: PTSD and Iraq War Veterans. Associated Content.
Retrieved from
http://www.associatedcontent.com/article/118081/the_invisible_injury_ptsd_and_iraq.html?cat=70

National Institute of Mental Health. (2008). Post-Traumatic Stress Disorder (Easy-to-Read). Retrieved from http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-easy-to-read/index.shtml

Grinage, B. D. (2003). Diagnosis and Management of Post-traumatic Stress Disorder [Electronic version].
American Family Physician, 68, 2401-2409

Overwhelmed by the Holiday Season?

2009-12-11T09:48:00.005-06:00

It’s supposed to be “the most wonderful time of the year.” However, if you can’t get into the spirit it may be more than just a case of the holiday blues.
Depression is a common, yet serious, illness that affects more than 19 million Americans each year. Sometimes a stressful event –such as the holiday season- can trigger depression, but other times it can occur with no specific cause.
Early warning signs for holiday depression include having a shorter temper than normal, sleep problems, losing interest in activities you normally enjoy, and over-reacting to minor annoyances.
Don’t let an undiagnosed mood or anxiety disorder get in the way. Gauge your emotional well-being by taking a free, anonymous online mental health self-assessment offered by BHSI (Behavioral Health Services). Visit www.mentalhealthscreening.org/screening/BHSI
and complete a simple online questionnaire. You will receive immediate feedback as well as the opportunity to schedule an appointment for further evaluation if necessary.

Tips for dealing with holiday stress:
1) Keep holiday expectations real: balancing the demands of the holiday season -shopping, parties and family obligations- can be very stressful. Create a realistic budget and try not to sweat the small stuff.
2) Use alcohol moderately: Alcohol is a central nervous system depressant. Excessive drinking can actually increase your feelings of sadness.
3) Eat right and nurture your body: A balanced diet, moderate exercise and rest can help you to reduce stress and enjoy life.
4) Set a reasonable holiday budget. Overspending during the season can increase stress and anxiety.
5) Pay attention to your moods: The holiday blues are a common response to a stressful season. However, if feelings of hopelessness and anxiety persist for longer than two weeks and interfere with your normal, daily routine, seek professional help.

Loss and Unexpected Gifts

2009-11-09T10:59:00.006-06:00

Dorit Miles, MA, LP
Behavioral Health Services (BHSI), Golden Valley, MNhttp://www.bhsiclinics.com/

These are difficult times. Many people are experiencing extreme losses and hardships. Over the years, life has presented many challenges to my clients and to me. I have learned that change is constant. Sometimes when bad things happen, good things follow unexpectedly. Effort is crucial to help the good to materialize.
Five months ago I was (along with 60 colleagues) laid off from a large mental health clinic. It was a shock since I planned to work there until retirement. Today I work for BHSI, which I found to be a much better fit for me. An opportunity presented itself; I acted on it quickly and ended up with more satisfying daily work and environment.
One year ago this month I lost my mother. Although she was 87 years old, ill and her passing was expected, it was still a very sad reality. Two weeks after her death, my husband showed up unexpectedly with a rescued puppy. We already had a four year-old Golden Retriever, and although earlier we discussed the possibility of two dogs, we both rejected the idea because of the added responsibility. Of course once we saw Lucca we fell in love with her and decided to keep her despite the extra work any puppy requires. To me, she was extra special and a gift from the universe to help with my grief. Lucca has become a member of our family and I often smile at the thought of Mom and her.
Eight years ago my best friend and partner in private practice died suddenly of a heart attack. My loss was immense. It took a lot of effort to recover. Since then I have made special friends and am working in a satisfying environment.
Ten years ago, when menopause hit, I found myself desperate and willing to do what it took to feel better. Two years earlier I had heard a presentation on Qigong; so I decided to practice daily for half an hour. It was a tremendous commitment on my part since I don’t like to get up early and have always gone to the pool or yoga class for exercise. I never before committed myself to disciplined daily practice on my own. My life changed. I felt healthier again.
These four examples have taught me a lot about loss and resilience. Working with clients for years, I have seen many people deal with horrific events. We all have inner reserves that we are unaware of until life presents us with challenges.
I have learned that we need to do our part to make the desired changes and recovery will happen. We also need to listen to our hearts and do what fits for us. Sometimes we need to make our own recovery the first priority in our life and ask others for help.

Dorit Miles, MA, LP is a psychologist at Behavioral Health Services in Golden Valley, Minnesota. She works with adults on a wide range of mental health issues. Her special interests include life transitions, mid-life issues, post-partum depression, parenting issues and overall wellness.

Seasonal Affective Disorder (S.A.D.)

2009-09-10T10:41:00.012-05:00

Susan Arquette, Ph.D., L.P.
Behavioral Health Services (BHSI), Woodbury, MN
http://www.bhsiclinics.com/

Seasonal Affective Disorder (SAD) was officially recognized as a distinct disorder about 20 years ago. More common in higher latitudes and thought to be more influenced by day length than temperature, it consists of a pattern including some or all of the following: depressed mood, decreased energy, increased need for sleep, loss of interest, enjoyment and motivation, increased appetite and/or cravings for sweets or carbohydrates, with associated weight gain. Onset is typically late fall to early winter, with symptoms remitting in Spring. A recent NIMH-funded study* concluded that most SAD symptoms can be traced to a disruption of body rhythms resulting from winter’s late dawn and early dusk.

Treatment of SAD using full-spectrum lights was proposed many years ago, and research has established light therapy as safe and effective. In many studies light therapy provided benefits equal to those found with antidepressant medication, often with faster results. While light therapy is the treatment of choice for SAD, other therapies also have been shown to be effective, either alone or in combination with light therapy. Lewy and colleagues* found that administration of small amounts of melatonin, usually in mid-afternoon, was a useful adjunct to morning light therapy in restoring normal daily rhythms and alleviating symptoms of SAD. Light therapy can be effective for a range of depressive disorders beyond its traditional use to treat seasonal affective disorders. It offers a safe alternative to antidepressant medication during pregnancy, and shows some promise in the treatment of premenstrual dysphoric disorder. It also has been used successfully for treating jet lag and sleep disorders among shift workers.

The standard dose is exposure to 10,000 lux of diffused white fluorescent light upon awakening in the morning. The timing and duration of light exposure can be tailored to individual needs, with some people benefiting from a longer exposure and others doing well with less. There has been much research and debate about the type and intensity of light that is safest and most effective. It is inadvisable to construct home-made light boxes due to the possibility of eye injury. The light apparatus should filter out wavelengths less than 450 nm to avoid damage to the eyes. Certain photosensitizing medications, including many standard antidepressants and
antipsychotics, can interact with ultraviolet and short-wavelength blue light with the risk of retinal damage. People who are taking medication should check with their physicians before beginning light therapy to avoid the possibility of eye damage. More information about commercially available lights and features to look for is available at the website of the Center for Environmental Therapeutics, www.cet.org.

An intriguing adjunct to light exposure is “wake therapy” consisting of either a full night’s sleep deprivation or sleep deprivation for the second half of the night only. This therapy is surprisingly effective for many types of depression, but the benefits wear off quickly when normal sleep is resumed. Some researchers have combined wake therapy with instructions to the patient to go to bed at 5:00 pm the following evening, with bedtimes advancing by two hours each night until a normal sleep-wake cycle is established. Light therapy and sleep phase advance have both prevented relapse after wake therapy. “Dawn simulation”--- exposure to light that gradually increases in intensity to mimic a natural dawn--- is also effective.

Cognitive behavioral therapy with a specific focus on seasonal issues and behavioral changes including engaging in enjoyable outdoor winter activities have also been demonstrated to be effective treatments for SAD, and the latter combines the known antidepressant benefits of exercise with those of light exposure.

References

*Lewy, Alfred J, Lefler, Bryan J, Emens, Jonathan S and Bauer, Vance K. (2006).
The circadian basis of winter depression. Proceedings of the National Academy of Science, Vol. 103, No. 19, 7414-7419.
DeAngelis, Tori (2006).
Promising new treatments for SAD. Monitor on Psychology, Vol 37, no. 2
Susan S. Arquette, Ph.D., L.P. is a psychologist at BHSI in Woodbury. She is BHSI’s Director of Regulatory Compliance and Director of BHSI's Woodbury and Fridley Clinics.

Stress, Health, and Coping with Life’s Problems

2009-08-06T23:12:00.007-05:00

Drevis Hager, EdD, LP
Behavioral Health Services (BHSI), Golden Valley, MNhttp://bhsiclinics.com/

The American Academy of Family Physicians estimates that 60% of the health problems brought to physicians are related to stress in one way or another. In some instances illness is the direct result of the body’s sustained stress response, while in other instances the stress response exacerbates or extends a pre-existing illness.

The list of stress-related maladies is very long and includes (but is not limited to) psychological disorders, sexual dysfunctions, insomnia, tics, tension headaches, diabetic instability, impaired immunity, hypertension and other cardiovascular distress, gastrointestinal problems, elevated cholesterol, and impaired wound healing.

The physiology of the stress-health nexus is complex, but several potent processes have been identified. Here is just one example: When you are stressed-out, your catecholamine hormone levels spike rapidly and your glucocorticoid levels elevate as part of the process of gluconeogenesis - the creation of new glucose necessary for extended fight-or-flight response. Then, if the stress in your life continues, the persistently high glucocorticoid levels actually impair the operations of your thymus, lymph nodes, and spleen, and this delivers a big hit to your ability to fight off illness. This is why you get sick right when it seems things couldn’t get much worse.

Why Coping Skills Are So Important

Technically speaking, environmental events really aren’t the most powerful “stressors;” your own thoughts are! There is tremendous variability to how people react to life’s problems, and this determined by each person’s unique problem-solving style. Studies have shown that stress-hardy people view life’s problems as challenges to be mastered, are optimistic problem-solvers, and maintain good perspective on the relative importance of each problem. Several studies have also shown that people who meditate daily and maintain healthy lifestyles demonstrate far better coping abilities. So it is no surprise that these people also tend to have fewer health complications.

In contrast, stress-impaired individuals view life’s problems as dangerous threats, over-react to problems, and mentally turn molehills into mountains. They tend not to exercise, meditate, or eat right. They usually have higher catecholamine and glucocorticoid levels in their bloodstream (even when resting) and, consequently, have more health complications.

Stress Reduction Tips

When it comes to this intersection of stress and health, an ounce of prevention is worth a pound of cure. If you’d like to reduce your deductibles and co-pays:
1. Learn and practice the mental habits used by stress-hardy individuals. Practice optimistic problem solving. View problems as challenges and maintain good perspective on the relative importance of each problem.
2. Improve your lifestyle habits. Schedule your time realistically. Exercise regularly, eat right, and develop good social supports. Get adequate rest, recreation, and sleep. Minimize or eliminate alcohol, illicit drugs, and tobacco.
3. Learn a relaxation or meditation technique, and practice it every day! The large body of research on meditation and health is impressive, with hundreds of studies demonstrating an array of benefits such as fewer infections, faster surgical wound healing, lowered cholesterol, reduced arterial occlusion, and far less anxious reactivity.
4. Read a stress-reduction self-help book like Joan Borysenko’s Minding the Body, Mending the Mind or Herbert Benson’s The Relaxation Response.
5. Seek mental health treatment such as individual psychotherapy or participation in a stress reduction group. A qualified mental health professional can help you to manage your stress effectively and boost your satisfaction with life.

Drevis Hager, EdD, LP is a psychologist at BHSI's Golden Valley clinic, where he is also the clinic's Director and BHSI's Director of Clinical Services. He works primarily with adults encountering a broad range of problems and issues, and has a special interest in stress management training, meditation, and relaxation techniques.