Categories
Mental Health

Adolescent Treatment: Mind and Body As One

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Since 2002, Visions has been in the forefront of providing adolescent treatment. Being well-versed in the characteristics of adolescent behaviors and cognitive development, it was only natural for us to refine our Mental Health Track in order to provide an optimal treatment model for teens. As we’ve seen time and time again, drugs and alcohol aren’t always the sole, causative factor in behavioral issues. Often times, there’s a mental-health component which needs to be addressed with the same skill and finesse used in the treatment of substance abuse.

It’s not easy being a teenager: for one, there’s the physical awkwardness, there’s the social constructs of trying to fit in and be liked, and there’s the desire to do well in school and meet the expectations of your parents. It’s tough. There’s no denying that. For some, it’s harder than others, and the pressure of “doing it all” is simply too much, which can present as the self-deprecating feelings of hopelessness, anxiety, and depression, et cetera. Unfortunately, the environment of adolescence isn’t always conducive to one talking to their friends about these experiences without the fear of being stigmatized. Most of the time, one’s left trying to figure things out for themselves, and that never really works out well.

This October, Visions will light the path to a refined treatment model, addressing the complex issues relating to adolescent mental health. By thoroughly addressing and updating the mental-health component to our existing modalities, we will ultimately provide an environment which will allow teens struggling with mental-health issues to truly achieve physical and psychological health. The goal is to do so while also removing the stigma typically associated with mental-health issues.

We all come with the physiological footprints of our families. On occasion, we need help navigating those seas so we may begin to create new, emotionally sound paradigms in which to live our lives. Between successfully providing mental health, substance abuse, and family treatment, I believe we are well on our way to helping families achieve this goal.

Categories
Depression Mental Health

Depression in Adolescence

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Depression affects teens as well as adults but is often missed partly because it can co-occur with the natural emotional ups and downs that are part and parcel to being a teenager. Simply put, growing up is a naturally stressful process, and that’s without any external conflicts acting as a contributing factor! The other organically occurring components fostering an environment for adolescent depression are things like hormones, and conflict with parents. When we include disturbing events like a breakup, death of a friend or relative, or difficulty at school, one’s susceptibility to depression increases.

Adolescence is a time for expressing independence, which sometimes means drawing a firm line in the sand with one’s parents in order to create autonomy. On occasion, those efforts can create a snag in parent/child communication. Puberty is inherent to the organic and experiential part of being human. It also means there is going to be infallibility and imperfection. Sometimes, as parents, we forget what it was like and spend too much time reacting and taking things personally and not enough time taking action. Think of it this way: if a teen is suffering from depression, they more than likely won’t tell you. In fact, they may be surreptitiously hoping that you take notice, because talking about it might be too scary or embarrassing.

According to the National Comorbidity Survey-Adolescent Supplement (NCS-A) via the National Institute of Mental Health (NIMH): “About 11% of adolescents have a depressive disorder by age 18. Girls are more likely than boys to experience depression. The risk for depression increased as a child gets older.” And according to the World Health Organization (WHO), “Major depressive disorder is the leading cause of disability among Americans age 15-44.” Further, the NIMH site notes that since childhood behaviors vary from one childhood stage to another, “it can be difficult to tell whether a child who shows changes in behavior is just going through a temporary ‘phase’ or is suffering from depression.

Since symptoms of adolescent depression differ slightly than those of an adult, it’s important to pay attention to any idiosyncrasies that may occur (sans getting over-analytical and paranoid). A child who’s depressed may complain of being sick, they may suddenly become excessively clingy, and they may often refuse to go to school; A teen, on the other hand, may sulk, get in trouble at school, be an overall grump, and feel a general sense of being misunderstood.

Symptoms of depression can include some or all of these factors:

  • Appetite changes (usually a loss of appetite but sometimes an increase)
  • Difficulty concentrating
  • Difficulty making decisions
  • Episodes of memory loss
  • Fatigue
  • Feeling upset, restless, and irritable
  • Feeling worthless, hopeless, sad, or self-hatred
  • Loss of interest or pleasure in activities that were once fun
  • Thinking or talking about suicide or death
  • Trouble sleeping, too much sleeping, or daytime sleepiness

Sometimes a person’s behavior may change, or there may be problems at home or school without any symptoms of depression:

  • Acting-out behaviors (missing curfews, unusual defiance)
  • Criminal behavior (such as shoplifting)
  • Irresponsible behavior
  • Poor school performance, grades dropping
  • Pulling away from family and friends, spending more time alone
  • Use of alcohol or other illegal substances

If you notice any of these behaviors lasting for more than two weeks, it’s time to seek help, particularly if these behaviors are beyond the normative rollercoaster ride consistent with adolescence.

For additional information and for documentation of sources for this article:


Depression in Children and Adolescents (Fact Sheet)
Use of Mental Health Services and Treatment Among Children (www.nimh.nih.gov)
Adolescent Depression (www.nlm.hih.gov)
Adolescent Depression (PubMedHealth: www.ncbi.nlm.nih.gov)
Adolescent Depression (https://health.nytimes.com) 

Categories
Bipolar Disorder Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Therapy

DBT, Mental Health & Addiction

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Sometimes someone comes into contact with treatment because their drug use got out of control only to discover their problem isn’t actually addiction, but rather, an untreated mental health issue. Often times the misuse of drugs and alcohol is an ardent attempt to quell the feelings of anxiety or lift the fog of depression. Sometimes it’s a way to disengage from the flashbacks of trauma. Sometimes it’s a way to close the door on a panic attack. However, many times, these modes of self-treatment go too far, and the claws of addiction sink in, creating another layer to uncover and treat. Still, once the addiction piece of the puzzle is treated, therein lies the deeper, more complicated issue of mental illness. What then?

At Visions, we have embraced the mental health component of treatment and are adding a mental health track to our existing treatment plan. We are utilizing a wider range of treatment methodologies and branching into the area of Dialectical Behavioral Training (DBT). DBT is a “comprehensive cognitive behavioral treatment developed by Marsha M. Linehan over the last 25 years,”[i] and has primarily been used to treat patients struggling with suicidal ideation, suicide attempts, a desire to self-harm, and self-mutilation. After discovering numerous problems with the traditional use of cognitive behavioral therapy (CBT) in treating this particular clientele, Linehan began to integrate validation strategies (also known as acceptance-based interventions) into her treatment methodology.  By integrating these validation strategies, Linehan inevitably began empowering her clientele and creating an environment of acceptance, while also encouraging them to begin to recognize the need to consciously change negative behaviors. DBT has also become one of the more successful treatments for patients suffering from borderline personality disorder (BPD), a group typically resistant to the traditional use of CBT.

To illustrate some of the problems Marsha Linehan and her team encountered, here are the three issues they found to be the most troublesome with traditional CBT:

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop out rate. And, obviously, if clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. In other words, therapists were unwittingly under the control of consequences outside their awareness, just as all humans are. For example, the research team noticed through its review of audio taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, or emotional withdrawal, or shame, or threatened self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they didn’t want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients – suicide attempts, urges to self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, etc, AND have session time devoted to helping the client learn and apply more adaptive skills.[ii]

In addition to utilizing validation strategies, DBT also employs the use of mindfulness as one of the core concepts behind this therapy. Mindfulness is beneficial in the treatment of addiction and mental illness: it introduces the concept of non-judgmental observation, where we can observe our own actions and behaviors without criticism; Being mindful requires that we are engaged in present-time awareness: the here and now. This is where mindfulness is truly invaluable. If we are aware of our actions in the here and now, we are less likely to get caught in the destructive patterns of “what if? and “remember when?” In the practice of meditation, the act of “coming back to the breath” helps one stay in the present. Learning how to label emotions and feelings that may present themselves can help sufferers from getting lost in negative thought patterns. For example, if we are feeling scared or triggered, paranoid or angry, naming that emotion with non-judgmental observation will help us retain our present-time awareness.

In time, hopefully, the implementation of treatments such as DBT and mindfulness will help provide sufferers with some valuable tools for regulating emotion, distress tolerance and managing interpersonal relationships.


For more detailed information on DBT, please visit these sites:
Categories
Addiction Alcoholism Recovery Self-Care

Love and Boundaries

What happens when someone you love relapses and decides not to get sober again?
Regardless of whether that person is a parent or a close friend, it’s a challenge, to say the least. In AA, we are told  “we simply do not stop drinking so long as we place dependence upon other people ahead of dependence on a higher power¹” This statement alone verifies the need to allay one’s reliance upon the static nature of the sick, and instead turn the focus on paving a new path toward healing.

In 1951, Al-Anon began using the steps, giving those married to and reared by the alcoholic, tools with which they could live by. One thing is key: Al-Anon and Alateen don’t focus or talk about the alcoholic; they instead focus on themselves and learn how they can lead a happier, freer life. Here, the lesson is not to fix the person we love, but rather how to live life fully and independent of their disease. That’s tough, especially when  our expectations have taken hold: “If only they get sober, then everything will be okay.” or  “I’m not the one with the problem, they are.” But when we place our focus on fixing someone else’s problems, obsess over their emotional health, and base our lives around their well-being, that IS a problem.

Alateen is a wonderful support for kids struggling with alcoholic/addict parents or siblings. When chaos is the norm, then Alateen provides tools for weathering the storm. As kids living with alcoholics and addicts know, reaffirming reality in their day-to-day lives is the norm; the steps and fellowship: however, help provide a healthy, non-threatening way to do that. At some point, we find that part of supporting someone else’s sobriety means allowing them to walk their own path, no matter how rocky that path may be. We can’t walk it for them. If that means that their sobriety is tenuous at best, then we have to learn how to step aside. I call it loving someone with boundaries. In other words, we can love you when you’re in your disease, but we won’t hold you up.

¹ BB Page 98 (Note: “God” was replaced with “higher power” in the post.)

 

Categories
Mental Health Recovery Spirituality

Acts of Kindness

I came across a beautiful article written by Ed and Deb Shapiro, authors of “Be the Change” in which they call for a “Revolution in Kindness.” Their article expressed the need for compassion and kindness and asks us to change our actions. It really made me think about recovery and how we so often come into the rooms bereft of problem-solving skills, angry, and hurting, and lashing out.

Most of us come in as the antithesis of kind. The change we experience in recovery is profound as we learn to transform our programmed responses to people, places, and things. Truly, these new actions do require a sort of metamorphosis. As we begin the recovery process, we are choosing to cease fighting. We admit we’re wrong, we admit powerlessness, and slowly, we begin to learn how to function gently and with clarity.

It’s tough to admit we’re wrong, especially when we are attached to the context of the situation itself, and even more so when we’ve invested so much energy in our anger and its corresponding story. But wouldn’t it be liberating NOT to fight–to admit that you are (gasp) wrong?! Sounds crazy, I’m sure, but think about it: so much of our conflict is created because our egos command us to prove we’re right (even when we’re not!). We often fight to the point of ending friendships, both personal and professional, but in the end, our fight means nothing at all.

The 12 steps ask us to give up our ego and self-centered behaviors. By demanding honesty in our inventories and actions, we are propelled to adopt a more altruistic approach to the world. We make amends for our actions, righting the wrongs we’ve caused, and we learn to stop the harming behaviors that got us here. This also means approaching our difficulties with kindness instead of closed fists. When we change our actions, we ultimately have a chance to end the incessant violence permeating our lives: the bullying, school shootings, hateful speech, drug and alcohol abuse.  Ed and Deb Shapiro said, “Kindness is completely revolutionary: it will change each one of us, it will change others, and it will definitely change the world.” What a wonderful reminder, then, to take responsibility for our actions and point less fingers at those around us. The world can be a sticky place, so why not begin to unstick it with small acts of kindness and compassion? Try it: One kind act, one day at a time.