Reinforcements and Holiday Presents for Your Kids

There are very few things that parents actually owe their children. These are shelter, education, nutrition, and healthcare. However, in today’s society, a large majority of children and teenagers have the expectations that they are owed the “add-ons” in life. These things can include (but are not limited to) toys, video games, cell phones, screen access, you-tube/Netflix access, etc.

Along with the approaching end of the school semester (prior to winter break), comes a lot of stress, and with stress comes dysfunctional behavior. In young children, this can mean not sleeping well at night, temper tantrums, bad grades, etc. In teenagers, this can translate to bad language, not completing chores, neglecting homework or other home responsibilities.

Sometimes, but not all the time, parents want to solve the experience of stress in their children with more “extras/add-ons.” This not only reinforces/increases the expectation of “add-ons” when they are stressed, but more importantly, does not allow for a child to internally cope and manage their emotions.

At our practice, we like to think of “add-ons” as reinforcements, specifically the use of these being tied to prosocial behaviors (e.g., expressing your needs verbally without throwing a temper tantrum). Feel free to use the reinforcements, but only when your child has demonstrated the ability to internally cope with their emotions.

Some tips for internal coping mechanisms (i.e., things kids can do and say):

Anxiety is a temporary state and cannot last forever

I have handled difficult situations before and I can do it again

How can I go about solving this problem and can I ask for help?

Don’t forget to breathe and be mindful of where I am, and what I am experiencing without making a judgment on it

Announcement: Presentation at Fairfax County Public School Wellness Fair

Tomorrow morning (10/21/17) Dr. Kaplan will be presenting on…..

Failure to Launch in Young Adults: How to Get Your Child to be a Successful Adult

 

Please come, as it is a free and informative event!

Pre-and post-natal depression

This is an article that our director, Dr. Johanna Kaplan, contributed to the authors at Brit and Co.  Please take a read,  as the writer of the article does a very good job capturing the personal experience of pre and post-natal depression/anxiety and getting a professional’s take on clinical assessment and treatment.

The Surprising Relationship Between Prenatal and Postpartum Mental Health

What is real Cognitive-Behavior Therapy (CBT)?

At our center, we practice Cognitive-Behavioral therapy, otherwise known as “CBT.”

CBT is an evidence-based treatment employed for the treatment of anxiety, depressive, and obsessive-compulsive spectrum disorders. It involves examining and challenging how our thought processes can contribute to and maintain feelings of anxiety and depression, how feelings of isolation and inactive interests can increase feelings of depression, and it focuses on how we can gradually confront the places, situations, or people that we fear so our fear reduces in the present and future.

Currently, only a small percentage (some studies estimate around 15%) of clinical psychologists are trained in exposure therapy. Exposure therapy is the most evidence-based treatment for anxiety. Exposure therapy comes in two iterations: gradual and flooding. It involves either a graduated, systematic approach to confronting one’s fears or facing the main fear directly. Most patients opt for the gradual approach, but both approaches are effective.

For example, a gradual approach with a specific phobia such as a snake phobia would start by looking at pictures of snakes, then movies of snakes, being in the vicinity of a snake, and finally touching and interacting with a snake. Exposure to these places, situations, people, etc. are accompanied with specific coping skills and allow for habituation (getting used to the anxiety at each stage) to be achieved.

Exposure therapy has effectiveness rates between 60 and 90%. CBT therapists also work to give the skills in their own repertoire to patients with the hope of empowering them the rest of their lives.

For more information, take a look at an article I co-authored on Exposure Therapy:

www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders

Summer Slump

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What happens when we, as adults, go on vacation? Most of us (I will not assume all) experience a sense of relaxation, a rejuvenating avoidance of our day to day responsibilities of the world. When our children (or even ourselves as times) go on vacation, it can be relaxation, avoidance, or a combination of those, but what does that mean exactly?

We have a saying in our practice, we talk about the August slump in the number of patients that we see and the September and October overflow that is very overwhelming, even as professionals. Why does this happen? Well, avoidance. There is a belief that somehow “time will heal” or that “everything is fine because it is summer!”  When our stressful life events again re-appear in our lives, such as school or our job, we begin to experience the same clinical symptoms. We have come to label it in our practice as the “clinical slump” instead of “summer slump.” When patients come in over the summer, there is a trend towards a better prognosis. After looking at years of clinical data, I have seen trends that typically these patients notice when something in their life BEGINS to be problematic, rather than waiting months or years to receive help. Imagine if you go to the doctor and you have been coughing for months and they give you a diagnosis of pneumonia. What would have happened if you had gone in after a week or two, when maybe it was a bad cough or just bronchitis? The treatment differs significantly, and so does our treatment as mental health providers.

What, if anything, should you take from this post? Be proactive! For your kids! For yourself. Do not wait until the problem is so bad that you ABSOLUTELY have to be seen.

Have a great rest of summer everyone!

The parenting battle with Netflix

Recently on Netflix, there has been an uptick in the number of movies that “focus” on mental health issues. We are talking about “13 reasons why” and “To the bone.” The former movie focuses on the events leading up to a teenage girl’s suicide and the role of her peers in her path. The latter focuses on the journey of a struggling anorexic teenage girl. Most pre-teens and teenagers have access to Netflix today. As parents, we question the safety and appropriateness of movies, but sometimes, we do not consider their (negative) learning value.

In this blog, I have discussed that learning occurs in many forms, one of the main methods being “Modeling.” When we watch our parents yell at traffic, our likelihood of demonstrating the same behavior dramatically increases. If we see a teenager self-regulate her emotions by withholding food or by hurting herself, does that increase the chances we will demonstrate these behaviors?? A short answer to a complex question is…..yes. We are parenting against these models of behavior. Children and teenagers do not intuitively know how to cope with their emotions, particularly the tougher ones like depression and anxiety. Now, we have famous, well-known models demonstrating ineffective and dangerous ways to cope with these emotions.

How we do handle these as parents? Yes, you can block these program under Netflix, as many of our local schools have advised parents. However, how effective is that really? The better action is proaction. In my practice, if a patient is having thoughts of ending their life, we discuss it a lot and do not avoid it. If our kids watch these shows and we don’t proactively address it with them, what are they learning? What are their take away points? Make sure that you address these shows as just pure entertainment. They are there to bring awareness to issues and causes, but not to properly educate you. Education is the job of parents and teachers, not Hollywood.

What are the main educational and preventative points? Encourage identifying and verbalizing how your children are feeling. Provide support and reinforcement for identifying difficult emotions (anxiety and/or depression). Try and identify some proactive solutions and most importantly, know when to seek out professional help.

Summer days…..of relaxation???

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Too many times have I seen children, adolescents and teens throw their school work away in pure and utter exhaustion from the school year. They seem to view summer as a time to COMPLETELY forget about school work. However, I am reminded of a therapeutic and general life lesson we all need: BALANCE.

If school is too exhausting and stressful, where are the kids, parents, and families working stress-free, rejuvenating activities into their schedule during the school year? It does not take much to “refill our energy cup.”  Try an experiment of one fun (at least 30 minutes) activity during the week and at least one on the weekend. The family can take turns completing one another’s ideas (as long as they are considered “fun” by ALL the family members–remember it needs to be rejuvenating and replenishing for EVERYONE!)

What happens if we give up on work entirely (especially) as kids over the summer? Time and time again, I see a lot of children, especially those with anxiety do 0% school-related work over the summer and then face a VERY difficult adjustment during the first few weeks of school. Can we proactive?!? YOU BETCHA!!! Think about ways to work in 30 minutes -1 hour of school-related work over a 7-day week. Or, get the homework from the teacher ahead of time for the first month of school and have them work on that, to ease the effect of adjusting back into the school environment. I find most teachers to be very open to this concept, as they want their classrooms less stressful as well.

 

HAVE A WONDERFUL SUMMER! I promise to be back as frequently as I can!

Seeking the right mental health provider: How to weigh the pros and cons

 

When seeking out a mental health provider you have a lot of choices to weigh, such as:

  1. What kind of doctor do I want to see? Psychiatrist, psychologist, social worker, etc. In a previous blog I addressed this issue in depth (May 11th, 2016 issue “What are the different types of mental health providers”).
  2. Am I willing to go out of network (i.e., see a professional who does not accept my insurance)? The Washington Anxiety Center of Capitol Hill, the practice at which I am Director is “out-of-network.” What does this mean? It means we are a specialized Cognitive-behavioral practice that does not accept insurance. However, it does not mean you do not already have out-of-network benefits, where you can submit a receipt on your own and get some coverage for your care. Bottom line: are you willing to pay out of network? How does this decision weigh in terms of your pros and cons?
  3. Seeking a specialized service requires a specialized doctor. Too many times have I heard patients who have been in treatment for 10+ years because they went to see a generalized mental health provider. Only after that didn’t work, did they seek out services with a specialized doctor. There are several studies that look at the overall cost-benefit analyses of this approach and find that those who do not initially seek out the appropriate services tend to spend significantly longer in treatment, an increased financial investment (compared to if they sought out more expensive treatment initially) and more emotional suffering.
  4. What are you hoping to get out of treatment? Exploration of yourself? Family system changes? Behavioral changes in your child? Alleviation of marriage/relationship distress? Reduction in anxiety and depression? Thinking about what you would like can help with your decision making as well.

Hope this helps those of you out there feeling a little lost in this process. It’s a complicated one, but one well worth traveling.

Is your child’s behavior out of control?

Lately, in my practice, I have been seeing families with the concern that one child in their family is “out of control.” It’s a difficult thing to hear that a child’s problem is not just caused by the child, but very often the family system (e.g., how they interact with their parents, what is the reinforcement system in the family like, what their relationships are like with their siblings, school environment, etc.).

When examining behavioral problems, it important for a treating clinician to look at the family system like a function. What purpose do interactions serve? What is the function of the bad behavior? Sometimes “bad” behavior can be a manifestation of anxiety or depression, poor distress tolerance and/or emotion regulation, or is it attention-seeking?

Understanding the function of a behavior is necessary to be able to address it effectively. Once you can understand the function, you can see the “recipe” and the ingredients that will effectively change the behavior.

Losing your voice to anxiety and depression

 

What does that mean, to use your voice? It means you feel empowered. Whenever we experience anxiety or depression we can feel as though our opinion, our presence, our minds, and our souls do not matter. This happens to adults and children suffering from anxiety and depression.

Cognitive-behavioral therapy, an evidence-based treatment for anxiety and depression, employs particular components that address this issue. Cognitive restructuring identifies how our thoughts can become distorted as anxiety and depression increase in severity and frequency. We can put on our “scientist caps” on and fully examine the evidence in favor of and against these types of thoughts. We can also implement behavioral strategies that can increase our participation in pleasurable, activating activities that will assist in the improvement in our mood.

Lastly, we can utilize strategies that allow us to face our fears in a gradual, controlled manner, with can lead to a decrease in anxiety over a short amount of time (i.e., exposure).

These strategies can help us find our own voice again, a voice that isn’t driven or does not belong to anxiety or depression.

Take a look at our website http://www.washingtonanxietycenter.com. On the main page is a link to an article written about Exposure therapy and CBT strategies with a more detailed explanation.