13 Reasons Why

13 REASONS WHY

Following the Netflix release of 13 Reasons Why in 2017, many mental health, suicide prevention, and education experts from around the world expressed a common concern about the series’ graphic content and portrayal of difficult issues facing youth. Resources and tools to address these concerns were quickly and widely disseminated in an effort to help parents, educators, clinical professionals and other adults engage in conversations with youth about the themes found in the show.

In advance of the release of season 2, SAVE (Suicide Awareness Voices of Education) brought together a group of 75 leading experts in mental health, suicide prevention and education as well as healthcare professionals (see full list below) to develop tools to help encourage positive responses to the series. In just a few short months, this group has developed a toolkit providing practical guidance and reliable resources for parents, educators, clinicians, youth and media related to the content of the series (suicide, school violence, sexual assault, bullying, substance abuse, etc.).

Using the toolkit and resources developed will help to encourage conversations, identify those at risk and prevent unexpected tragedies. Hopefully, it will also help those in need get the appropriate level of support and professional care to ensure that youth are protected, nurtured and our communities are stronger.

Dan Reidenberg

Executive Director – SAVE

SAVE especially thanks the following sub-group leaders in this effort:

Katherine C. Cowan

Christopher Drapeau

Frances Gonzalez

Sansea Jacobson

Matthew Wintersteen

ABOUT

The organizations listed below represent thousands of mental health and suicide prevention, education experts and healthcare professionals from around the world with decades of experience working with youth, parents, schools and communities.

SAVE thanks the following organizations for their participation in this effort:

  • American Academy of Child and Adolescent Psychiatry
  • American Association for Emergency Psychiatry
  • American Association of Suicidology
  • American Psychiatric Association
  • Australian Institute for Suicide Research and Prevention
  • Befrienders Worldwide
  • British Psychological Society
  • Danish Research Institute for Suicide Prevention
  • International Association for Suicide Prevention
  • International Academy for Suicide Research
  • Medical University of Vienna, Center for Public Health, Dept of Social and Preventive Medicine
  • Mental Health Foundation of New Zealand
  • National Association of School Psychologists
  • National Council for Behavioral Health
  • National Suicide Prevention Lifeline (USA)
  • National Suicide Research Foundation (Ireland)
  • Orygen, The National Centre of Excellence in Youth Mental Health, Australia
  • Prevention Communities
  • Samaritans UK
  • Stanford Psychiatry’s Center for Youth Mental Health and Wellbeing
  • School of Public Health, University College Cork, Ireland
  • Society for the Prevention of Teen Suicide
  • Suicidal Behaviour Research Laboratory, University of Glasgow, Scotland
  • Suicide Awareness Voices of Education
  • The Jason Foundation
  • The Jed Foundation (JED)
  • The Lancet Psychiatry
  • The Trevor Project
  • University of Michigan Psychiatric Emergency Services

https://www.13reasonswhytoolkit.org/

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Midlife Anxiety

When someone goes through dissatisfaction with their job or marriage and they are in their forties or fifties, the first thing everyone says is that they must be having a midlife crisis. We hear about this phase of life as people transition from young adult to middle age so often that it almost feels like a crisis is a “given”. And, on some level, it may be. As people go from being the young, carefree person of their twenties who is just getting established in a career or marriage, to the responsible person who is expected to have gotten their lives together by the time they reach their forties, it is inevitable that people will look back and second guess decisions or wonder “what if.” For many people, this emotional jolt can bring on midlife anxiety.

Midlife Crisis Symptoms

Unlike a medical condition, midlife anxiety doesn’t have specific symptoms. Instead, it’s a mixture of emotions, feelings, and body changes that lead to the strong sense that something needs to change.  Among other things, it can be triggered by factors such as an event that reminds you that you are aging, the death of a parent, children leaving home for college, or a health scare of your own.

Things that might be signs of midlife crisis are:

  • Unexplained annoyance or anger
  • The desire to get in shape or surgically modify your body
  • Coveting that shiny new sports car or wanting to try something daring, such as skydiving
  • Feeling trapped – whether it’s financially, career-wise, or in your relationships
  • Becoming preoccupied with death
  • Constantly wondering where your life is heading or regretting your life choices
  • Losing sleep or changing your eating habits
  • Dissatisfaction with the things that used to make you happy

Additionally, keep in mind that the feelings of helplessness or worry aren’t just confined to midlife anxiety. These emotions can come up anytime during a period in which you are transitioning to a new phase of life. Leaving the teen years and becoming a college student, a parent’s empty-nest syndrome, or an elderly person who moves from a beloved home into a senior-care apartment are all examples of situations that can bring on the same symptoms as those of midlife anxiety. Even being diagnosed with a medical illness or condition can make you feel vulnerable and may bring up these symptoms.

How to Cope if You’re Having a Midlife Crisis

When you’re faced with midlife anxiety, the urge to do something – anything – can be very powerful, so the first thing to do is: nothing. Despite how you feel, this really isn’t the time to make major changes in your life that you may find yourself regretting when your anxiety has diminished.

Instead:

  • Mourn your losses, but don’t dwell on them. Try to reframe the negatives by looking at them in a different way.
  • Take some space away from your daily routine to pause and think about the next phase of your life. What new ambitions do you have? What would you like to accomplish over the next few years? Ignore the little voice in your head that tells you that you are being selfish or should stop daydreaming.
  • Count your blessings. Recognize and write down the things in your life for which you are grateful, then reread your list when you are feeling regretful about something.
  • Do something that will refocus your thoughts – volunteer, take a class, or get involved with a mentoring program.
  • Let go of the things that aren’t serving you and embrace the positives. Challenge your negative thinking (for example, make a list of the trials and pitfalls you went through to get where you are today to remind yourself that the “good old days” weren’t always carefree and wonderful).
  • Be gentle with yourself. Don’t try to stuff your emotions or judge yourself for having them.
  • Talk to someone. Psychotherapy for phase of life anxiety can help lessen or alleviate the ongoing symptoms that come with a midlife crisis before they get out of hand. For some, group therapy is a great way to interact with others who are going through the same issues so you can see that they have the same concerns and problems as you. If therapy isn’t an option, reach out to supportive friends, read books on how to help a midlife crisis, or turn to your clergy for support.

Can Midlife Anxiety Actually Help You?

Remember that midlife anxiety doesn’t have to be something that leads to a crisis! You can channel your concerns into new opportunities and bring greater meaning to your life. This can be a time to:

  • Set new goals to replace your outdated or less relevant objectives. For example, if you’re no longer aiming to climb the corporate ladder, try mentoring a younger colleague.
  • Start that hobby you’ve been thinking about pursuing. After all – if not now, when?
  • Learn a new language or acquire a new skill.
  • Give back through volunteering or community work, such as coaching a team sport or helping out at a soup kitchen.
  • Renew or consider beginning a spiritual life to help you find strength outside yourself.
  • Begin stress management strategies. Take up yoga or learn meditation. Practice mindfulness. Keep a gratitude journal. Start an exercise program.

Professional Help for Midlife Anxiety

If you or a loved one is experiencing midlife anxiety, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can help. For more information, contact us or call us today at 561-496-1094.

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ADAA Session Recording -Treatment Resistant Panic Disorder

Our team presented at the 2018 ADAA Conference on Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach. You can access the audio recording of our session here with the below login credentials.

Username: arosen1980@aol.com

Password: 1667947

We hope you find the recording of our presentation helpful and informative!

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LGBTQ Mental Health

Studies have shown that people who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) suffer from higher levels of anxiety and depression than the general public. In fact, approximately 30 – 60 % of the LGBTQ population have anxiety and depression and, as a whole, the LGBTQ community faces disproportionately high rates of suicide, self-harm, substance abuse and addiction. While there are many things that can influence a person’s mental and emotional wellbeing, prejudice and discrimination add additional trauma to LGBTQ mental health concerns.

Factors that Affect LGBTQ Mental Health

In and of itself, simply being LGBTQ does not affect a person’s mental health condition. Identifying against a cultural norm, however, exposes an LGBTQ person to prejudice and discrimination that their heterosexual counterparts don’t generally face. Some factors that affect LGBTQ mental health are:

  • Bullying
  • Homophobic societal attitudes
  • Hate crimes against LGBTQ people
  • Minority stress, which is a constant need to be “on guard” and to watch out for potential threats
  • Negative self-image and self-loathing due to societal attitudes
  • Lack of awareness of where to find positive role models
  • Media coverage that is beginning to embrace the LGBTQ culture on one hand, but shows detrimental news stories about the treatment of the community on the other
  • Worry about showing their true selves at work for fear of losing clients or promotions
  • Fear of being denied housing
  • Discrimination against transgender people within the LGBTQ community

Despite the fact that society is slowly becoming more accepting of the LGBT community, an uphill battle still remains. LGBTQ people have heard from birth that being something other than heterosexual or identifying with the gender you were born into is wrong. For example, although gay marriage was recently legalized, federal law still allows for legal discrimination in the workplace because it doesn’t protect people based on sexual orientation or gender identity. People can still legally be evicted from housing, fired from their job, or refused public or private services because of their LGBTQ status. Additionally, it is all too common for family members to reject someone who comes out to them.

Up to 65% of LGBT people suffer from some level of homophobia themselves (the belief that being LGBTQ is wrong). Hearing throughout their lives that they are somehow flawed causes many people to internalize those negative thoughts. Those who don’t have family or peer support have a harder time, as do those individuals who tend toward more negative personalities or have gone through adverse experiences, such as rejection or bullying.

On the other hand, even LGBTQ people who have supportive family and friends can end up feeling that their sexual or gender identity is somehow wrong. Often, people who love them want to help, but have no idea how to do so, and end up suggesting “cures” or a laundry list of worries (“you’re going to get AIDS”). These things contribute to the person’s feeling of being unworthy or hopeless. When the individual internalizes this shame from a young age, it often leads to long-term mental and emotional consequences.

Compassionate Care is Needed

For LGBTQ people, talking about their problems can feel like they are reinforcing the damaging stereotype against the gay and transgender community. Many individuals have been kicked out of their homes or shunned by family members and friends after they’ve come out. As an example, it’s estimated that about 40% of the homeless population in Southern California consists of homeless LGBT youth.

Compassionate care is needed to help the LGBTQ community recover from its serious mental health issues. Obviously, mental health providers should approach and treat their LGBT patients in the same manner as they would any other patient. However, they also need to understand how oppression and other factors contribute to anxiety and depression in these patients.

We Can Help

Our mental health professionals provide caring, compassionate LGBTQ mental health services. For more information, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Call us today at 561-496-1094.

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Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach

Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach

Panic Disorder is one of the most common anxiety disorders. Its impact on quality of life can be significant and incapacitating. One third to one half of panic patients demonstrate incomplete or absent remission after treatment. This Roundtable addressed the importance of the bio-psycho-social components of the evaluation and treatment of the resistant panic disorder patient.
The clinical team is challenged with determining what rendered the individual patient treatment resistant. Examples of complicating variables in such patients include medical mimics of panic disorder, occult substance use disorders, co-morbid psychiatric disorders like trauma syndromes, obsessive compulsive and pediatric spectrum disorders.
Treatment often entails a multi-modality approach that identifies the critical variables discovered during the evaluation phase. At our center the presence of multi-disciplinary clinicians in one location allows for ongoing case discussion and most importantly reassures the patient that they are being supported by an interactive treatment team.
This Roundtable reviewed the appropriate psychopharmacological interventions during the course of treatment that can provide a synergistic addition to the cognitive behavioral treatment plan. The CBT plan must be individually tailored to the patient since not all panic disorders are alike. When possible, we have found that a manualized workbook approach can be invaluable and supports greater patient adherence.
Recent technological advances have allowed for the development of state of the art clinical tools that incorporate specific biofeedback and virtual reality protocols. We will present examples of both and discuss the importance of a multi-pronged approach to the difficult to treat patient. Prevention is the core goal of mental healthcare and early childhood detection of panic disorder has become a major goal. This Roundtable will review early warnings of future panic disorder and importance of interventions that foster resilience and stress control capabilities in children.

Learning Objectives

1. Recognize the seriousness and frequency of treatment resistant panic disorder.
2. Apply the contents of this Roundtable to develop a multimodality treatment plan.
3. Demonstrate an effective systems approach to the evaluation of the treatment resistant panic disorder patient .

Chair(s)

David Gross, MD, Center for the Treatment of Anxiety and Mood Disorders
Dr. Andrew Rosen, PHD, Center for the Treatment of Anxiety and Mood Disorders

Discussant(s)

David Gross, MD, Center for the Treatment of Anxiety and Mood Disorders
Dr. Andrew Rosen, PHD, Center for the Treatment of Anxiety and Mood Disorders

Presenter(s)

Dr. Christiane Blanco-Oilar, PhD, Center for the Treatment of Anxiety and Mood Disorders
Joseph Brand, PhD, Center for the Treatment of Anxiety and Mood Disorder
Ryan Seidman, PsyD, Center for the Treatment of Anxiety and Mood Disorders
Dr. Andrew Rosen, PHD, Center for the Treatment of Anxiety and Mood Disorders

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How Stress Affects Child Development

free anxiety workshop on childhood anxietyStress surrounds us on a daily basis. From traffic delays to work projects, worries about finances or health, and news reports of world events, the demands of our everyday lives produce both positive and negative stress. Stressors (which are the things that cause your stress) can be physical, emotional, theoretical, or environmental. Even positive events like weddings and job promotions cause stress.

Whether negative or positive, one thing is certain – stress raises the body’s anxiety levels. When we’re under stress, the “fight or flight” response kicks in, raising blood pressure and heart rate, and sometimes causing you to lose sleep or feel like you can’t breathe. While this response usually subsides after the stressor is removed, a prolonged or permanent stress response can develop in someone who is under constant stress. It’s called toxic stress, and children can be affected by it just the same as adults.

What are the Effects of Stress on Kids?

The incidence of obesity, diabetes and heart problems, cancer and other diseases goes up when a child lives with toxic stress. Additionally, their chances of depression, substance abuse and dependence, smoking, teen pregnancy and/or sexually transmitted disease, suicide and domestic violence greatly increase. So does their tendency to be more violent or to become a victim of violence.

Studies done by the Centers for Disease Control and Prevention (CDC) have shown that when a child is subjected to frequent or continual stress from thing like neglect, abuse, dysfunctional families or domestic abuse, and they lack adequate support from adults, their brain architecture is actually altered and their organ systems become weakened. As a result, these kids risk lifelong health and social problems.

Of the 17,000 people who took part in the CDC study, two thirds had an Adverse Childhood Experiences (ACE) score of 1 or higher. 87% of those people had more than one ACE. By measuring and scoring ten types of trauma ranging from childhood sexual abuse to neglect or bullying and even divorce, researchers were able to assess the chronic disease risk for the study’s mostly white, middle class participants. Their results show that the problem of toxic stress isn’t limited to children who face poverty or to those who come from certain ethnic groups – children from all walks of life can have high ACE scores.

If you are interested in finding out your ACE score and what it might mean for you, go here.

Signs of stress

Children who are exposed to toxic stress exhibit:

  • Poorly developed executive functioning skills
  • Lack of self-regulation and self-reflection
  • Reduced impulse control
  • Maladaptive coping skills
  • Poor stress management

Research on children who face continued toxic stress shows they have:

  • More trouble learning in school
  • More difficulty trusting adults and forming healthy relationships and an increased chance of divorce as an adult
  • Higher incidence of unhealthy behaviors such as substance abuse, sexual experimentation and unsafe sexual practices, engaging in high-risk sports, smoking and alcohol abuse
  • Higher incidence of depressive disorder, post-traumatic stress disorders (PTSD), behavioral disorders, and even psychosis
  • Poor health outcomes such as obesity, heart disease, diabetes, cancer, and a higher suicide risk

Help for Toxic Stress

Awareness is key to preventing and reducing toxic stress in kids. Now that we know about the effects of ACEs, many states have conducted their own research. Some cities have set up task forces and others are working with schools, pediatricians, daycare centers and the justice system to set up screening programs that can turn lives around.

Protecting children from toxic stress involves a multi-faceted approach that targets both the caretaker and the child in order to strengthen family stability. Treatment includes intervention and implementation of methods that decrease stressors and strengthen the individual’s response to stress.

As more programs are enacted, researchers are finding that children benefit even when the solutions are solely focused on their caregiver and not on the child. This is likely because the caregiver’s altered interaction with the child makes the child feel safer. Parenting classes, family-based programs, access to social resources for parents, telephone support and peer support are beneficial, as are cognitive behavioral therapy and relaxation methods like yoga and mindfulness. Additionally, community-based programs like Head Start have been shown to be effective.

Do you have Questions?

For more information about toxic stress and its effects on child development, talk to the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Contact us or call us today at 561-496-1094.

 

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Gambling Addiction

We’d all like to be rich. Playing the lottery or making an occasional trip to Las Vegas or some nearby casino allows us to indulge in the dream of being wealthy someday. Bright lights lure us in and sporadic gaming payouts tempt us into believing we might just hit it big. But, while it’s generally fine for most people to wager on games of chance once in a while, for those at risk of a gambling addiction, giving into the temptation may trigger a slide into a gambling problem.

Why do People Gamble?

People don’t usually gamble for one single reason, although the underlying motivation for gambling is typically profit based. The thought of seeing coins flowing out of a slot machine like an endless silver waterfall or the Hollywood movie scene of a casino piling stacks of money in front of a winner can move almost anyone to take a chance on gambling.

Aside from profit, however, people often gamble for:

  • Excitement – think about the thrill of the flashing lights and bells that go off when someone wins on a slot machine
  • Pleasure and the euphoria of winning every so often
  • Escape from troubles
  • Social valuation – even if they lose a lot of money, a person may feel that the act of gambling shows they are successful enough to be able to afford to lose it (even if that isn’t really true)
  • Pride – if someone wins a few hands of poker, they feel smart and invincible
  • The chance you could change your life with very little effort
  • Social acceptance – this applies to many games, ranging from playing bingo at church to joining in football pools with friends on Game Day

Pathological Gambling Risk Factors

Around 1 to 3 percent of people in the United States are impacted by a gambling problem. As with other addictions, gambling disorders tend to run in families. Those who suffer from this impulse-control disorder also tend to have issues with anxiety and depression and/or problems with substance abuse or alcoholism. The disorder symptoms may come and go, but without treatment, the problem will return.

A gambling addiction usually starts between the ages of 20 and 40 in females and in early adolescence in males, however it can happen at any stage of life. While it can affect anyone, the risk of compulsive gambling increases in those who are highly competitive, are workaholics, have a friend or family member with a gambling compulsion, or in those who have bipolar disorder, obsessive-compulsive disorder (OCD), or attention-deficit/hyperactive disorder (ADHD).

Symptoms of a Gambling Addiction

In the same way as alcohol or drugs, gambling stimulates the brain’s reward center. Just like with any addiction, a person with a gambling disorder can’t resist gambling even if they don’t have the money to lose. They hide their need to gamble from family and friends and vehemently deny they have a problem. They feel compelled to keep playing in order to recover their losses. They also become tense and anxious when they can’t satisfy their urge to gamble and will feel relief when they finally get their “fix.”

The American Psychiatric Association (APA) defines a gambling disorder as involving “repeated problematic gambling behavior that causes significant problems or distress. It is also called gambling addiction or compulsive gambling.”

If family, friends, or coworkers have talked to you about your gambling, you may have a gambling problem. To help clarify if you may be a compulsive gambler, this list from the APA can help you decide:

A diagnosis of gambling disorder requires at least four of the following during the past year (Note: this questionnaire is not intended to replace professional diagnosis):

  1. Need to gamble with increasing amount of money to achieve the desired excitement
  2. Restless or irritable when trying to cut down or stop gambling
  3. Repeated unsuccessful efforts to control, cut back on or stop gambling
  4. Frequent thoughts about gambling (such as reliving past gambling experiences, planning the next gambling venture, thinking of ways to get money to gamble)
  5. Often gambling when feeling distressed
  6. After losing money gambling, often returning to get even (referred to as “chasing” one’s losses)
  7. Lying to conceal gambling activity
  8. Jeopardizing or losing a significant relationship, job or educational/career opportunity because of gambling
  9. Relying on others to help with money problems caused by gambling

Add up your score:

  • 4 to 5: Shows a mild gambling problem
  • 6 to 7: Points to a moderate gambling problem
  • 8 to 9: Indicates a severe gambling problem

Self-Help for Gambling Addiction

The biggest step toward recovery is acknowledging that you have a gambling problem. While it is difficult to quit gambling, many people have done so and were able to rebuild their lives. The path is easier when you have support.

Some self-help tips are:

  • Find a support group, like Gamblers Anonymous or get support from a mental health professional
  • Seek treatment for any underlying mood disorders, such as anxiety or depression, which can trigger a gambling problem
  • Reach out to family and friends for help
  • Practice relaxation techniques, such as yoga or mindfulness
  • Distract yourself by starting an exercise program or taking up a sport.
  • Spend time with non-gambling friends or take up a hobby. Be certain not to isolate yourself
  • Visualize what will happen if you gamble. How will you feel if you disappoint everyone again or if you lose all your money again?
  • If you are the family member or friend of a gambler, don’t pay off their debts. You run the very real risk of enabling them to gamble again.

Help for Gambling Addiction

If you or a loved one need help to stop compulsive gambling, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can help. For more information, contact us or call us today at 561-496-1094.

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