Useful Covid-19 Mental Health Resources

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Mental Health Tidbits

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The definition of panic disorder is impossible without a thorough understanding of the central feature of the disorder which is the panic attack.

A panic attack is a sudden and often unexpected onset of intense fear that is basically a false alarm of the “fight-or-flight” reaction. Panic attacks will be accompanied by at least four symptoms, although it is not uncommon to have many more symptoms. The symptoms can be physical or cognitive. The physical symptoms include:

The cognitive symptoms include:

The symptoms of a panic attack usually peak within ten minutes. When the sufferer of the attack does not know that it is a panic attack, it is not uncommon for them to go to the emergency room with the belief that they are suffering from a heart attack.

A panic attack leads to panic disorder when the attacks are recurrent and the person develops anticipatory anxiety of upcoming attacks. This anticipation often leads to avoidance of places or activities that the sufferer fears might trigger a panic attack.

Panic disorder is treated with psychotherapy and/or medication. Cognitive Behavioral Therapy (known as CBT) customized for panic disorder is typically the therapy of choice.

Panic disorder can cause tremendous impairments in one’s life. The good news is that it is very treatable when one sees a mental health clinician who is experienced in the treatment of this disorder.

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Raising an adolescent can be mystifying. This is especially true if your teen is suffering from a diagnosable disorder. Parents with teenagers are often faced with the question if their child has a real problem or are they “just being a teenager”.

In this segment we will focus on teens with depression. Let us first give a general description of the mood disorder known as depression and then we will see how it relates to teens.

Clinical depression is very different than normal sadness or “the blues”. It is a mood disorder that affects your feelings, thoughts and behaviors and is accompanied by a variety of emotional and physical problems. It causes significant impairment in normal functioning and can continue for months or years. Symptoms can include:

Teens are unique that depressed mood is often expressed as irritability. Obviously, this does not mean that an irritable or angry teen is suffering from depression. Sometimes moodiness is a normal phase for a teenager. Nevertheless, it deserves to be explored, especially if there are other symptoms of depression besides the irritable mood. Consider how long the symptoms have been going on, how severe are the symptoms and are these behaviors different than his or her normal self.

Depression comes in all shapes and sizes, and the treatment is also not a one-size-fits-all. However, the first step to recovery is recognizing that there is a problem. Untreated depression can potentially be the beginning of a downward spiral.

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There are basic characteristics that effective therapists have in common. It is worthwhile to look for these traits when seeking out a therapist.

Another point to bear in mind is that a therapist’s talents outside of the therapy room are not indicators of how they practice in the therapy room. Some therapists are great authors. Others are incredible speakers. Unfortunately, these talents have nothing to do with actual therapy.

People also often wonder about the importance of using a licensed clinician. In short, the advantages are that they have had thousands of hours of work under supervision, they are required to take courses in Continuing Education, they are bound by the HIPPA laws of confidentiality and they are often liable if they cause harm.

Just like a driver’s license does not mean that the bearer of the license is a good driver, similarly a license does not mean that the therapist is effective. But it does indicate that they have met certain qualifications and the risk of losing their license keeps them focused on practicing ethically and competently.

 

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Many people are often puzzled by the concept of diagnosing certain behaviors or emotions as mental health disorders? Don’t we all suffer from a certain amount of anxiety, depression, impulsivity, or many other common experiences of the human condition?

The answer is that of course we all have a little bit of everything. The uniqueness of a disorder is not the condition itself but the level of impairment of our functioning.

For example, if someone has all of the classic traits of ADHD, but it is not affecting them socially, academically, and in their occupation, then that person does not have ADHD even though all of the symptoms are present. Similarly, if someone has anxiety, but it does not significantly impair their functioning then that person does not have an anxiety disorder.

Another aspect of a clinical diagnosis is the duration of the symptoms. It is not clinically significant to have symptoms of depression after suffering a loss. It is clinically significant if those debilitating symptoms persist well beyond the appropriate period of grieving.

There are situations when the disorder is not in the individual but in the system. This is common in marriages and families, where there is no individual person who has a disorder, but the members of the family or the marriage are having difficulty interacting with each other.

The bottom line is that the purpose of a diagnosis is not to pathologize normal issues; rather it is a tool to measure if a person’s life is being affected enough to the degree that intervention would be beneficial.

 

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Both boys and girls can have ADHD. However, the number of girls diagnosed with ADHD in childhood is significantly lower than the number of boys. This is often based on the different presentation of ADHD in boys and girls.

Boys often have more of the hyperactive symptoms of ADHD such as fidgeting or tapping hands or feet, inability to remain seated, restlessness, inability to partake in leisure activities quietly, acting as if “driven by a motor,” talking excessively, blurting out an answer before a question has been completed, and having trouble waiting one’s turn.

Girls, on the other hand, often have more of the inattentive symptoms of ADHD such as failing to pay close attention to details, making careless mistakes in one’s work, difficulty in sustaining attention to tasks or play activities, seeming to not listen when spoken to directly, not following through on instructions, failing to finish one’s work or projects, having trouble organizing tasks and activities, reluctance to do tasks that require mental effort over a long period of time (such as schoolwork or homework), losing things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, cellphones), getting easily distracted, and being forgetful in daily activities.

These differences become very apparent in a school setting. A boy with ADHD might be swinging from the rafters, shooting spitballs, or engaging in the kinds of mischievous behaviors that boys with ADHD are notorious for. Since he is so disruptive, the school will often ask the parents to have their child tested for ADHD.

A girl with ADHD might be daydreaming and staring out of the window. Although she might have very poor grades, since she is not being disruptive the parents might not be asked to have their daughter tested for ADHD. Even girls with symptoms of hyperactivity, will usually restrain themselves from blatantly disruptive behavior in school.

Highly intelligent girls with ADHD are the most difficult to spot. The brighter a girl with ADHD, the later her difficulties tend to emerge. Many girls with above-average IQ can keep it together academically. But the more demanding and complicated life becomes, the more their problems with concentration and organization are likely to impede them.

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Our personality is the totality of our behaviors, temperaments, perceptions, attitudes and emotions that makes us into distinct and unique individuals. It governs how we relate to other people, the environment that we live in, and even how we view ourselves.

Since children have flexible personalities, a nurturing and affectionate environment can help the child develop a healthy and well-adapted personality. However, when a child suffers from neglect, abuse, or simply a lack of appropriate affection, his personality can develop with maladaptive perceptions and emotions. As he gets older and the personality becomes less flexible, a disordered personality can develop that may significantly interfere with interpersonal relationships. This causes severe emotional distress in many area of life.

Personality characteristics do not change easily and cannot be altered by medication. If the emotional distress leads to clinical depression or other psychiatric disorders, then the medication may help those symptoms, but the core personality remains. As Reb Yisroel Salanter zt”l famously said that it is easier to study the entire Shas in depth that to change a character trait!

It is therefore understandable that therapies which are designed for clients with personality disorders are often long term with progress coming in increments. This should not discourage someone from seeking help for a personality disorder; rather this should encourage the client to be patient with the therapeutic process.

 

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Clients often look to their therapists for advice. However, therapists usually avoid overtly giving advice which can be very frustrating for the client. Why are therapists so averse to offering advice?

When a therapist starts giving advice, there is a risk that the client will become dependent on the therapist, and then the goal of therapy, which is to grow in our emotional health, will not be accomplished. Furthermore, people tend to like their own ideas. If the client comes up with the answer on his own, he is more likely to follow it. Also, if the therapist gives advice, he might fall into the “fix-it” mode. The client might then feel that the therapist is not really listening. As a result, the client might not feel understood which can jeopardize the entire therapeutic process.

Does that mean that a therapist can’t be directive? Of course not! If so, what is the role of the therapist?

The simple answer is that the therapist is there to help you with the process. For example, if a client asks, “Should I quit my job since my boss is mean?” the therapist will not answer yes or no. The therapist can help you with the process of making that decision. We often have the decision-making process distorted by impulsive reactions and irrational thinking. We often do not understand what causes us to think and act in the way that we do. When the therapist helps you understand yourself and have better control of your thoughts and feelings then you can make the decision on your own. This not only helps for this specific dilemma, rather you are learning skills that will help you in many of life’s twists and turns. This is truly therapeutic.

Similarly, if a client asks the therapist, “Is it a problem that I compulsively wash my hands?” the therapist will usually guide the client in the process of how to determine if a specific behavior is one that the person really wants to deal with. If the client then decides that he wants help with his behavior, the therapist can be there to guide him in how to do that.

This can be summed up with the famous saying, “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.”

 

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Human beings have a built-in “cruise control” that keeps our mood somewhere in the middle between depressed mood and elevated mood. Sometimes we briefly dip into an extremely depressed or elevated mood due to life’s circumstances, but we usually return relatively quickly to our equilibrium. For example, after an accepted marriage proposal, the engaged couple might be briefly “on cloud nine”, but their mood will return pretty quickly back to normal. Similarly, if one suffers a loss, there might be a period of depressed mood, but the body’s natural tendency to return to a balanced mood will usually prevail.

People who have bipolar disorder do not have the same built-in system of mood stability, so they will have periods of severely depressed or extremely elevated mood. These episodes can last from a week to several months. There are usually periods of normal mood in between the episodes.

The extremely elevated mood of bipolar disorder is known as mania. During periods of mania the person may feel high and on top of the world or uncomfortably irritable and “revved up.” Mania will usually have some of the following symptoms: feelings of grandiosity, decreased need for sleep, being excessively talkative, racing thoughts, attention drawn to irrelevant items, increase in goal related activity, and excessive involvement in pleasurable activities that have drastic consequences (such as unrestrained buying sprees or foolish business investments). When mania is very severe, the person can experience psychosis and have a break from reality.

Sometimes the mood is not sufficiently elevated to be called mania and then it is called hypomania (“hypo” is Greek for “under”). Hypomania has similar symptoms as mania, but they are less severe and often briefer in duration, and therefore it is less impairing than actual mania. Mania will often require hospitalization, whereas a hypomanic episode will not.

Bipolar disorder is broken down into bipolar I and bipolar II. Bipolar I is episodes of major depression and at least one manic episode. Bipolar II is episodes of major depression and at least one episode of hypomania but without ever having a manic episode. There is a third disorder that is called cyclothymic disorder which is periods of elevated and depressed mood just like bipolar disorder, but the mood swings are not as severe and they tend to be more frequent.

Medication alone or a combination of medication and psychotherapy is how these disorders are usually treated.

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Oppositional Defiant Disorder (ODD) is a diagnosis that was developed in the 1980s. It is defined in the DSM (The Diagnostic and Statistical Manual of Mental Disorders) as a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months. Obviously, all children engage in these behaviors periodically, but when the behaviors are so recurrent that they are severely impairing then the child might have ODD.

In order to officially receive the diagnosis, there must be at least four of the following symptoms:

Often loses temper; Is often touchy or easily annoyed; Is often angry and resentful; Often argues with authority figures or for children and adolescents with adults; Often actively defies or refuses to comply with requests from authority figures or with rules; Often deliberately annoys others; Often blames others for his or her mistakes or misbehavior; Has been spiteful or vindictive at least twice within the past 6 months.

There are three settings that we look at when analyzing a child’s behavior: home, school, and social interaction with peers. Some children have symptoms of ODD in only one setting, whereas others will have symptoms in all three settings.

There is no medication for ODD. Medication could only be appropriate if the child has another diagnosis in addition to ODD such as ADHD or an anxiety disorder.

The diagnosis of ODD does not have a specific intervention since the intervention is very much dependent on the root of the child’s behavior. Some children by their nature do not naturally know how to regulate their emotions or tolerate frustration. Other children developed these behaviors in response to abuse or neglect. Sometimes, there is an illness or death in the family that can greatly affect the child. The parenting style of the child’s parents might also be a factor. Also, conditions such as anxiety, ADHD, or learning disorders can be a major factor in the child’s behavior.

There are many possible interventions for ODD. Some of them are focused on the interaction between the parents and the child, some of them are more focused on the child himself, and sometimes there will be a synthesis between the two approaches. As mentioned, it is very dependent on the source of the child’s behavior.

The ODD diagnosis is more complicated than just counting symptoms and should only be made by a clinician who has experience with ODD. Even if a child is diagnosed, that does not mean that he has a disease; it is merely a description of a group of behaviors that are clustering together. Furthermore, the diagnosis of ODD by itself does not offer a complete picture of the child’s challenges, but it is a red flag that the child needs help.

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