Clinician Guidelines to Culturally Competent Care

Attention-Deficit/Hyperactivity Disorder is a highly prevalent and pervasive neurodevelopmental disorder. ADHD typically occurs in early development, prior to a child’s school enrollment and is characterized by persistent inattention and/or hyperactivity/impulsivity that affects an individual’s functioning and/or development. Individuals with ADHD can present with symptoms of inattention, hyperactivity/impulsivity, or a combination of both.

Inattention manifests behaviorally as failing to attend to details or making careless mistakes, wandering off task, lacking persistence, difficulty sustaining focus, and being disorganized. Individuals with inattentive features tend to reduce their engagement in tasks or activities that require sustained cognitive effort and may appear forgetful or distracted. Hyperactivity and impulsivity manifest behaviorally as excessive motor activity, restlessness or an inability to sit still when appropriate, appearing as if “driven by a motor”, difficulties waiting for one’s turn in social settings, social intrusiveness, and engagement in actions without recognition of the potential for harm or aversive consequences.

For a diagnosis of ADHD to be met, individuals must exhibit six or more symptoms of inattention or hyperactivity/impulsivity or a combination of both. Symptoms must be present for at least six months, are inconsistent with developmental norms, and directly interfere with an individual’s functioning. Symptoms must be present in at least two settings, such as at home, school, with peers/family, or during leisure activities.

ADHD is highly prevalent among youth and adult populations, with 11% of youth and 8.1% of adults affected during their lifetime. Recent research by London & Landes (2021) has demonstrated a significant increase in estimates of ADHD in adult populations by 24.6% in individuals aged 18-64 and a decrease in gender differences with respect to ADHD prevalence.

While estimates have shown higher rates of ADHD among men and boys, greater diagnostic clarity, symptom recognition, and systematic changes in health care have increased the assessment and recognition of ADHD symptoms in women and girls. However, disparities continue to exist for ADHD prevalence cross-culturally. These disparities in prevalence among diverse cultures may be due to cultural biases inherent in diagnostic assessment and clinical screening tools. Cultural prevalence rates may also differ, due to differences in the ways ADHD manifests in diverse cultures, interpretation of diverse youth behavior by clinicians or caregivers, and bias in rating and screening.

Despite research that demonstrates ADHD occurs in virtually all cultures and countries, the majority of the research on ADHD focuses on Caucasian Americans. However, race, culture, and ethnicity are critical to the assessment, diagnosis, and treatment of ADHD. While, searches for articles that include “ADHD” and “Race” have increased from 1990-2000, as well as reductions in bias in clinical care through diversity training that aim to reduce implicit bias, cultural biases in ADHD diagnosis continue. Furthermore, factors such as racism, stereotyping, trauma, and social disadvantage contribute to the maintenance or exacerbation of ADHD symptoms. These factors can also affect how an individual’s symptoms manifest, the likelihood an individual receives a diagnosis and treatment, and the rate of ADHD detection. Thus, recognizing how ADHD can present across various cultures is significant for clinicians and our communities.

For example, people of Hispanic heritage may be at risk for over-diagnosis, due to expectations within their culture to attend to and perform a variety of tasks during one period of time. This is in contrast to European American cultures who organize tasks and activities in a linear fashion, attending to a singular task or activity, prior to initiating another. Additionally, Hispanic culture deemphasizes structure, routine, and punctuality, whereas European Americans place a higher value on these factors. Therefore, Hispanic children may be at a higher risk of being perceived as impulsive and inattentive, symptomatic of ADHD, rather than behaving in accordance with their culture.

Because ADHD occurs during early, critical periods of an individual’s development, assessment and treatment of ADHD in all cultural groups is critical for the attainment of important skills required for a successful transition into adolescence and adulthood.

Tips for Clinicians in Providing Culturally Competent Care:

1. Identify your own cultural biases and reduce them, through:
   1. Intellectual Engagement (learning about cultural groups through articles, videos, journals)
   2. Emotional Engagement (engaging in personal reflection with own biases, attitudes, and experiences with diverse groups)
   3. Relational Engagement (developing positive relationships with people from different cultural groups)
2. Reflect on your life experiences with people of diverse cultural backgrounds
3. Consider your own experiences of discrimination. Ask yourself: “Are there aspects of your identity that impact the way you perceive others?”
4. Understand and assess key historical events, sociopolitical issues, basic values and beliefs, and cultural practices of your client.
5. Consider cultural explanations in the diagnosis and conceptualization of mental health issues.
6. Assess mental health through the use of a Cultural Formulation Interview*

Cultural Formulation Interviews in the diagnosis of mental disorders aims to identify and clarify key aspects of the presenting problem from the point of the individual and family members within the client’s social world.

A Cultural Formulation Interview:

1. Elicits the individual’s view of core problems and key concerns
2. Focuses on the individual’s way of understanding the problem
3. Uses client language in the description of the problem
4. Asks how the individual talks about their difficulties or symptoms with family and friends
5. Focuses on the aspects of the problem that are most salient to the individual
6. Obtains cultural perceptions of the cause of the problem, as well as factors that contribute to resiliency or the worsening of symptoms.
7. Identifies the role of culture as a protective or promotive factor in healing and wellness.

While little research has been conducted on ADHD in diverse cultures, and racial/ethnic minorities are less likely to be assessed, diagnosed, and treated for ADHD, clinicians can mitigate these disparities in mental health care by utilizing a culturally informed approach to care with all clients.

Specialized Therapy Associates includes staff that is highly skilled in the assessment and treatment of a wide range of mental health issues.  For a free consultation with our intake coordinator who will match you to the best provider and service to fit your needs and goals, call 201-488-6678 or visit https://www.specializedtherapy.com/make-an-appointment/ to schedule an appointment.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Centers for Disease Control (2020, November 16). Attention-Deficit/Hyperactivity Disorder  (ADHD). Data and Statistics About ADHD. https://www.cdc.gov/ncbddd/adhd/data.html

Conrad, P., & Potter, D. (2000). From hyperactive children to ADHD adults: Observations on the expansion of medical categories. Social Problems, 47(4), 559-582. https://doi.org/10.2307/3097135

Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Null, 47(2), 199 212.         https://doi.org/10.1080/15374416.2017.1417860

Fletcher, J. M. (2014). The effects of childhood ADHD on adult lab market outcomes. Health

Economics, 23(2), 159-181. https://doi.org/https://doi.org/10.1002/hec.2907

Fletcher, J., & Wolfe, B. (2009). Long-term consequences of childhood ADHD on criminal activities. The journal of mental health policy and economics, 12(3), 119–138.

Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Null, 47(2), 157-198. https://doi.org/10.1080/15374416.2017.1390757

Hook, J.N., Davis, D., Owen, J., & DeBlaere, C. (2017). Cultural Humility: Engaging Diverse Identities in Therapy. Washington, D.C., USA: American Psychological Association. ISBN 1-4338-2779-4 (Digital, undefined format) or ISBN 978-1-4338-2779-2 (Digital, undefined format)

Iwamasa, G.Y. & Hays, P.A. (2019). Culturally Responsive Cognitive Behavior Therapy: Practice and Supervision (2^nd edition). Washington, D.C., USA: American Psychological Association. ISBN 1-59147-360-8 (Hardcover)

Lensing, M. B., Zeiner, P., Sandvik, L., & Opjordsmoen, S. (2015). Psychopharmacological treatment of ADHD in adults aged 50+: An empirical study. Journal of attention disorders, 19(5), 380–389. https://doi.org/10.1177/1087054714527342

London, A. S. & Landes, S. D. (2021). Cohort change in the prevalence of ADHD among U.S.  adults: Evidence of a gender-specific historical period effect. Journal of attention disorders, 25(6), 771-781. https://doi.org/10.117/1087054719855689

Richards, P. S & Bergin, A. E. (Ed.). (2014). Handbook of Psychotherapy and Religious

Diversity (2^nd edition). Washington, DC, US: American Psychological Association.

ISBN 1-4338-1736-5 (PDF) or ISBN 978-1-4338-1736-6 (PDF)

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For many children and adolescents who struggle with social anxiety, the thought of returning to school and other in-person interactions has triggered increased anxiety symptoms. Early on in the pandemic many children and adolescents who struggle with social anxiety may have experienced relief. They may have experienced relief from bullying and social anxiety and may have worried less about their performance and how they are perceived by others.  Studies show that some children and adolescents who struggle with social anxiety reported an improvement in their symptoms of anxiety and depression since the start of the pandemic and their ability to attend school and other events remotely. Attending school virtually has decreased unpredictability and uncertainty which is the trigger for anxious symptoms in many children and adolescents. Many children and adolescents have become accustomed to attending school remotely. Therefore, some may be experiencing intensified anxious symptoms as they emotionally prepare to return to in-person school and activities.

What is Social Anxiety?

Social anxiety also referred to as Social Phobia, is a mental health condition where you may suffer from increased anxious symptoms and self-consciousness in social situations. You may experience a persistent fear of social situations and be watched or judged by others. This may affect work, school, and your other everyday activities and functioning. For children the median age of onset is 13-years-old, however, onset can also occur between the ages of 8 and 15-years-old (Psycom.Net).

For children and adolescents who struggle with social anxiety, they may be easily triggered by numerous situations, including engaging in conversations with others, speaking in public, making eye contact, entering rooms, using public restrooms, reading out loud, reading out loud, going to parties, eating in front of other people, starting conversations, and going to school or work. They may experience fearfulness of being judged in social situations or embarrassment, accidentally offending another person, experiencing increased anxious thought processes during conversations, or being the center of attention. Children may experience intensified worries in social situations, including school, play dates, and sports teams.

Those who experience social anxiety may avoid social stimulation and social events engaging in the cycle of avoidance. This can later lead to low self-esteem, poor social skills, depression, and increased negative thought processes.

Social Anxiety can cause many children and adolescents to experience high distress and may harm social relationships, academic performance, self-confidence, and academic performance.

What symptoms do those with Social Anxiety Experience?

Many children who struggle with Social Anxiety experience fear and anxiety manifested as meltdowns/tantrums, clinging, crying, freezing, or refusing to speak (psycom.net).  They may also experience several physical symptoms including:

• Rapid heartbeat
• Dizziness/Lightheadedness
• Stomach distress
• Muscle tension
• Inability to catch a breath
• “Out-of-body” sensation/ Disassociation
• Shakiness/Trembling

How you can support your socially anxious child?

Parents can assist children to cope with their Social Anxiety by helping them understand the nature and meaning of their mental illness and coping with their symptoms. Parents and mental health professionals can assist children to make connections between emotional responses, physical symptoms, and triggers to begin learning how to cope. Providing psychoeducation and providing normalcy in how anxiety impacts thinking and behavior can significantly impact the ability to cope with negative emotional experiences.

Helpful Coping Mechanisms for Children and adolescents who Experience Social Anxiety:

• Relaxation Strategies
  • The first step is to assist your child to understand physical responses to anxiety within their body and relax to utilize adaptive coping strategies.
    • Deep Breathing: Deep breathing has been effectively proven to calm the rapid heart rate and slow down breathing and feelings of dizziness. You can teach your child numerous deep breathing strategies, including ocean breathing, balloon breathing, and deep belly breathing (inhale for 4 seconds, hold, exhale for 6 seconds).
    • Progressive Muscle Relaxation: For those who experience intensified anxious responses they may experience tension and stress within their muscles. Progressive Muscle Relaxation teaches children to relax muscles and release tension throughout the body from arms, neck, and shoulders to feet and legs.
    • Imagery: As our thoughts have a powerful influence on our feelings guided imagery focusing on a calming environment, such as the beach, mountains, or sky, can significantly reduce intensified anxious symptoms.
  • Problem Solving Skills
    • Children and adolescents who struggle with social anxiety tend to engage in the cycle of avoidance. This may provide temporary relief, however, may worsen the anxious symptoms over time. Problems solving techniques can assist children to manage feelings of anxiety. Assisting your child to identify triggers that lead to social anxiety in order to discuss problem-solving skills can assist them to work through these anxiety-provoking themes or situations. For example, assisting your children to develop social skills through role-play and modeling can assist them to gain confidence and reduce anxiety symptoms.
  • Challenging Anxious Thoughts & Cognitive Reframing
    • Children and adolescents who struggle with social anxiety are sometimes overwhelmed with negative core beliefs which magnify anxious thoughts. They may experience anxious thoughts surrounding assuming worst-case scenario, believing that others view them negatively/struggling to differentiate between self-image verse others perceptions, personalization, etc. Therefore, examining evidence of the thoughts can reduce anxious feelings. Teaching children to recognize anxious thoughts, examine the evidence which does not support anxious thoughts, and replacing them with positive thoughts can assist in reducing anxious thoughts and symptoms.

If you would like personalized support and guidance on how you can support your socially anxious child, please call Specialized Therapy Associates at 201-488-6678 to schedule your complimentary consultation.

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This week is National Eating Disorder Awareness Week! Did you know that eating disorders are among the deadliest mental illnesses second only to opioid overdose? 10,200 deaths each year are the direct result of an eating disorder (1).

Some common myths surrounding eating disorders are:

1. “People who have eating disorders must be underweight”. Eating disorders look different for everybody and present themselves in many different ways. Less than 6% of people with eating disorders are actually diagnosed as being underweight (2). Just because someone doesn’t look physically sick, doesn’t mean they aren’t suffering.
2. “Only women can have eating disorders”. Men can have eating disorders, too, and the number of cases has increased in recent years. From 1999 to 2009 the number of men hospitalized for eating disorder-related causes increased by 53% (4). Males account for 25% of individuals with anorexia or bulimia eating disorders. Gay men represent almost half of men with eating disorders and are more likely to fast, vomit, or take laxatives or diet pills to control their weight (5).
3. “Eating disorders are a choice”. Eating disorders are serious mental illnesses, not lifestyle choices.

Click here to fill out our Eating Disorder Self-Assessment checklist.

If you feel like you or someone you know is suffering from an eating disorder, we are here to help! Our staff offers a unique holistic and integrative approach to eating disorder treatment using psychological therapy and a functional medicine approach to regain health.

Call 201-448-6678 to make an appointment or click here to enter your information and learn more about how our team can help!

By Taylor Groff, MS Functional Nutritionist

References:

1. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders.June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
2. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
3. Zhao, Y., Encinosa, W. Update on Hospitalizations for Eating Disorders, 1999 to 2009. HCUP Statistical Brief #120. September 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb120.pdf
4. Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007) “The prevalence and correlates of eating disorders in the national comorbidity survey replication.” Biological Psychiatry, 61, 348–358.
5. Eating Disorders in LGBTQ+ Populations. (2018, February 21). Retrieved February 22, 2021, from https://www.nationaleatingdisorders.org/learn/general-information/lgbtq

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The impact of holiday stress and pandemic stress on your immune system and the role of perception.

We are undoubtedly living through a stressful time in history. The coronavirus has proposed new and unforeseen challenges to each and every one of us as individuals and collectively as a nation. Suddenly, our daily routine built on stability and predictability has taken a deep dive into uncharted turbulent seas and we have been left to tread water. Between staying on top of the rapidly evolving CDC guidelines, managing our newly virtual careers, keeping small businesses afloat, online schooling, and trying to stay socially connected at a physical distance, it is no wonder we are more stressed than ever!

On top of all that, the holiday season is upon us which proposes a whole new set of challenges. Stress levels tend to be higher this time of year due to the demanding nature of the holiday season. This increase in stress comes with an increase in the incidence of cold and flu, especially as we transition into the winter months. This is no coincidence because stress suppresses the immune system which increases our susceptibility to cold and flu⁴.

This year, we must consider the double affliction of holiday stress and pandemic stress on our immune system’s ability to cope with potential invaders like COVID-19. Therefore, in addition to eating healthy, getting enough sleep, and taking immune-boosting supplements like vitamin D, we must make sure we have our stress levels under control this holiday to make sure our immune system is in fighting shape.

To do this, we must first understand how stress suppresses the immune system so we can determine where and how we can intervene to alleviate its effect.

When we perceive emotional or environmental stress, our hypothalamic-pituitary-adrenal (HPA) axis becomes activated in our brain¹. Once activated, the brain sends a signal to the hypothalamus to release corticotrophin-releasing hormone (CRH) which signals the pituitary gland to secrete an adrenocorticotrophic hormone (ACTH)¹. ACTH signals the adrenal gland to produce and excrete cortisol, the primary stress hormone^1,2. Cortisol is a steroid hormone that normal physiologic levels is anti-inflammatory ². This should be considered a good thing… right? In acute situations, yes! Glucocorticoids are so effective at reducing inflammation that they have been reverse-engineered into pharmaceuticals to be prescribed in conditions caused by inflammation like allergies, asthma, and autoimmunity.

However, in today’s world, we are faced with chronic stress which keeps our cortisol constantly activated, and our immune system chronically suppressed. So, the hormone with the initial intention of protecting us by lowering inflammation is causing more harm than good by chronically suppressing our immune system. The current state of the coronavirus pandemic on top of holiday stress comes at an incredibly high price to our immune system. So, what do we do?

The only way to mitigate activation of the HPA axis is to halt cortisol release is by intervening at the source- taking back control over how we perceive stress and what stressed us out. Of course, this is easier said than done, but research shows that people who are better equipped to handle stress with appropriate coping mechanisms have a heightened ability to fight off viral or bacterial threats to the immune system⁵.

There are thousands of studies that link mindfulness meditation to lowering stress levels and improved immunity. From a functional medicine perspective, this is an imperative intervention to bolster your immune response³. In addition, speaking to a licensed clinical therapist or making time for stress-lowering activities like biking, journaling, or painting are quintessential to prime your immune system’s defense and should become a non-negotiable part of your lifestyle- especially this year, this time of year, and always.

If you would like more guidance on how to beat the stress of the holidays, please contact Specialized Therapy Associates at (201)-488-6678 to make an appointment. You can also visit us online at Specialized Therapy.

By Taylor Groff, MS Functional Nutritionist

References:

1. Katz, D. A., Locke, C., Greco, N., Liu, W., & Tracy, K. A. (2017). Hypothalamic-pituitary-adrenal axis and depression symptom effects of an arginine vasopressin type 1B receptor antagonist in a one-week randomized Phase 1b trial. Brain and Behavior, (3). https://doi-org.uws.idm.oclc.org/10.1002/brb3.628. Retrieved from: https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.485132319&site=eds-live&scope=site
2. Sapolsky, R. M., Romero, L. M., and Munck, A. U. (2000) How Do Glucocorticoids Influence Stress Responses? Integrating Permissive, Suppressive, Stimulatory, and Preparative Actions. Endocrine Reviews 21(1): 55–89.
3. Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. 2016;1373(1):13-24. doi:10.1111/nyas.12998
4. National Institutes of Health (US), National Institute of Mental Health. Fact sheet on stress
   [cited 2013 Aug 21] Available from: URL: http://www.nimh.nih.gov/health/publications/stress/index.shtml
5. Abdurachman, Herawati N. THE ROLE OF PSYCHOLOGICAL WELL-BEING IN BOOSTING IMMUNE RESPONSE: AN OPTIMAL EFFORT FOR TACKLING INFECTION. Afr J Infect Dis. 2018;12(1 Suppl):54-61. Published 2018 Mar 7. doi:10.2101/Ajid.12v1S.7

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The Coronavirus (COVID-19) has had an affect on the mental health of adults, children, and teenagers. Socialization with friends and peers has been limited because of the quarantine, causing many teenagers to feel isolated and withdrawn. Now that teenagers are returning to school, the affect of COVID-19 on their mental health is even more apparent. Many activities including sports have been postponed or cancelled. Students are unable to socialize with their friends at school due to safety precautions, and some schools remain all-virtual during this time.

Many of these changes can cause teenagers to appear sad, down, disappointed, and angry or irritable. If your teenager’s mood has changed, you may be wondering how to tell the difference between sadness and clinical depression. It is valid to  have concerns about your child’s mental health during this stressful time.

 Signs and Symptoms of Depression in Teens

1. Social isolation and withdrawal. Be aware if your teen has started to isolate from family, friends and peers.
2. Negative self-talk and self-criticism. Listen to what your teen is saying. If they are making negative self-statements such as “I’m a failure,” “Everything I do is wrong,” or “I’m useless,” this could be a sign of depression.
3. Hopeless self-talk. Similarly, be aware if your teen is making hopeless statements such as “What’s the point” or “I just can’t do this anymore.”
4. Academic changes or decline. Another sign of depression may be a decline in academic performance.
5. Physical complaints, such as headaches and stomachaches, can be connected to depression.
6. Increase in reckless behaviors, including substance use. Teenagers who struggle with mental health disorders may be more likely to self-medicate using substances or engaging in other impulsive behaviors.

Talking to Your Teen About Mental Health

1. Validate, Validate, Validate. It is important to let your teenager know that you can understand things have been hard. Let them know that if you were in their shoes, you might feel the same way. Express your love, care and concern.
2. Ask them how they are feeling. Don’t make assumptions about what your observe. Encourage your teen to use ‘feeling words’ such as  ‘sad,’ ‘mad’ or ‘worried.’
3. Stick to the facts and be specific. Let your child know what symptoms and behaviors concern you. Ask them if they have noticed the same concerns. You can also ask them what they think about a particular concern (i.e. ‘I noticed your grade went from an A to a C, what do you think is going on there?’).
4. Let your child know that you want to speak to them, and choose a day and time together. This can allow them to feel they are participating in the conversation, and can also help them feel more prepared for a conversation.

 Getting Help and Support

Helping your teenager get help and support can be an important part of showing your care for them. Teenagers may want to speak to an objective person about their problems, such as a therapist or counselor. You can explore support services at your teenager’s school, such as school counselors or a Student Assistance Counselor (SAC). It can be very helpful to find a therapist for your child to speak to as well. Keep in mind that if you have safety concerns for your child, or if they are making statements about self-harm or suicide, then it is recommended for you to bring your child to a local emergency room to keep them safe.

PerformCare NJ offers a list of treatment resources and support resources for youth, parents and caregivers. You can visit their website here: PerformCare NJ Resources

The New Jersey Hopeline is a 24/7, confidential peer support and suicide prevention hotline. Hotline specialists can provide youth and family with resources and referrals for additional help during a challenging time. The phone number is 1-855-654-6735.

2nd Floor Youth Helpline is a 24/7 helpline available to youth ages 10-24, to provide support and to help come up with solutions to problems. 2nd Floor can be reached by phone or text message at 1-888-222-2222.

If you would like more information about therapy treatment services for your teenager, or for family therapy, please contact Specialized Therapy Associates at (201)-488-6678 to make an appointment. You can also visit us online at Specialized Therapy.

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• Rest & Relaxation: Stress is one of the most prevalent causes of fatigue. We often react to chronic stress with a fight-flight-freeze response. “Fight” may mean increased irritability or reactivity. “Freezing” may look like shutting down or disengagement. And “flight” may entail feeling a need to escape or run away. Day to day threats, whether real or perceived, and the cascade of hormones and neuro-chemicals that follow, can leave your system depleted and in need of serious repair. Implement one new relaxation technique such as meditation, reading, journaling, listening to inspirational music or whatever allows you to feel calm.

• Sleep: Sleep is one of the most underrated tools we have. Clearly, lack of quality sleep can leave you feeling tired, but did you know that over time, being sleep deprived can set you up for mental and physical illness? Sleep is needed for cellular repair, detoxification, brain health, immunity, and balanced mood and hormones. Our non-stop culture and 24/7 access to information and entertainment can trick you into thinking of a full night’s sleep as optional. If you are struggling to fall asleep, waking in the night, or wake up and do not feel rested, start with the basics: eliminate exposure to blue light, have a wind-down routine, make sure your bedroom is sufficiently cool and dark, and avoid working in bed.

• Nutrients: Food is meant to make you feel nourished. But if what you are eating leaves you feeling fatigued, it may be due to a food sensitivity, such as gluten, poor blood sugar balance, or a lack of micro-nutrients such as vitamins, minerals and antioxidants. Beyond avoiding sugar bombs and reading labels, focus on adding in a rainbow of vegetables each day. Eat a combination of fat, fiber and protein from whole-food sources to avoid spikes and crashes in your energy levels. Work with a practitioner to try an elimination diet or get tested to rule out any food sensitivities.

• Movement: Physical activity doesn’t have to mean a grueling workout. In fact, studies show that more moderate exercise is less likely to contribute to inflammation than a more strenuous regimen. Do what you enjoy most, whether that’s walking, biking, tennis, dancing, swimming, yoga or MIIT (moderate- or medium-intensity interval training). Movement is important for your body and mind, supporting detoxification pathways, mood, insulin sensitivity, stress, immunity, longevity, and yes, energy-balance. Speak with your health or medical practitioner prior to starting a new exercise plan, especially if you are recovering from an acute illness, have a chronic condition or suspect adrenal issues.

• Connection: Whether you are still adjusting or have already adapted to life “at home”, this can be a time of significant isolation, even for those with family or friends nearby. Detachment from significant others, withdrawal, or even a feeling of disconnection from yourself, can be read flags. If you don’t feel secure spending time with loved ones even while physically distant, outdoors, with a mask, try spending time in nature. Connection to the natural world can increase perspective, optimism, and take you beyond the four walls of your home, or your mind. Speaking of nature…

• Sunlight: You know how plants need sunlight to thrive? So do we. If you are finding yourself spending days on end indoors, this can definitely contribute to low energy and fatigue. There are plenty of ways to venture out in a safe and secure way. This may mean a walk around the neighborhood. Perhaps a day trip to a botanical garden or beach. Try hiking in a forest, boating on a lake, or even a picnic in a local park. You can even make it a point to have a meal outside on your deck, patio or yard each day. Sunlight is an important source of vitamin D and can help lift your mood, boost immunity and help you get more restful sleep.

• Tech break: More than ever, we are attached to our devices. In addition to excess exposure to blue light and its consequences for sleep, bombardment by media images of danger and suffering, or increased sedentary lifestyles, both the American Academy of Pediatrics and American Heart Association advise dramatically reducing time on tech for both children and adults. This can help combat fatigue. Even if you and your family need to stay connected for work and school, identify certain times each day or places in the home, to have a “screen-free zone” such as the dinner table or between 10pm and 8am. Experiment by staying off media for several hours or even one whole day to sense the difference in how you feel. Focus on what you will gain, such as time or energy, instead of what you will potentially miss out on.

• Functional Medicine: Many illnesses can lead to fatigue, in some cases extreme. Functional medicine uses root-cause assessment and resolution to find out why you are having the symptoms, and provides a more comprehensive plan for how to address them. If you suspect an illness such as autoimmunity, fibromyalgia, anemia, chronic fatigue syndrome, adrenal insufficiency, gut imbalance, infections, or thyroid issues, a functional medicine practitioner can help you combat fatigue and can offer a more lasting solution. Learn more at https://fxmedcenters.com/

• Therapy or coaching: Fatigue and exhaustion can be serious. Don’t ignore the signals. Depression, anxiety, bipolar disorder, alcohol use disorder, and many other conditions can increase fatigue, and if you have fatigue, it can make these conditions harder to manage. If you are struggling with your emotions, mood, relationships, or traumas, consider working with a therapist. If you are interested in implementing some of the above lifestyle suggestions, but aren’t sure how, or would benefit from more support to follow through, a coach can partner with you to work toward your goals and help you make your vision a reality. Call 201-488-6678 to learn more or schedule your first appointment to help combat fatigue.

By Anna Sandbank, LCSW, INHC, CMHIMP, Director of Integrative Mind-Body Health, Specialized Therapy Associates, Fx Med Centers, Xceptional You

Disclaimer: This post is for informational purposes only. It does not constitute medical advice, or replace treatment or intervention by a qualified medical or mental health professional.

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 Loneliness During a Pandemic

Over the past few months, we’ve heard the term ‘social distancing’ and the importance of keeping a 6-foot distance from others, to reduce the risk of spreading the coronavirus. Many of us have practiced social distancing to keep ourselves, our families, and others safe. Some have had to adhere to social distancing and self-isolation due to contracting coronavirus or suspecting they have been in contact with someone who has had it. Many of us have not been prepared to cope with feelings of loneliness resulting from a loss of connection with others. This can cause us to feel isolated. Research on loneliness has found significant associations between social isolation and poorer mental health outcomes, such as depression and anxiety.

Although some restrictions regarding social distancing have been lifted, it can still be difficult to cope with feelings of isolation during this time. Here are some strategies to cope with isolation and loneliness.

Coping Strategies to reduce Isolation and Loneliness

• Stay active and go outside
  • Exercise in ways that feel safe for you during the day. Brief periods of exercise can boost mental health.
  • Yoga has benefits for both the mind and body. Yoga can help you practice being mindful of the present.
  • Go outside to take a walk around the block, or find a local park where you can remain socially distanced.

• Connect with Others
  • Phone calls, text messages, or emails are great ways to stay in touch with friends and family members. Consider using Zoom or Facetime to connect with loved ones visually. There are benefits to seeing others  “face-to-face.”
  • Send mail to family members and friends. Sending an old-fashioned letter is a great way to feel connected, and receiving one in return feels even better.
  • Be creative in connecting with others! Agree to read the same book or watch the same movie with friends, and then set up a Zoom call to discuss it.
  • Explore online connections. Social media sources, such as Facebook, have online groups for a variety of topics you may be interested in. Consider online classes in your community or online exercise classes where you can interact with the instructor and other students.

• Keep a schedule and structure
  • Have a plan each day including a few things you want to accomplish that day. Keep your list realistic and achievable.
  • Practice normal self-care habits such as getting up, showering, getting dressed, and so forth. Doing these things will help you feel that your day is more “normal.”

• Think about future plans
  • Develop a ‘goals’ list of things you want to accomplish going forward in your life.
  • Think about fun plans or events after the quarantine is over.
  • Engaging in these activities can increase hopefulness.

• Distract yourself and practice Self-Soothing
  • Take a bath, light a candle, play with a pet, watch your favorite movie…do something soothing.
  • Listen to music or soothing sounds, such as ocean waves
  • Play puzzle games, or online games where you can interact with other players.
  • Write in a journal
  • Do a creative project such as painting, drawing, or building something

 Seeking Additional Help

When you find yourself struggling with isolation and loneliness, consider the benefits of talking to a licensed professional. Not only will this help you feel a sense of connection. Talking to a professional can help you feel accepted, validated, and supported. A therapist can help you to learn and practice coping skills and strategies to combat loneliness.

If you or someone you know could benefit from seeking professional help, call Specialized Therapy Associates today at (201)-488-6678. One of our intake specialists can help connect you with a licensed professional who can best meet your needs.

The post Preventing Isolation in a time of Social Distancing first appeared on Specialized Therapy.

The post Preventing Isolation in a time of Social Distancing appeared first on Specialized Therapy.

Procrastination is usually discussed as ‘self-sabotage’, a weakness, and shameful. In his Tedx talk, Voge invites his audience to see a different understanding of the question “Why Do We Procrastinate?”. The answer he provided was rooted in the need to feel worthy and competent. It’s something we can expect and predict given we understand human motivation and self-worth theory. When we fear our efforts will not render perfection, high achievement, or the standard we set for ourselves, we choose avoidance instead to protect ourselves from feeling incompetent and unworthy.

Self-Worth Theory of Achievement Motivation

The self-worth theory assumes a simplistic view that ability signifies self-worth (performance=ability=self-worth). If I am able, I am worthy. Thus, if you are afraid of performing poorly, you must protect your self-worth by employing certain strategies. One of those strategies is procrastination.

It’s not just a grade that’s on the line, its our self concept

Here’s a familiar scenario: You are a college student and a paper is due. After a long day of mild productivity, you start to do the paper. All of a sudden, you think “I’ll check my email”. 45 minutes later you say, “I’m tired, I should sleep and do the paper tomorrow. I will wake up extra early.” When the alarm goes off the next morning, you are not refreshed, so you turn the alarm off and sleep more. When you wake up again, you start doing other things that are easier than the paper, such as taking a long lunch with friends, cleaning, etc. The cycle continues until the fear of not getting it done exceeds the fear of failure .

Procrastination is a feeling of stuckness. You can’t sleep but you can’t work, Voge says. Procrastination is a self-protective strategy to deal with competing motivations-the drive for success and the powerful motivation to avoid failure. With procrastination, you can rationalize that it was poor sleep, being busy with other things that left you no choice but to do less at the last minute, not your ability to perform at a high level.

DTC-a helpful acronym to remember some tips for combatting procrastination

• Developing awareness
  • Gaining knowledge of self worth theory will help you combat procrastination because you understand the root
  • Gaining awareness of what you are feeling and notice when you might be avoiding through other activities, such as cleaning, checking emails, etc.
  • Getting to know your thoughts and feelings surrounding procrastination without judgment will help you to overcome it

• Tip the balance
  • It is not that you aren’t doing the task because you “don’t want to” or “don’t feel like it”; rather, it is fear and feeling overwhelmed that dominates the motivation to approach certain tasks, especially if they are particularly meaningful to you.
  • Balance that fear with thinking about the reasons why you want to do something, how doing so fits into your larger goals and mission. For instance, Voge said that he was anxious while preparing his Tedx talk about procrastination. He balanced that anxiety with his goal and mission to “reduce suffering and help people.”

• Challenge your beliefs
  • Acknowledge and challenge the belief that your self-worth comes from your ability to perform.
  • Voge offers these words:
    “Your ability is not equivalent to your worth.”
    “Worth comes from your human qualities of kindness, thoughtfulness, and vulnerabilities.”

If you need help with combatting procrastination and improving your self-worth, please call Specialized Therapy Associates at 201-448-6678 or visit our website at www.specializedtherapy.com

The post Why Do We Procrastinate? first appeared on Specialized Therapy.

The post Why Do We Procrastinate? appeared first on Specialized Therapy.

Although kids are home with family, they still struggle with social isolation, feeling lonely and missing their friends. If you think about how children interact at school, they are frequently in physical contact, hugging each other or jostling in line, putting an arm around a buddy’s shoulder. Suddenly everyone is home away from all their friends. Suddenly, in quarantine, the closest we can come is 6 feet.

Self-Isolation

We know that in adults, social isolation and loneliness are correlated with premature death. In infants and toddlers, the lack of social interaction and physical contact can lead to “failure to thrive”, poor weight gain, and delayed development. We clearly all need ‘contact comfort’, a term coined by Harry Harlow in his research during the 1950s and 1960s.

So try to be patient with your children (and yourself!). Kids are home, trying to manage schoolwork without the teacher or only seeing teachers a couple of days each week on a Zoom conference. They feel lonely and keep trying to connect with friends through zoom, texting, or video games. Children can’t go out and play in the parks, get lots of physical activity and social contact. They are quarantined at home, struggling with schoolwork, struggling with parents who are feeling overwhelmed themselves, struggling with feeling lonely. No wonder tempers are short, tantrums are more frequent and whining is on the increase.

So, during this difficult time, take more time to cuddle with your child, give them backrubs, and quiet time together reading books. Encourage them to call friends, have face time visits, and tell jokes. Vary your routine on the weekends. Discover new activities and hobbies. And above all, be patient with your kids. They are suffering and struggling as much as you.

If you would like more information, visit specializedtherapy.com or give us a call at 201-488-6678.

The post Children and COVID-19 Quarantine first appeared on Specialized Therapy.

The post Children and COVID-19 Quarantine appeared first on Specialized Therapy.

Being a People Pleaser can hurt your own mental health.

A people pleaser is a type of person who are “too nice”, almost always putting everyone else’s needs before their own. They never say “no”, are always volunteering to help, and make sure that everyone else’s needs are met first before they worry about themselves. It may sound like a good thing to always help others but this can quickly lead to emotional and physical burnout. Common examples include:

• Agreeing to cover a shift or pick up a project at work that you know you cannot do
• Not doing activities that you want to do because it may bother other people
• Doing things that you don’t want to or can’t do because you’re afraid others will be mad at you if you say no
• Experiencing guilt at the thought of saying “no” to someone
• Being afraid people would not like you if they knew the real you
• Having a hard time sharing your true feelings
• Going to great lengths to avoid conflict
• Becoming very uncomfortable at the thought of someone being mad at you

All of these qualities point to the larger theme that you are the last priority in your own life. An important step for healthier well being is learning to put your own needs first. Recognizing that you are not responsible for anyone else’s feelings, not their happiness, sadness, anger, etc.  Sharing your wants and needs in an assertive and healthy way reduces people pleasing behavior  and is a critical step in your own journey of wellness. Meaning, you are able to stand up for your own needs and still be respectful of the other person.

If you’re interested in learning more or taking the next step in avoiding the negative aspects of  being a people pleaser and putting yourself first, please visit us at https://www.specializedtherapy.com/ or call 201-488-6678.

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The post You Don’t Need To Be a People Pleaser first appeared on Specialized Therapy.

The post You Don’t Need To Be a People Pleaser appeared first on Specialized Therapy.