Environment | Psychotherapy Toronto

Asthma Brings Surprising Challenges

March 21, 201900Anxiety, Cognitive Behavioral Therapy, Depression, Environment, Fear, Featured news, Health March, 19

Source: Free-Photos at Pixabay, Creative Commons

During the summer of 2017, Adrian and his partner, Kayla, ventured out to explore the dense forest in a remote area of south-eastern Canada where they were vacationing. Hiking on a trail that took them deep into the woods, Kayla shouted back at Adrian, urging him to catch up. Turning to him, Kayla could instantly tell something was wrong. After a wave of panic, he collapsed to the ground, gasping for air.

As Adrian began to fade in and out of consciousness Kayla frantically dialed 911, despite knowing there was no cellphone service within miles of their location. They were completely isolated. Trying to provide comfort, all Kayla could say was, “This is not the end.”

Approximately 300 million people worldwide suffer from asthma. This inflammatory lung disease, which causes swelling of the airways and constricted breathing, can be life-threatening. Globally, 250,000 people die each year from the condition, and researchers have yet to find a cure.

Asthma is a common health concern, and the traumatic experience of an asthma attack can affect the emotional well-being of the sufferer and loved ones.

A Canadian study by Renee Goodwin and colleagues published in the Journal of Psychosomatic Research found that asthma is related to numerous mental health conditions, with the greatest links between asthma and posttraumatic stress disorder (PTSD), mania, and panic disorder. Using data from the World Health Organization, Kai On Wong and a team of researchers found that, globally, asthma is associated with depression and anxiety.

Alex Watford is not surprised by these findings. In an interview with the Trauma and Mental Health Report, he discusses the toll his asthma has had on his mental health, and provides insight into what it is like to experience an asthma attack:

“It feels like you’re drowning. All of a sudden, you’re not getting enough oxygen despite how much you try to breathe. While attempting to breathe, you can hear phlegm rapidly filling your lungs, slowly suffocating you. You then become light-headed and begin to lose vision while your body becomes weak and lifeless.”

With diagnoses that include PTSD, anxiety, and depression, Watford believes his psychological distress is largely due to his terrifying flashbacks that cause him to live in constant fear of the next attack; fear which in turn provokes a level of anxiety that makes breathing difficult.

Clinical health psychologist Laura Flower, and Senior Research Fellow at the University of Southampton, Ben Ainsworth, describe Watford’s experience as the ‘cycle of breathlessness,’ a factor that contributes to the “complex and bi-directional” association between asthma and mental health challenges:

“The experience of breathlessness is distressing; and it’s a normal reaction to be anxious about it. This anxiety then leads to an increased chance of breathlessness – which causes more anxiety.”

According to Flower and Ainsworth, the association between asthma and mental illness is further complicated by the complex relationships asthma sufferers have with their symptoms:

“Some people are deconditioned to them (e.g. “it’s just my lungs, it’s just me”) and therefore aren’t motivated to manage them. Other people find them really uncomfortable, and are unable to work or enjoy a satisfactory quality of life. Both of these can lead to social isolation, poor lifestyle factors, such as fitness, which in turn worsen asthma symptoms.”

Watford describes how his daily life has been impacted by the disease:

“Having asthma affects my everyday life, as it makes having to walk long distances, such as across campus, really tough. This often deters me from going to class because I will feel so exhausted afterwards that attending feels useless. I often find myself avoiding many other activities for this same reason.”

In a UK-based asthma community forum, members offer further insight into asthma’s invasive nature and speak to the unpredictability and uncertainty of life with asthma.

“You don’t know what to expect tomorrow. Will you be able to breathe? Will there be someone there wearing strong perfumes or aftershave? Is there dust in the air? Oh, and just the sheer tiredness of it all, the worrying, not being in control of your surroundings…”

Some members say they are unable to perform simple tasks, such as walking up staircases or showering. Asthma sufferers describe the impact of the disorder as “genuinely life destroying and heart breaking”.

Complicating matters further is the stigma associated with asthma, resulting from a lack of awareness and understanding. The stigma can lead to improper management of the disease, as well as social isolation that creates further mental health challenges in asthma sufferers.

This is a theme that comes up in the asthma community forum:

“…sometimes we trivialize asthma as a society. It makes us think our illness isn’t that bad and so all the problems associated with it aren’t genuine.”

Clinical health psychologist Stacy Thomas, shares some of the ways psychologists, like herself, help asthma sufferers cope with the mental health aspects of chronic disorders, including asthma:

“Using therapeutic interventions, health psychologists help to eliminate the psychological barriers that moderate the experience of asthma. For example, cognitive behavioural therapy, considered the ‘gold standard’ in terms of therapeutic approach, examines the thoughts and beliefs that contribute to problems with mood or anxiety, the tools one can use to find more balance in their thinking, and the behaviours that might need to be changed.”

Adrian survived his close call that summer hiking in the woods. But like many others, he continues to re-live the attack with great intensity and struggles with the anxiety that such an experience leaves. Sometimes Adrian forgets that he suffers from asthma. For now, Adrian tries to remain positive, while patiently hoping for a cure.

-Julia Martini, Contributing Writer, The Trauma and Mental Health Report.

-Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller

This article was originally published on Psychology Today

Solitary confinement offers no prep for the outside.

March 9, 201910Anxiety, Environment, Featured news, Loneliness, Social Life, Social Networking March, 19

Source: Solnovi at DeviantArt, Creative Commons

Ryan Pettigrew is a Colorado native who spent eight years of a 12-year prison sentence in solitary confinement. Struggling with bipolar disorder as a teen, he was abandoned by his parents and left homeless. On the streets, Pettigrew turned to drug trafficking to survive, and was eventually indicted on assault and drug charges. His resulting incarceration led to time in prison isolation for fighting with another inmate.

Solitary confinement is the practice of keeping a prisoner apart from the general population of a correctional facility. Prisoners spend up to 23 hours per day in their cell alone, deprived of both environmental and social stimulation. The majority of Colorado inmates in isolation have a mental illness.

In an interview with the Trauma and Mental Health Report, Pettigrew said:

“For the most part, solitary in Colorado is 24-hour lockdown. I went eight years without seeing sunlight, without human contact. Without anything.”

Cells vary widely, even within North America. Some cells include a bed, toilet, and television. Others contain no furnishings and a bucket or hole for use as a toilet. Not surprisingly, the United Nations (UN) states that placing a person in solitary confinement for more than 15 days constitutes cruel and inhumane treatment, and is tantamount to torture.

Partly due to pressure from the UN, both American and Canadian governments have expressed intentions to reduce the use of isolation in correctional facilities. Pettigrew believes that this change is long overdue, stating in another interview that solitary confinement exacerbated his bipolar disorder. He claims that this type of prisoner abuse often leads to anti-social behaviour after incarceration, rather than to rehabilitation:

“My message to the public is: regardless of how you feel about criminals, most of them get out [of prison], and public safety requires they be released prepared to become productive citizens rather than angry and ignorant. I’m not asking for sympathy, just a rational win-win solution.”

Stuart Grassian, a psychiatrist from Harvard Medical School, spent much of his career researching the impact of solitary confinement. His findings show that it produces a distinct psychiatric condition. Symptoms include hypersensitivity to external stimulation, hallucinations, panic attacks, problems with thinking or memory, intrusive and obsessive thoughts, paranoia, and impulsivity.

Pettigrew experienced many of these symptoms himself:

“The first six months to about a year [in isolation] was really hard. It felt like the walls were closing in. I would have panic attacks and start hyperventilating.”

In a recent PBS documentary, Last Days of Solitary, Grassian stated:

“One of the important clinical findings in solitary confinement is that people deprived of an adequate level of stimulation become intolerant of stimulation. They overreact; they become hyper-responsive to it, and they can’t stand it.”

Upon being released, Pettigrew found that he was not the same person he used to be. Before his incarceration, he was outgoing and loved to socialize. Afterward, he no longer enjoyed being around people and moved to the countryside to avoid contact:

“I get overly stimulated very quickly. Just too much going on drives me crazy. My first week out, I locked myself in my brother’s basement. That’s why I like the country. There are not all the noises and lights.”

In an interview with PBS, Grassian also explained that the brains of people who are exposed to extended periods of isolation show greater activity in response to external stimuli, compared to those who haven’t.

In light of these findings, some U.S. prisons, including Maine State Prison, are reducing their dependence on this type of punishment. The prison’s warden Rodney Bouffard said in the PBS documentary that every effort should be made to reintegrate prisoners into the jail’s general population. He believes that keeping them in isolation is harmful:

“Putting them in confinement and forgetting about them is going to make them worse. There’s no question in my mind. If I have someone who comes in with a five-year sentence, you can have them do their whole time in segregation. But I wouldn’t want them living next to me when they release them.”

Instead, Maine State Prison’s program teaches inmates to resolve conflicts without violence and to control their actions and emotions. Between 2011 and 2017, Maine State Prison successfully reduced the number of inmates held in solitary confinement from 100 to 8. And now over 30 other state prisons are attempting solitary reforms.

It may not be possible to eliminate solitary confinement immediately, but reducing its use is in the best interest of prisoners and the public.

– Stefano Costa, Contributing Writer, The Trauma and Mental Health Report.

-Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller

This article was originally published on Psychology Today

A Brain Stimulation Device May Power Healing

February 8, 201800Cognition, Cognitive Stimulation Therapy, Environment, Featured news, Health, Neuroscience February, 18

Source: UCI Research at flickr, Creative Commons

Promising new treatments for neurological disorders are aimed at transforming disease management through neuroplasticity—the brain’s ability to alter its structure and function to adapt to changes in the environment. Leading-edge research is investigating how technological solutions can enhance neuroplasticity, boosting recovery from neurological damage.

In September 2016, Helius Medical Technologies announced positive results for its pilot study using a brain stimulation device to treat pediatric Cerebral Palsy (CP). CP affects muscle control due to injury or malformation of the brain. For the study, some participants received standard physiotherapy, while others received standard physiotherapy along with 20 minutes of brain stimulation with Helius’s experimental device.

Those who received brain stimulation showed improvements in muscle spasms and gross lower limb motor function, over those who did not. And, there were improvements in quality of life, social status, and cognitive function. One explanation is that the brain stimulation device heightens the brain’s natural ability to heal, producing enhanced benefits from physiotherapy.

This new method of brain stimulation is termed cranial nerve non-invasive neuromodulation (CN-NINM). A successful feasibility study was done for the treatment of Multiple Sclerosis (MS), and studies are underway for Parkinson’s disease, brain injury, and stroke. Participants are reporting improvements in mental health and wellbeing, such as greater mental clarity and increased energy. And benefits may extend to other neurological conditions as well.

The brain stimulation device used in these studies comes from decades of work by researchers at the University of Wisconsin-Madison, in the Tactile Communication and Neurorehabilitation Laboratory (TCN Lab). The team named the device the Portable Neuromodulation Stimulator (PoNS). The PoNS consists of a small array of electrodes that transfer an electrical current to the patient’s tongue, activating areas of the brainstem and cerebellum. Researchers theorize that this activation induces a sequence of activity that spreads through the brain.

In his book, The Brain’s Way of Healing, researcher and psychiatrist Norman Doidge explains how brain stimulation enhances neuroplastic healing. Doidge says an underlying cause of symptoms in neurological disorders is a dysregulation of electrical activity in the brain. He explains the sequence of activity caused by the PoNS may help the brain balance the electrical activity in its networks of brain cells. Balancing promotes rest and relaxation of these cells, allowing further stimulation alongside appropriate rehabilitative therapy. Stimulation reactivates dormant or dysregulated brain cells, and reintegrates them into functioning networks. Taken together, these changes make an ideal state for neuroplastic healing to take place.

Doidge shares a story about Broadway singer Ron Husmann’s remarkable recovery, which Doidge attributes to neuroplastic healing. Multiple Sclerosis led Ron to lose control of his bladder, mobility, and singing voice. Devastated by the loss of his voice and feeling he had nothing to lose, Ron travelled to the TCN Lab. He spent two weeks in intensive speech therapy, accompanied by brain stimulation with the PoNS device. By the end of his stay, Ron was singing and dancing again.

Brain stimulation and modulation are not new. They are central to established, FDA-approved treatments, such as deep brain stimulation (DBS), for neurological disorders. But, an important difference between the PoNS device and deep brain stimulation is that DBS is a highly invasive treatment. It involves the insertion of an electrode into the patient’s brain, and introduces several possible risks, including infections and strokes. And so, DBS is only used as a last resort. But the PoNS is non-invasive and presents few risks. Plus, the effects of the PoNS appear to continue even after the stimulation ends, whereas the benefits of DBS tend to end when stimulation is turned off.

Reported side effects for treatment by the PoNS, though, include increased salivation, mild headaches, and jaw pain. To reduce side effects, researchers teach participants swallowing and relaxation techniques that manage saliva and tension in the jaw.

Although early evidence for the PoNS device is impressive, skeptics point out that the number of participants used in the studies is small, which reduces confidence in reported outcomes. And although the team at the TCN Lab has shown that the PoNS increases activity in key brain areas, theories on how, precisely, it contributes to healing are still unclear.

Still, the PoNS shows promise as an addition to rehabilitation programs, and as a way of promoting physical and mental health. This technology is one to watch.

–Stefano Costa, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

Climate Change Affecting Farmer’s Mental Health

December 7, 201760Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A reportfrom the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts in the farmers. Failure of crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behaviour, including greater isolation due to a growing distance between farms, increased competition and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

Climate Change Affecting Farmers' Mental Health

December 7, 201700Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from an insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A report from the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts by the farmers. Failure of a crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behavior, including greater isolation due to a growing distance between farms, increased competition, and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

This article was originally published on Psychology Today

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Trauma Documented Three Decades after Chernobyl Disaster

December 1, 201600Appetite, Depression, Environment, Featured news, Health, Stress, Trauma December, 16

Source: Surian Soosay on Flickr, Creative Commons

Chad Gracia’s award-winning 2015 documentary, The Russian Woodpecker, addresses the legacy of trauma caused by the Chernobyl nuclear disaster. The film documents the investigative journey of Fedor Alexandrovich, a Kiev based artist who shares his own experience as a survivor while exploring the disturbing question: Was the disaster at the Chernobyl power plant an ‘inside job’?

When a reactor at the power plant exploded on April 26th, 1986, the effects were catastrophic. As radiation levels rose, hundreds of thousands of people were evacuated from their homes in Ukraine, Belarus, and Russia.

Forced evacuation and relocation was traumatic for many who had no hope of returning home. In the most contaminated areas, entire villages were bulldozed and buried. Further, citizens were not notified of the risks they faced from radiation. Tamara Kovalchuk, who was employed by the Chernobyl power plant, tells Alexandrovich in the film:

“When the explosion happened, no one thought anything of it. They put on masks and we were surprised. Why wear a mask in such good weather?”

After the event, political authorities failed to implement policies to protect the health of their citizens. For example, the World Health Organization claims that:

“If people had stopped giving locally supplied contaminated milk to children for a few months following the accident, it is likely that most of the increase in radiation-induced thyroid cancer would not have resulted.”

Trauma is a recurrent theme of The Russian Woodpecker. Alexandrovich was four years old at the time of the disaster—he was evacuated from Kiev, Ukraine, separated from his parents, and sent to an orphanage. Reflecting on this experience, he says, “I thought I would be there forever. It’s quite a serious trauma for a child. And from that time I’ve felt strange…different.”

But this trauma is not unique to Alexandrovich—it extends to the hundreds of thousands of people who faced relocation, suffered from illness, and coped with deliberate misinformation from their government about health risks. To this day, those affected by the explosion continue to struggle, living in fear of long-lasting consequences such as birth defects and contaminated foods.

According to psychologist Lynn Barnett, trauma from the Chernobyl disaster is cumulative because it is “characterized by repeated adversity with no foreseeable end”. She describes radiation as an “unseen, unheard, unfelt and ‘un-smelt’ terror.” Its elusiveness, in conjunction with government deception following the event, has led to the spread of misinformation guided by unscientific explanations and recommendations for coping with radiation.

One such recommendation is that small doses of radiation are good for people of middle or old age. Others are that drinking red wine, or swabbing the throat with antiseptic iodine, can protect against radiation. But maybe false beliefs like these lessen the threat of the unknown by providing a sense of control.

Other research corroborates this notion. Anthropologist Richard Sosis at the University of Connecticut studied the effects of psalm recitation during the Second Palestinian Intifadain northern Israel. Among secular women, those who recited psalms to cope with violence experienced lower anxiety.

In relation to the Chernobyl disaster, Barnett wrote:

“The secrecy and lies that enshrouded the Chernobyl accident led to an almost total lack of knowledge about the facts, leading to the impossibility of any kind of personal control.”

Perhaps Alexandrovich was seeking control over the chaos inflicted by the event when he decided to look into the politics surrounding the disaster.

His inquiry led him to interview Vladimir Komarov, head of the Chernobyl investigation committee. This committee was tasked with identifying the cause of the explosion. In the film, Komarov tells Alexandrovich that the last Soviet Head of Atomic Energy, Georgy Kopchinski, made phone calls to Chernobyl engineers demanding that they conduct experiments on an unstable nuclear reactor.

Kopchinski, who Alexandrovich also interviews, denies that he made these phone calls, despite the fact that they were reported by engineers at the time.

Like trauma that affects the individual, politically motivated trauma leaves people with a sense of vulnerability and fragility. In traumatic events, key values, beliefs, and attitudes are largely compromised, and individuals turn to external sources of authority, such as political figures, for answers.

But when political figures are complicit in the trauma, or fail to perform their leadership duties, basic trust in one’s society and culture is challenged, and the ability to cope is further hindered.

Alexandrovich’s theory that the Chernobyl disaster was politically motivated is provocative and incendiary. But is it true? According to Chernobyl historian Natalia Baranovskaya, “To prove this you need all the documents. But the documents are still classified.”

Secrecy around the events of the Chernobyl disaster persist, preventing those affected from understanding the cause of their suffering. For now, the truth remains elusive.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Remote Northwest Territories Lacking Mental Health Care

November 17, 201600Environment, Featured news, Health, Self-Harm, Suicide, Therapy, Trauma November, 16

Source: Gloria Williams on Flickr, Creative Commons

On April 26, 2015, 19-year-old Timothy Henderson, a resident of the North West Territories in Canada, was taken off life support after sustaining self-harm injuries, the culmination of a long battle with depression and other mental health issues.

Beginning in adolescence, Timothy struggled with symptoms of ADHD and Asperger’s syndrome (Autism spectrum). When he felt overwhelmed by his condition, he reached out for support, but felt dismissed, and began to lose hope that the help he needed would be available.

Shortly before his death, Timothy admitted himself to Stanton Territorial Hospital for the fifth time in a year, where he again disclosed details about a tendency to self-harm. He was released two days later, without adequate follow-up or a long-term care plan. Later that month, he sustained self-inflicted injuries that led to his death.

Timothy’s case is not uncommon in the Northwest Territories, a remote region of northern Canada. The NWT Mental Health Act states that a medical practitioner can only detain an individual for psychiatric assessment for a maximum of 48 hours. This time limitation often results in rushed and insufficient care—a result of a system that is understaffed and overworked.

The territory’s current Mental Health Act, introduced in June 1988, has been cited as a main cause of inadequate services for individuals suffering from mental illness. The act is out-of-date and has not been modernized with strategies to address the current mental health climate of the NWT.

In a report by the Alternative North Health Coalition, the mental wellbeing of residents in the NWT is shown to be much lower than that of the average Canadian, with a national rate of suicide three times greater than those living in the more populous south. Lack of access to staff, resources, and community-based treatments are all relevant aspects of the act that impede adequate treatment and prevention strategies.

Timothy’s mother, Connie Boraski, believes Timothy’s mental health began to worsen when he turned 17, and no longer qualified for the pediatric healthcare program. This transition resulted in lengthier waits for treatment and drastic changes in privacy laws that prevented Timothy’s parents from having access to information about their son’s treatment. Mental health legislation regarding the legal rights of family members and other caregivers is an aspect of the Mental Health Act that restricts parents, like Timothy’s, from intervening to support their children.

After being repeatedly dismissed, Timothy eventually stopped asking for help. Boraski explains:

“Timothy never wanted to be a burden to anyone. That was a real challenge for him, to ask for help.”

Deficiencies in the quality and quantity of staff and resources reflect the isolation and socioeconomic climate of the NWT. Due to the small and relatively isolated nature of the region, accessing facilities within the community can be difficult. Timothy had to travel between hospitals in the NWT and Alberta to obtain psychiatric help, which resulted in seeing a different doctor on each occasion. This kind of disjointed doctor-patient relationship makes it difficult to stay connected.

The public outrage following Timothy’s death eventually drove NWT Health Minister, Glen Abernethy, to open a review into Timothy’s case and bring changes to mental health legislation. In addition to other important components, the new act will include information on services such as Assertive Community Treatment (ACT), which will allow patients to have access to specialized treatment and supervision within remote communities of the NWT.

The revised act, if passed, is expected to come into effect sometime in 2016. Though implementation of a new mental health act is too late for Timothy Henderson, the hope is that a new mandate will provide the Northwest Territories with better preventative measures and resources for residents suffering with mental illness.

– Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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RUSH Prevention Program Helping Children of Bipolar Parents

May 5, 201620Bipolar Disorder, Emotion Regulation, Environment, Featured news, Health, Parenting, Stress, Therapy May, 16

Source: Rolands Lakis on Flickr

“It was just kind of not knowing what you were going to get every time. Emotionally when I was younger, I always cared about her. She was my mom. As I grew up, I kind of became disconnected because I didn’t know the real her. I only knew her from her diagnosis. I only knew her emotions. I didn’t know the real her.”

– Steven, child of a bipolar mother.

In 2004, the World Health Organization named Bipolar Disorder (BD) the seventh-leading cause of ‘disease burden’ for women between 15 and 44, a measure that combines years of life lost to early death and years lost to living in subpar health. Public Health Agency of Canada reports that BD occurs in one percent of Canadians, and their reported mortality rates are two to three times greater than the general population.

The disorder is marked by alternating periods of manic euphoria and intense depression. In a manic state, people experience elevated moods, racing thoughts, and sleeplessness, in addition to overspending and engaging in risky sex. The depressive phases make for overwhelming feelings of sadness, withdrawal, and thoughts of death and suicide.

Research has related BD to aggressive behaviour, substance abuse, hypersexuality, and suicide. But more recently, studies have been showing the kinds of challenges faced by children of those diagnosed with the disorder.

The Pittsburgh Bipolar Offspring Study reports that children of bipolar parents are 14 times more likely to develop bipolar spectrum disorder. Children of two bipolar parents are at an even higher risk.

And these children are also more vulnerable to psychosocial problems. A study by Mark Ellenbogen at Concordia University finds them at greater risk for problems with emotional regulation and behavioral control.

Ellenbogen and colleagues have explained how stressful home environments can alter biology to influence mood disorders in adolescents and adults.

In an interview with the Trauma and Mental Health Report, Ellenbogen stated that OBD individuals (that is, offspring of parents with bipolar disorder) show higher levels of daytime cortisol, a hormone that is released during times of stress. OBD are psychologically more sensitive to stresses in their natural environments.

“We have found that high cortisol levels in offspring may represent a biomarker of risk for affective disorders, particularly in vulnerable populations like the OBD. We believe that these changes in cortisol levels can be linked to stress, inconsistent parenting practices and disorganization in the family environment.”

Reducing the stressors in early childhood may help decrease elevated levels of cortisol, and ward off the development of BD and other problems.

Recognizing the need for early intervention, Ellenbogen initiated a pilot prevention program, Reducing Unwanted Stress in the Home (RUSH), which targets bipolar parents and their vulnerable children between six and eleven.

An assessment measures salivary cortisol, looks at the family environment, and evaluates the child’s behaviour. Then parents and children participate in weekly sessions.

With parents, the focus is on improving communication and problem-solving skills, and increasing structure and consistency in the home. With children, they teach skills for understanding and coping with stress through age–appropriate exercises and educational games.

“The goal of the RUSH program is to prevent the development of affective disorders and other mental disorders by intervening in families well before these serious mental disorders begin. That is, this is a prevention program for children at high risk of developing debilitating mental disorders.”

To date, children and parents have been responding well, but the research is ongoing.

Programs like RUSH aim to prevent the development of mental illness in vulnerable youth. And an ounce of prevention can mean a whole lot to quality of life down the road.

– Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Underage Models Need Federal Protection and Regulation

October 22, 201500Environment, Ethics and Morality, Featured news, Gender, Law and Crime, Post-Traumatic Stress Disorder, Stress, Work October, 15

Source: Anna Fischer/Flickr

When Jennifer Sky launched her career at age fourteen, she imagined a glamorous lifestyle, fame, and designer clothes. Flash forward to seventeen: Her experiences turned out to be very different.

For Jennifer and many other young models, the fashion world includes foreign locations and a cascade of highly sexualized situations with little supervision, grueling twelve-hour days with few breaks, and high-stress photo-shoots.

In a recent interview with the Trauma & Mental Health Report, Jennifer shared her experiences as a young model abroad, and discussed the repercussions she’s now facing.

Jennifer: In Japan I was molested several times on the subway. In France, I stood in hypothermic-temperature waters every day for a week. In Mexico, I was given drugs and coerced into going topless at age sixteen. The human trafficking elements of fashion were all around me.

It was during this time that Jennifer began experiencing symptoms of what was later diagnosed as Post-Traumatic Stress Disorder (PTSD). In her latest book, Queen of the Tokyo Ballroom, and herYouTube video that went viral earlier this year, Jennifer describes how her normally gregarious personality started to change. She became withdrawn, easily startled, and feared new places. Eventually, she felt so timid she barely spoke.

Although the symptoms began in the 1990s, Jennifer did not seek treatment until 2010 when she moved back to New York City.

Jennifer: I moved back to finish college and the symptoms returned with such a force that I could no longer ignore them.

Jennifer experienced panic attacks during stressful events, which were sometimes followed by dissociative episodes where she would lose, in her words, “whole swaths of time.” These overwhelming symptoms led her to visit her university’s clinic where she was formally diagnosed.

Almost twenty years since modeling, through anti-anxiety medication and psychotherapy, Jennifer is managing her symptoms and is now a graduate student and activist.

Jennifer: I’m working toward transforming a problematic and corrupt industry into a positive one. Fashion can be fun. It can be a rewarding opportunity. It can also be abusive, opportunistic, corrupt, and traumatizing.

So what is currently being done to make youth modeling a safer profession?

In the Fall of 2013, New York State passed the Child Model Law, which ensures protection for individuals under eighteen, who work in the fashion industry. The law requires tutors and chaperones, and that 15% of the model’s earnings be held in financial trust. It also requires that all working children and adolescents be in possession of a permit while on set, and limits the amount of time they are allowed to be there.

The changes to labour laws in New York State saw instant successat the 2014 New York Fashion week, where only three underage models obtained permits, and were able to work the fashion shows. Previously, as many as 60% of the models were under eighteen.

As promising as these changes are, the new labour laws are not federal – they only protect models that are working in the state of New York. In general, models still face a working world devoid of adequate labour regulation or protection.

Jennifer still questions whether the modeling industry is the right environment for children. But, by raising awareness and promoting models’ rights, Jennifer hopes to convince the U.S. federal government to change laws on underage modeling.

Jennifer: When we are talking about the protection of children, there really should be no debate.

– Magdelena Belanger, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright: Robert T. Muller

This article was originally published on Psychology Today

Coping With Traumatic Brain Injury

February 26, 201570Anxiety, Child Development, Cognition, Depression, Empathy, Environment, Featured news, Health, Memory, Neuroscience, Productivity, Sleep, Sport and Competition, Trauma February, 15

Source: Shine In Your Crazy Diamond//Flicker

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems. The Centre for Disease Control has reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI. Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q: What are the most common injuries that lead to the development of a TBI?

A: A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body. Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object,) and war related injuries.

Q: How is a TBI diagnosed?

A: Professionals in emergency services diagnose a TBI in the acute state at the time of injury. They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability. CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up. Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q: What is involved in rehabilitation following a TBI?

A: In the acute state, the TBI is managed medically, including neurosurgical intervention. Once stabilized at the hospital, children move on to rehabilitation. An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school. The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q: As a clinical neuropsychologist, what is your role with patients who have a TBI?

A: Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home. They can be followed for many years after the injury. Typically, they are seen during transitional periods such as the transition from primary school to high school. A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q: What daily activities can become difficult for an individual with a TBI?

A: Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported. Common complaints across all injuries include: keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated. Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q: How can secondary mental health symptoms develop from a TBI?

A: Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain. Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again. This is common for children who developed a TBI as a result of a sports injury. Children can also be anxious about their academic achievement and about performing well in school. It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q: What advice can you offer someone with TBI?

A: Be patient with yourself and try to normalize your emotional variability. It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on. Individuals should keep in mind that while there are variable outcomes, full recovery is possible. Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q: Do you have any further suggestions for coping with a TBI?

A: Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems. The Centre for Disease Controlhas reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI. Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q: What are the most common injuries that lead to the development of a TBI?

A: A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body. Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object), and war related injuries.

Q: How is a TBI diagnosed?

A: Professionals in emergency services diagnose a TBI in the acute state at the time of injury. They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability. CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up. Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q: What is involved in rehabilitation following a TBI?

A: In the acute state, the TBI is managed medically, including neurosurgical intervention. Once stabilized at the hospital, children move on to rehabilitation. An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school. The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q: As a clinical neuropsychologist, what is your role with patients who have a TBI?

A: Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home. They can be followed for many years after the injury. Typically, they are seen during transitional periods such as the transition from primary school to high school. A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q: What daily activities can become difficult for an individual with a TBI?

A: Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported. Common complaints across all injuries include: keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated. Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q: How can secondary mental health symptoms develop from a TBI?

A: Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain. Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again. This is common for children who developed a TBI as a result of a sports injury. Children can also be anxious about their academic achievement and about performing well in school. It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q: What advice can you offer someone with TBI?

A: Be patient with yourself and try to normalize your emotional variability. It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on. Individuals should keep in mind that while there are variable outcomes, full recovery is possible. Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q: Do you have any further suggestions for coping with a TBI?

A: Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr

This article was originally published on Psychology Today

Category: Environment