New parent anxiety

There is a lot of research out there regarding postpartum depression, but a lot of parents do not know about the postpartum clinical anxiety.

Some quick facts and figures:

  1. Approximately 75% of women experience postpartum blues (looks like clinical depression, but self-resolves within 2 weeks post birth) after birth.
  2. Of those women, around 20% will go on to experience postpartum depression.
  3. 16% will go on to experience postpartum anxiety (although you do not have to experience postpartum blues beforehand)
  4. Only 20% of OBGYNS screen for postpartum anxiety (which, although related, is different from assessment for postpartum depression)
  5. The majority of OBGYNs first line of treatment are SSRIs, antidepressants, which take 4-6 weeks to BEGIN working
  6. A small majority of OBGYNS recommend CBT (cognitive-behavioral therapy) treatment
    1. CBT treatment for postpartum anxiety and depression is evidence-based and begins to work right away. The effects will also maintain post SSRI treatment completion.

Great sites for finding a CBT therapist, especially ones that can do home visits in the postpartum period are http://www.abct.org and http://www.adaa.org

And if you are in the DC area, our center also does this type of treatment, with home visits (www.washingtonanxietycenter.com)

Remember that a happy mommy and daddy means a happy baby!

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How to know when to get help for your child

The medical field, including the mental health field, typically addresses curative problems as opposed to preventative. Curative refers to problems only after they have reached a diagnosable clinical level. Oftentimes, people wait for their problems to reach the clinic/curative level before coming in for treatment. This can result in longer, more intensive and expensive treatment. What can you look out for when it comes to knowing when to come in?

  1. Has your child’s problem become too frequent (i.e., more than 2x a week)?
  2. Has your child’s problem become severe (i.e., even if not occurring frequently, when it comes, does it come with a very high intensity)?
  3. Do you find your child’s self-report is inconsistent with the school’s report?
  4. Does your child ask for outside help?
  5. Pay attention to your parental intuition. Clinical psychologists/mental health providers may be the experts in anxiety, depression and behavior, but you are the expert in your child. If your alarms go off (even in the slightest bit), it’s time to pay attention now, and not wait until the alarm is glaring.
  6. Has school mentioned more than 1x that your child demonstrates anxious, depressed or behavioral problems?
  7. Has school asked for a meeting with you about your child’s behavior or anxiety/depression?

If you answer “yes” to any of these questions, it may be time to seek professional help. Remember that if you get help sooner rather than later you can reduce expense, duration, and intensity of treatment.

Recommendations on how to take care of yourselves as parents this holiday season

  1. Take 30 minutes 2-3x a week to “refill your energy cup.” With all the small stressors in life, especially during the holiday season, our “cups” can become depleted. Here are some activities that can help replenish your mental health energy resources (self-care strategies that combine behaviorally activating/getting up and moving):
    1. Going for a walk (and listening to music)
    2. Going to an enjoyable volunteer event
    3. Going shopping (but only if it’s enjoyable)
    4. Taking a pleasurable exercise class
    5. Cooking
    6. Playing a family game
    7. Fill in the blank—just make sure it combines you becoming physically activated with an enjoyable activity
  2. Quiet your mind
    1. Plan out mindfulness activities, including mindful eating, or scanning your body for stress and employing strategies such as progressive muscle relaxation or diaphragmatic breathing can be very helpful
  3. Saying “No”
    1. The holidays are a time where we can say “yes” to everything. It is important to know your limits. Don’t overextend!
  4. Knowing when to ask for Help
    1. Don’t be afraid to ask your kids for help, in addition to friends and family. Kids are more than capable of holding their own, we just have to give them that opportunity.

To all my parents reading this blog. You are amazing!!! Remember you are just as important to prioritize! Happy holidays!

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

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!