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    1. Why Is There A Stigma Around Seeking Mental Health?

      Research shows that over half of the people who need mental health care in the United States go untreated. A variety of reasons can contribute to this, including lack of mental health professionals, access in a given geographic region, or even limited insurance coverage. More often than not however, the common barrier to overcome involves our own stigmatization of what seeking mental health services means about us. Study after study reveals that many people avoid or delay seeking treatment due to their perception that they may be treated differently, or that seeking treatment may impact their jobs or social status.
      Despite Progress, Studies Show Many Still Have A Negative View Of Mental Illness
      According to the American Psychiatric Association, “a review of studies on stigma shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness”. Another study concluded "there is no country, society or culture where people with mental illness have the same societal ranking as those without mental illness." These views and perceptions cause public and self-stigma around mental health issues:
      Self-Stigma is internalized negative attitudes people with mental illness may have about their own condition.
      Public Stigma is negative or discriminatory attitudes that may be held by others about mental illness.
      Media Stereotypes Contribute To The Stigma
      The media has been guilty of exploiting both types by sensationalizing mental health disorders in an effort to amplify character personality traits or storytelling. A study revealed how entertainment and news media dramatize, distort, or over-simplify mental illness. The portrayals are often overly dramatic, distorted, and over-simplified characterizations that emphasize danger and unpredictability, or describe people with mental illness as ‘helpless’ with little chance of recovery. 
      We can all probably think of a news story, movie, or series that distorted characterizations. The popular Netflix series “Behind Her Eyes”, based on a novel of the same name, is a good example of a simplistic and negative portrayal of stereotypical (and not inherently true) characteristics related to mental illness and trauma, which propels the notion of hopelessness and acts as a deterrent by someone wanting to seek help with their symptoms but because don’t want to “be like the characters” . Fortunately, people are starting to recognize the media’s role in stigmatization and are proposing steps to address it. More on that below.
      What Are The Harmful Effects Of Stigma Around Mental Health Issues?
      As you can imagine, the most harmful effect of stigma is a reluctance to seek help for mental illness or maintaining a regular treatment plan. Other negative impacts include:
      Worsening Of Mental Health Conditions
      Reduced Hope
      Lower Self-Esteem
      Self-Sabotage
      Impaired Recovery
      Social Isolation
      Difficulties At Work And In Relationships
      How Do We Address The Stigma Around Mental Health Issues?
      The good news is that many influential organizations and institutions are aware of the problem and are working hard to develop ways to address it. The two approaches that look to have the greatest impact are:
      Educating the public broadly to alter stereotypical stigmatizing beliefs and attitudes.
      Enhancing individual skills for coping with self-stigma through improvements in self-esteem, self-empowerment, and improved help-seeking behavior.
      On the public side, experts have suggested and are already making in-roads in implementing required mental health issues training for journalists, including expert input from psychiatrists in movie or TV productions (and including disclaimers or further information at opening or closing credits), using non-individualized descriptions of mental illness (i.e., “a person with an addiction”, rather than “an addicted person”), and using mental-health terminology with more precision, fairness, and expertise.
      On the individual side, the National Alliance on Mental Illness (NAMI) has come up with some tips to guide conversations with those who may be feeling stigmatized, and to improve our own potentially-stigmatized thinking about our mental health issues:
      Don’t Underestimate The Unfortunate Power Of Self-Stigma. Assume that your family member, friend, or patient is experiencing self-stigma, given its prevalence. Try to identify and understand its potential consequences. We often don’t want to admit that stigma impacts us as much as it does. Consider if you have made stigmatizing comments, even if unintentionally, and be prepared to recognize this behavior.
      Use Facts & Resources To Prove That Common Stigma Examples Are False. Talk about common examples of stigma to show your familiarity and experience with them. You may also note common emotional reactions triggered by stigma, for example, sadness and anger.
      Be Aware That Although It May Not Seem Reasonable For Them To Believe Stereotypes To Be True, They May Still Be Feeling Them. Be cautious about delegitimizing, diminishing, or dismissing emotions by saying things like, “you shouldn’t feel that way” or “why do you feel that way?” This may provoke an emotionally defensive response.
      When Someone Is Willing To Discuss Their Self-Stigma, Simply Listen. Empathize and validate their emotions. Engaging with peers, including conversations about stigma, can help normalize the feelings associated with self-stigma and allow for a “collaborative” resistance to stigma.
      Increased Availability Of Telebehavioral Health Services Can Also Help Alleviate The Stigma Around Mental Health
      The recent increased availability of telebehavioral health services has also been shown to help decrease self-stigma in accessing treatment for mental health issues. Since people don’t have to leave their house to access mental health professionals, no one is aware they’re receiving treatment. For those who worry about being treated differently because of their mental illness, this extra level of privacy has had significant positive effects. Virtual behavioral health services obviously also increase access for those with mobility issues or who live in areas that don’t have enough mental health providers.
      Considering A Career In Telebehavioral Health Or Know Someone Who Could Benefit From Virtual Access To Licensed Professionals?
      Telemynd offers patients the ability to connect with providers from the safety and convenience of their homes. Providers can join our network by applying online. If you’re a patient, choose your current insurance provider to request an appointment online or call our live support for assistance in scheduling care today!
      Sources
      Mental Health America (MHA): Access to Care 2020
      National Alliance on Mental Health (NAMI): The Many Impacts of Self-Stigma
      American Psychiatric Association: Stigma and Discrimination Around Mental Health
    2. When Soldiers Return Home: Mental Health & Adjusting to Life Post-Deployment

      With the recent announcement that the U.S. will withdraw all its forces from Afghanistan by September 11th of this year, we thought it was a good time to look at the issues that veterans may face adjusting to life post-deployment. Over 2.2 million troops - men and women - have served in the conflicts in Iraq and Afghanistan since 2003. While many service members readjust to life after being deployed, many do not.
      An Assessment of Readjustment Needs of Veterans, Service Members and Families by the Institute of Medicine of the National Academies found that many service members returning from the conflicts in Iraq and Afghanistan “report that their experiences were rewarding, and they readjust to life off the battlefield with few difficulties. Up to 44%, however, return with complex health conditions and find that readjusting to life at home, reconnecting with family, finding work, or returning to school is an ongoing struggle...These military personnel often have more than one health condition. The most common overlapping disorders are PTSD, substance use disorders, depression, and symptoms attributed to mild TBI.
      Common Challenges Facing Soldiers Readjusting To Life At Home
      Soldiers face unique challenges when they separate from military service and return to civilian life. Even the most resilient find adjustment somewhat stressful; unfortunately these challenges are also associated with mental health disorders like PTSD, depression and anxiety.
      Post-Deployment Adjustment Challenges Include:
      Relating to civilians who do not know or understand what they’ve experienced in the field.
      Families may have created new routines during deployment. 
      A returning vet may have never applied or interviewed for a civilian job, and needs to figure out how to translate their military skills into civilian terminology for a resume.
      Or if returning to a job, they may need to catch up, learn new skills, or adjust to a new position.
      No clear chain of command or hierarchy outside the military; they don’t know where to go for help.
      Learning how to buy clothing, groceries and other seemingly mundane civilian needs, and having to negotiate the overwhelming choices of civilian shopping outside the PX.
      Adjusting to subtle nuances in social conversations and workplace lingo that are unfamiliar.
      These are just a few of the logistical adjustments that returning soldiers must make, never mind the emotional adjustments they face, such as losing an immediate support group of fellow troops, recovering from the loss of friends who died overseas, feeling isolated and alone among people who don’t understand what they experienced, feeling challenged by a new civilian job, having to renegotiate family relationships, and dealing with good and bad memories of deployment. And this commonly (and understandably) leads to problems with mental health.
      Mental Health Issues Among Returning Veterans
      They call them “war’s invisible wounds.” While physical wounds are easy to identify, the psychological wounds of war are often not as easy to spot. Multiple studies have found a link between combat experiences and mental health issues related to military service. And it's not just soldiers who suffer - one study found that lengths of deployments are associated with more emotional difficulties and mental health problems among military children and spouses too. Below are three of the most common mental health issues associated with returning soldiers.
      Post-Traumatic Stress Disorder (PTSD)
      Traumatic war-time events such as military combat and violent accidents or deaths in the field involving themselves or unit members can have long-lasting negative effects such as trouble sleeping, anger, nightmares, feeling constantly jumpy, and alcohol and drug abuse. Many vets find that these symptoms are in fact Post-Traumatic Stress Disorder (PTSD). A JAMA Psychiatry study found the rate of PTSD to be 15 times higher in returning veterans than in civilians.
      Depression & Anxiety
      Overall, the rate of depression in returning vets is 5 times higher than for civilians.However, research has found that depression is currently one of the most prominent health conditions among female veterans, who experience higher rates of depression than their male counterparts. Women who have been exposed to combat during deployment or witnessed the injury of unit members and civilians in war zones are especially vulnerable to depression and anxiety — all of which makes readjustment that much harder. Over half of all female veterans have needed to access mental health treatment with a primary diagnosis of depression and/or anxiety disorder.
      Suicide
      Suicide is a particular concern that has emerged for veterans, who experience a 50% higher incidence than the general population. And like depression and anxiety, female veterans have an 80% higher incidence of suicide than male veterans. A recent study of active-duty soldiers and veterans found that 3% of men and 5.2% of women reported suicidal ideation in the previous year. And of those who reported suicidal ideation, 8.7% also reported a recent suicide attempt. This is a trend that must be stopped.
      Tips For Acclimating Upon Return 
      These are just a few tips to help with the transition from deployment to civilian life:
      Allow yourself to feel all kinds of emotions. Give yourself permission to feel the way you feel, even if it’s uncomfortable. Go easy on yourself and give readjustment time to unfold.
      Talk about how you’re feeling with family and friends. Your loved ones may not know how to ask about your experience, but talking about your feelings can be an important part of the readjustment process. 
      Try not to overbook yourself. You may have lots of things on the post-deployment to-do list, but give yourself time to ease back into your routine. And give yourself a break if it doesn’t all feel comfortable right away.
      Limit your use of alcohol. Drinking too much can confuse your thinking, cloud judgment, and exacerbate mental health disorders.
      Watch spending. It's very common to want to celebrate your return with a new car or electronics, but those bills can catch up quickly and cause extra stress at a time you don’t need it.
      Most importantly, know when to seek help. If you or a loved one are feeling signs of stress — either physical or emotional — seek expert help from a behavioral health specialist as soon as possible. (And if you or a loved one are suicidal, contact the National Suicide Prevention Hotline at 1-800-273-TALK (8255), Option 1). 
      Consider Telebehavioral Health
      Telemynd supports veterans and their families. Through our national partnership with TRICARE, we’re able to offer you and your beneficiaries access to licensed therapists or psychiatrists from the convenience and privacy of your own home. Request an appointment online or call our live support for assistance in scheduling care today!
      Sources
      Institute of Medicine of the National Academies
      U.S. Department of Veterans Affairs
      American Psychological Association
    3. What’s the difference between stress and burnout?

      Stress and burnout are concerning - especially regarding our work lives. A recent Deloitte study found that 91% of people say that having an unmanageable amount of stress negatively impacts the quality of their work. Additionally, 77% say they’ve experienced burnout at their current job, with more than half citing more than one occurrence.
      But is there a difference between stress and burnout? Is burnout a kind of stress? Is stress at work always bad? And what can be done about both? In this article, we look at what the research says about the difference between stress and burnout, and how to prevent chronic stress from becoming burnout. 
      What is burnout? What is stress?
      In 1974, psychologist Herbert Freudenberger first coined the term “burnout” - which he said usually occurs within the context of work - to mean emotional exhaustion, depersonalization, and feelings of inefficiency or lack of accomplishment. His studies found that burnout diminishes productivity and ultimately leads to a lesser quality of work. 
      Stress is a physical or mental response to any external cause. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time (chronic stress). Stress can be a negative factor (scientists call this dysfunctional stress) or a positive one (called functional stress or eustress). 
      Surprised about that last part? Yes, stress can be good - in the right context. The American Psychological Association defines functional stress as “stress that involves optimal levels of stimulation resulting from challenging but attainable, enjoyable or worthwhile tasks. It has a beneficial effect by generating a sense of fulfillment or achievement and facilitating growth, mastery, and high levels of performance.” So for example, functional stress can help you perform better in an athletic event or get a job done more quickly at work.
      When too much stress becomes burnout
      However, if stress interferes with your everyday life, causes you to avoid doing things you normally like, or seems to be always present, you may have tipped the scales over into burnout. A recent research review suggests burnout is on the extreme far end of the stress continuum. When you are stressed, although it may feel miserable, you can still take steps to cope with pressures. But once burnout takes hold, you’re emotionally fatigued and have more than likely given up hope of overcoming obstacles. You have less ability to cope with regular stress. Your interests and motivation dry up, and you may fail to meet even the smallest obligations. 
      Here are additional symptoms of burnout:
      Lowered immunity to illness Withdrawal from coworkers and social situations Job absenteeism and inefficiency Sleep deprivation Foggy thinking and trouble concentrating Lack of joy Recent research on the relationship between stress and burnout found that work stress and burnout are mutually reinforcing; however, the effect of work stress on burnout is smaller than the effect of burnout on work stress. This means that the more severe a person's burnout becomes, the more stressed they’ll feel at work. 
      Try these tactics for keeping burnout in check
      Bottom line, don’t let negative stress tip over into burnout if you can help it. Experts suggest these self-care tips for keeping burnout in check:
      Focus on very short-term and realistic goals and wins Make time for yourself Take a break from the situation, if at all possible Exercise, and make sure you are eating healthy, regular meals Stick to a sleep routine, and make sure you are getting enough sleep Avoid drinking excess caffeine Identify and challenge negative and unhelpful thoughts Reach out to friends or family who help you cope in a positive way If none of these tactics work, speaking with a mental health professional is your next step before you experience severe burnout. They can help you develop new coping skills and provide a safe space to vent. They may suggest trying a combination of medication with your therapy. Each person is unique and will respond differently to each technique. Your therapist can help you find the right combination for you.
      Sources
      Journal Personality and Individual Differences: Stress and burnout: The significant difference
      NIH: Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions
      Frontiers in Psychology (Journal): Is Burnout Primarily Linked to Work-Situated Factors? A Relative Weight Analytic Study
    4. What Undiagnosed ADHD Looks Like In Adults

      We focus so often on the treatment of ADHD (attention deficit hyperactivity disorder) in children, that tend to overlook the fact that just as many adults are living with the condition; experts suggest even more remain undiagnosed. While some children outgrow their ADHD symptoms, up to 70% will continue being treated into adulthood.
      ADHD in adults follows a slightly different pattern than in children, as symptoms tend to evolve and may become more subtle over time. For example, adults with ADHD tend to have more problems with memory and attention rather than with hyperactivity.
      Adult Symptoms Of ADHD & The Impact On Daily Life
      In order for an adult to be diagnosed with ADHD, the must meet the following criteria in accordance to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): six or more symptoms of inattention that have lasted at least six months, or six or more symptoms of hyperactivity and impulsivity that have persisted at least six months.
      Specific Symptoms Of ADHD In Adults May Include:
      Forgetting names and dates
      Missing deadlines and leaving projects unfinished
      Chronically late for work or important events
      Becoming easily distracted and disorganized
      Low frustration tolerance
      Putting off boring tasks in favor of more enjoyable activities
      Trouble multitasking
      Executive function deficits
      Excessive activity or restlessness
      Extreme emotionality and rejection sensitivity
      Generalized anxiety and mood disorders 
      Blurting out inappropriate or hurtful thoughts
      The effects of adult ADHD are an overall inability to remain focused to follow through with responsibilities and an overwhelming accumulation of incomplete tasks — impacting careers and relationships over time.
      Adults With ADHD Often Remain Undiagnosed
      There is an abundance of materials focused on the general education of signs to look for in children with ADHD, but not nearly as much on awareness for similar symptoms and diagnosis in adults. That’s why some experts believe up to 75% of adults who have ADHD don’t know they have it. Without knowledge or outreach for treatment, day to day life can be much more challenging and lead to false feelings of inferiority. In fact, studies show that substance abuse as well as other compulsive bad habits impact a far higher percentage of adults with undiagnosed ADHD than the general population.
      So What Can Be Done?
      We need to better inform the public and broaden the conversation surrounding ADHD to include the adult population and eliminate common misconceptions & stereotypes that surround ADHD as “only a childhood condition affecting hyperactive kids”.
      If you are able to recognize these symptoms in yourself or someone you know, consider checking in with a mental health specialist who can conduct a clinical assessment to diagnose ADHD. Neuropsychological tests are often used for diagnosis. These can include timed, computer-based tests to measure attention and problem-solving skills. Neuropsych testing is not essential to making a diagnosis, but it can help shed light on how ADHD can be affects your daily life. It can also uncover potential coexisting conditions.
      Once Diagnosed, Adult ADHD Is Highly Treatable
      Getting the right diagnosis and proper treatment can be life-changing. Adults with ADHD don’t outgrow the condition, but most learn to manage it to great success. Standard treatments for ADHD in adults usually involve a combination of medication, education, skills training and psychological counseling. As with most treatments, it may take some time to determine what works best for each person, so stick with it.
      Considering A Career In Telebehavioral Health Or Know Someone Who Could Benefit From Virtual Access To Licensed Behavioral Health Professionals?
      Telemynd offers patients the ability to connect with providers from the safety and convenience of their homes. Providers can join our network by applying online. If you’re a patient, choose your current insurance provider to request an appointment or call our live support for assistance in scheduling care today!
      Sources
      Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): Diagnosis of ADHD in Adults
      American Family Physician: Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults
      Harvard Medical School - Harvard Health Letter: Recognizing and managing ADHD in adults
    5. What Toll Do Natural Disasters Take On Our Mental Health

      The news is full of stories of natural disasters - hurricanes, tornadoes, blizzards, forest fires, floods, and more. In fact, the number of disasters has increased 5 times over the past 50 years - driven by climate change and the weather extremes caused by it. And the trend won’t be changing anytime soon. But beyond the dramatic pictures on the news of homes and businesses underwater or destroyed by fire - what is the psychological toll that natural disasters take? In this article, we look at the link between natural disasters and mental health, and what can be done to address it.
      Research shows a clear link between natural disasters and mental health
      The impact of a natural disaster is often measured by obvious numbers such as fatalities and injuries, number of homes and buildings destroyed, and the cost of cleanup and repair. But those numbers don’t account for the emotional wounds suffered by survivors. Last year, the Federal Emergency Management Agency (FEMA) said, “the toll that disasters put on mental health is well documented… and more Americans are affected by climate-driven disasters every year”. 
      Multiple studies show that natural disasters often result in a  large number of ‘psychological casualties’. One well-known study, conducted after Hurricane Katrina, found that suicide and suicidal ideation more than doubled in survivors, with 1 in 6 people meeting the diagnostic criteria for PTSD. The study went on to say that the potential for immediate and severe psychological trauma after a natural disaster is high, and related to “personal injury, injury or death of a loved one, damage to or loss of personal property (e.g., home) and pets, and disruption in or loss of livelihood”.
      Another report suggests that natural disaster survivors are at higher risk for depression, anxiety, and other mental health conditions; even more specifically, people whose homes had suffered from adverse weather events had a 50% increase in risk for mental health issues. Following Hurricane Sandy, a telephone screening of local residents 6 months afterward, identified 15% of adults still suffering from PTSD.
      How does our body and brain react to trauma like natural disaster?
      When any kind of trauma occurs, the brain stem - the part of the brain which is responsible for the most vital functions of life (breathing, blood pressure, heart rate, etc.) - takes over. The brain stem kicks in the “fight or flight" response and all nonessential body and mind functions are shut down so that we can focus only on what we need to survive. When the threat ceases, the parasympathetic nervous system - that part of the brain that controls activities that occur when the body is at rest - steps in again and resumes the higher functions that were recently shut down. 
      However, for some trauma survivors, after-effects remain. Some survivors become so distressed that they become withdrawn or increase their use of drugs and alcohol. Even after the disaster ends, many people continue to feel an enormous amount of stress and anxiety that, if not dealt with, can turn into long-term mental health problems. Chronic stress can impair the parts of the brain which govern reason and self-control — leading to more unhealthy choices and an increased likelihood of addiction. 
      To add to the suffering, after a natural disaster many are unable to return to work, lack strong social support, or suffer the added financial burden of repairing or replacing damaged property. The long rebuilding process can perpetuate feelings of uncertainty and chronic stress. More vulnerable populations - children and the elderly, for example - are especially susceptible to mental health impacts of natural disasters. They may experience changes in behavior, memory, or executive function.
      Other common psychological responses in the days and weeks following a disaster can be:
      Disbelief Fear and anxiety about the future Disorientation; difficulty making decisions or concentrating Apathy and emotional numbness Nightmares about the event Irritability and anger Sadness and depression Feeling powerless Changes in eating patterns; loss of appetite or overeating Headaches, back, or stomach pains  Difficulty sleeping or falling asleep What can be done to better help survivors of natural disasters?
      Implementing targeted psychological care is critical to saving lives, jobs, and families after a natural disaster. Many have advocated for local and federal government agencies to incorporate psychological recovery programs into their disaster preparedness plans - and that has been happening - but slowly.
      On a local level, experts urge survivors to recognize that symptoms of mental health issues after a disaster are normal. And asking for help is not a weakness. To move toward healing, survivors can:
      Talk about the event: share experiences with others in order to relieve stress. Spend time with friends and family: stay in touch with family outside the area by phone if possible.  Get plenty of rest and exercise, and eat properly. Avoid drugs and excessive drinking: drugs and alcohol may seem to temporarily remove stress, but in the long run, they create additional problems. Limit exposure to images of the disaster: it’s tempting, but watching news about the event over and over increases stress. Take one thing at a time: pick one urgent task and work on it, then once you accomplish that task, choose the next one, and so on. Join a support group of individuals with similar life experiences. Ask for more help when you need it: if you have strong feelings that won’t go away or if you are still struggling more than 4-6 weeks after the event, seek professional help.  Don’t try to cope alone. If you’ve been involved in a natural disaster and need help with mental health issues, consider contacting a qualified mental health professional
      If you’re a client, request an appointment online or call our live support for assistance in scheduling care today. Our mental health professionals are trained in multiple mental health disorders and have experience treating them. If you’re a behavioral health provider looking to join our network, see all the benefits and learn how to apply here.
      Sources
      Journal Family Medical Primary Care
      Current Psychology
      International Journal of Emergency Mental Health and Human Resilience
      Scientific American
    6. What is Generalized Anxiety Disorder?

      Feeling nervous about life? Having a hard time concentrating or relaxing because you worry all the time? Can't shake the feeling that something bad will happen and you are unprepared?  You’re not alone.
      If you are in a chronic state of anxiety and stress, you may have Generalized Anxiety Disorder (GAD), which can make a person feel constantly worried even when there is little or no reason to. You may worry about missing a deadline, losing a job or a loved one, or having an accident. You may even worry about worrying too much. The stress can become debilitating and can lead to a loss of perspective on your current situation.
      Definition of Generalized Anxiety Disorder
      Generalized Anxiety Disorder is characterized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as “6 months or more of chronic, exaggerated worry and tension that is unfounded, or much more severe than the normal, everyday worry most people experience”.  An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives. The disorder can begin at any age, and affects children as well as adults. 
      The good news is that GAD is treatable.
      Symptoms of GAD
      People with GAD can't rid themselves of the feeling of worry, even while recognizing that it may be unwarranted. They may be unable to relax and have trouble falling or staying asleep. In addition, they may:
      Feel restless, irritable or feel “on edge”
      Have a hard time concentrating
      Be easily startled
      Feel easily tired or exhausted all the time
      Have headaches, muscle aches, or stomach aches 
      Have a hard time swallowing
      Tremble or twitch
      Feel sweaty, light-headed or out of breath
      Feel nauseous or tingling in the extremities
      Have to go to the bathroom a lot
      Experience hot flashes
      Causes and risk factors
      Scientists find that anxiety disorders result from a combination of genetic, behavioral, and developmental causes. Risk factors include a family history of anxiety and recent periods of stress. People with certain personality traits, such as shyness, may also be more vulnerable to developing anxiety disorders.
      Physiologically, scientists believe that GAD probably arises from over-activation of the brain mechanism responsible for fear and the “fight-or-flight” response. The amygdala is the part of your brain that initiates a response to perceived danger. It communicates with the hypothalamus which then releases hormones that raise your heart rate and blood pressure, tense your muscles, and ready your body to fight or run. According to scientists, in people with GAD, the amygdala may be so sensitive that it overreacts to situations that aren't really threatening, inadvertently provoking an emergency stress response. Over time, anxiety can become attached to thoughts that are not related to true sources of danger -  in a sense, “the brain may inadvertently create its own fears”.
      How does GAD impact daily life?
      All of us worry about everyday things - how we are going to get all our errands done while staying on top of work deadlines; how we’ll pay for the next vacation or the kids’ college education; how we’ll take care of an aging parent or deal with an in-law at the next family holiday. These are all normal.
      It’s when this worry becomes uncontrollable, lasts for months at a time, and interferes with our ability to function, that it’s time to seek a behavioral health professional to diagnose potential GAD. Adults who have been diagnosed with Generalized Anxiety Disorder say things like, “I dreaded going to work because I couldn’t keep my mind focused”, or “I was having trouble falling asleep every night because my mind was racing with worry, so I was always tired”, or “I was irritated with my family all the time”.
      If you or your loved one are in the military or serve as a first responder, there is already a justifiable amount of things to worry about, such as separation from those you hold dear, frequent moves, or parenting alone while a loved one is deployed; however this worry can sometimes develop into something more. Active duty military as well as veterans can develop anxiety disorder after experiencing trauma, or during high-stress situations, such as the transition from military to civilian life. In fact, the VA stated there was a 327% increase in reported anxiety disorders among service members between 2000 and 2012. Caring for a loved one with anxiety disorder presents its own challenges, and you want to make sure you have the best professional resources available to help.
      Children and teens are also susceptible to developing an anxiety disorder. According to NIH, an estimated 31.9% of adolescents have some form of anxiety disorder. Symptoms are identical to adults - excessive, chronic worry plus physical symptoms. Children with GAD tend to dwell about the same things as their non-anxious peers, but do so in excess. They may focus obsessively on things they see in the news, such as forest fires or crime. These worries and symptoms can impair daily functioning, and may cause them to avoid activities that trigger or worsen their feelings of stress, so school work and relationships suffer.
      Treatment for Generalized Anxiety Disorder
      GAD can be treated with a combination of therapy, medication, or both. Speak  with a behavioral health professional on how best to approach a treatment that is right for you. In some cases, a healthy lifestyle including good diet, exercise and the right amount of sleep can help reduce symptoms.
      Although different techniques may work for different people, a therapist can help you identify new ways of thinking and reacting to situations that help you feel less anxious. You may be advised to track your responses over time to discover potential behavior patterns, or learn techniques to promote relaxation. Both medication and therapy take time to work, so it is recommended to continue with your prescribed regimen and not get discouraged too quickly. This is manageable, and there is help to cope with these feelings. You can feel better.
      Feeling like you or a loved one may have some of the anxiety symptoms described here? 
      Telemynd is a nationally delegated telebehavioral health provider for TRICARE members. You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists from the convenience of your home. You can review benefit coverage or visit our request appointment page to choose your current insurance provider and get started!
      Sources
      NIH | National Institutes of Mental Health: Generalized Anxiety Disorder
      American Psychiatric Association: What are Anxiety Disorders?
      Harvard Mental Health Letter: Generalized Anxiety Disorder
      National Alliance on Mental Health Illness: Anxiety Disorders
    7. What Is Bipolar Disorder?

      Bipolar Disorder, formerly called Manic Depression, is a mental illness associated with dramatic shifts in mood, energy, and the ability to think clearly. Individuals with Bipolar Disorder experience repeated and significant mood swings, or ‘episodes’, that can make them feel very high (manic) or very low (depressive). These moods differ from the typical ups-and-downs most people experience. 
      The condition affects men and women equally, impacting approximately 2.8% of the U.S. population. The average age of onset is 25, but it can also occur in teens. With a good treatment plan including therapy, medications, and a healthy lifestyle, individuals can manage their symptoms effectively.
      Definition of Bipolar Disorder
      There are three types of Bipolar Disorder, according to NIH | National Institutes of Mental Health:
      Bipolar I Disorder: when people experience one or more episodes of mania. Most people diagnosed with Bipolar I have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with Bipolar I, manic episodes must last at least seven days or be so severe that hospitalization is required.
      Bipolar II Disorder: when depressive episodes shift back and forth with hypomanic episodes, but never a “full” manic episode.
      Cyclothymic Disorder: a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. They may have brief periods of normal mood, but these periods last less than eight weeks.
      In addition, some individuals experience symptoms of Bipolar Disorder that do not exactly match the three categories listed above, and are referred to as “other specified and unspecified Bipolar Disorders”.
      Symptoms of Bipolar Disorder
      According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), symptoms of Bipolar Disorder break down into manic and depressive symptoms, depending on what kind of episode is happening. During an episode, the symptoms listed below may last every day for most of the day, and episodes may last for several days or weeks.

      It can sometimes be more difficult to identify symptoms of Bipolar Disorder in teens than in adults since moodiness is common in teens anyway. If you or a loved one are experiencing any symptoms, be sure to check with a behavioral health professional who can rule out Bipolar Disorder or make an official diagnosis.
      Causes And Risk Factors Of Bipolar Disorder
      Most scientists agree that there is no single cause of Bipolar Disorder and it’s likely that multiple factors contribute to an individual’s chance of having the illness. Factors that may increase the risk of developing Bipolar Disorder, or act as a trigger for the first episode include:
      Having a first-degree relative, such as a parent or sibling, with the disorder
      Periods of high stress, such as the death of a loved one or other traumatic event
      Drug or alcohol abuse
      Treatment For Bipolar Disorder
      Bipolar Disorder is very treatable. Medication or a combination of therapy and medication are used to manage the disorder over time. Since people respond to treatment in different ways, those with Bipolar Disorder may need to try different combinations of medications and therapy before finding the plan that works for them.
      Bipolar Disorder doesn't get better on its own. If you or a loved one have any of the symptoms of depressive or manic episodes listed above, see a behavioral health professional. Treatment can help keep your symptoms under control.
      Do you or a loved one have symptoms of Bipolar Disorder? 
      Telemynd is a nationally delegated telebehavioral health provider for Tricare members. You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists who can diagnose and provide treatment for Bipolar Disorder from the convenience of your home. Click here to find your current insurance provider to request an appointment today!  
      Sources
      American Psychiatric Association: What Are Bipolar Disorders?
      National Alliance on Mental Illness (NAMI): Bipolar Disorder
      NIH | National Institutes of Mental Health: What Is Bipolar Disorder?
    8. What Is ADHD? (Attention-Deficit/Hyperactivity Disorder)

      Everybody can have trouble sitting still or paying attention now and then. However, for some people, it’s so difficult that it interferes with school, work, and social life. These individuals may have ADHD (short for Attention-Deficit / Hyperactivity Disorder), one of the most common neurodevelopmental disorders of childhood – and for many, it lasts well into adulthood. Approximately 9% of children and 5% of adults have been diagnosed with ADHD, and professionals believe there are likely more who are undiagnosed. Fortunately, our society has become more cognizant of ADHD symptoms, so there’s a better chance of catching it early and getting treatment.
      Definition of ADHD
      ADHD is defined as a “persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”.
      Scientists first documented children exhibiting inattentiveness, impulsivity, and hyperactivity in 1902. Since that time, the disorder has had many names. Previously known as simply ADD, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), renamed the disorder Attention-Deficit / Hyperactivity Disorder, which better reflects the importance of the inattention part of the disorder as well as the other characteristics of hyperactivity and impulsivity.
      Symptoms and Diagnosis of ADHD
      The DSM-5 criteria for ADHD are lengthy, and are slightly different for children vs. adults.
      To be diagnosed with Inattention, 6 or more of the symptoms below must be present for children up to 16 years old, while 5 or more symptoms must be present for those 17 years and older. Symptoms must be present for at least 6 months, and be disruptive and inappropriate for developmental level:
      Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
      Often has trouble holding attention on tasks or play activities.
      Often does not seem to listen when spoken to directly.
      Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
      Often has trouble organizing tasks and activities.
      Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
      Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
      Is often easily distracted
      Is often forgetful in daily activities.
      To be diagnosed with Hyperactivity and Impulsivity, 6 or more of the symptoms below must be present for children up to 16 years old, while 5 or more symptoms must be present for those 17 years and older. Symptoms must be present for at least 6 months, and be disruptive and inappropriate for developmental level:
      Often fidgets with or taps hands or feet, or squirms in seat.
      Often leaves seat in situations when remaining seated is expected.
      Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
      Often unable to play or take part in leisure activities quietly.
      Is often “on the go” acting as if “driven by a motor”.
      Often talks excessively.
      Often blurts out an answer before a question has been completed.
      Often has trouble waiting their turn.
      Often interrupts or intrudes on others (e.g., butts into conversations or games)
      In addition, the following conditions must be met:
      Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
      Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
      There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
      The symptoms are not better explained by another mental disorder (such as anxiety disorder, dissociative disorder, or a personality disorder). 
      Causes And Risk Factors
      Scientists are not sure what causes ADHD, although many studies suggest that genetics plays a big role. In addition, researchers are looking into possible environmental factors such as lead paint, and are also studying how brain injuries, nutrition, and social environment might contribute to ADHD.
      Scientists do know that the risk of ADHD can increase with the following factors:
      Close relative, such as a parent or sibling, has ADHD or other mental health disorder
      Alcohol or drugs during pregnancy
      Premature birth
      How Does ADHD Impact Daily Life?
      Children with ADHD often experience delays in independent functioning and may seem to behave younger than their peers. They may also have mild delays in language, motor skills, or social development that are not part of ADHD, but often co-occur. Kids with ADHD tend to have low frustration tolerance, difficulty controlling their emotions, and often experience mood swings. Ultimately, they’re at risk for potential problems in adolescence if the ADHD is not diagnosed and treated, such as academic failure or delays, difficulties with peers, risky behavior, or substance abuse. Early identification and treatment by a behavioral health provider is extremely important.
      Many adults who have ADHD don’t know it. They may feel that it’s difficult to get organized, stick to a project or job, or remember to keep appointments. Daily tasks such as getting up in the morning, getting ready for work, arriving on time, and being productive on the job can be especially challenging for adults with undiagnosed ADHD.  Adults with ADHD have difficulties with attention, focus, executive function, and working memory. If you feel you or your loved one have any of these symptoms, check in with a behavioral health provider who can diagnose and treat you – individuals with ADHD can be very successful in life with the right help!
      Treatment for ADHD
      ADHD can be treated with a combination of support, therapy, and medication. Speak with a behavioral health professional to learn how best to approach treatment that is right for you or your loved one. They will assess current symptoms and history to determine the best treatment plan.
      For example, certain kinds of therapy can help individuals with ADHD become more aware of their deficits in attention or focus and can provide skills for improving organization and efficiency in daily tasks. Therapy may also address feelings of low self-esteem, and help control impulsive and risky behaviors. 
      Do you or a loved one have symptoms of ADHD? 
      You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists who can diagnose and provide treatment for ADHD from the convenience of your home. Click here to find your current insurance provider and request an appointment today!  
      Sources
      Centers for Disease Control (CDC): What is ADHD?
      Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): ADHD
      NIH | National Institutes of Mental Health: What is ADHD?
    9. Watch & Learn: Top Ted Talks About Mental Health

      Last week, we curated 8 informative podcasts [link] about mental health, and this week, we continue our mental health resources series in a more visual medium. Listed below are 8 compelling and illuminating TED Talk videos about mental health. TED Talk videos are described as “the best talks and performances from the TED Conference, where the world's leading thinkers give the talk of their lives in 18 minutes or less”.
      Topics range from depression to PTSD to schizophrenia and everything in between; and from mental health issues for teens to mental health issues for veterans. The nice thing about TED Talks is that each video is short - meaning you can watch and learn a lot in a small amount of time - maybe even squeeze one in between classes or meetings, or while waiting in line at the coffee shop. 
      Feel free to bookmark this page, go through the videos, and share with friends, family, or if you are a clinician, patients who may also benefit.
      There's no shame in taking care of your mental health - Entrepreneur Sangu Delle found himself suffering from anxiety and depression but up against the stigma that seeking help meant weakness. In this inspiring TED Talk, he describes confronting his own deep prejudice: that men shouldn't take care of their mental health, and then shares how he learned to handle anxiety in a society that's uncomfortable with emotions.
      The voices in my head - She started off college like every other student: hopeful, energized, and ready to meet the world. But author Eleanor Longden soon began hearing voices in her head. Soon the voices became antagonistic, turning her life into a nightmare. Finally diagnosed with schizophrenia and hospitalized, she describes the moving tale of her years-long journey back to mental health.
      Confessions of a depressed comic - “For a long time, I felt like I’d been living two lives…” So starts comedian and perpetual “life of the party” Kevin Breel’s story of the night he realized he had to admit he was suffering from depression in order to save his life. Inspiring and relatable tale of how what looks like a happy life from the outside might not necessarily be so.
      We train soldiers for war. Let's train them to come home, too - Frontline psychologist Hector Garcia urges society to help our soldiers better learn how to transition from the battlefield back to civilian life. He tells stories of real soldiers suffering from PTSD and explains how we can improve our care of veterans’ mental health.
      Why students should have mental health days - Teen mental health advocate Hailey Hardcastle describes how school days can be rife with stress, anxiety, panic attacks, and burnout – but there's often no formal policy to help students prioritize their mental well-being. We have “sick” days but no “mental health” days. She advocates for that to change.
      The brain-changing benefits of exercise - Author and Professor of Neuroscience and Psychology at New York University, Wendy Suzuki discusses the science of how exercise boosts our mood and how it can be used to work alongside therapy and pharmaceutical solutions to address mental health issues.
      How to connect with depressed friends - Very useful and actionable discussion on how to approach friends who may exhibit symptoms of depression or have been diagnosed with depression. Comedian and storyteller Bill Bernat provides ‘dos and don'ts’ for talking to people living with depression - and how to handle the conversation with grace and maybe even a little humor.
       
      Break the silence for suicide attempt survivors - Host JD Schramm addresses this very sensitive topic with care and concern. He advocates for resources for suicide attempt survivors because “it gets better”, and hopes that those who have tried and failed but found their way back to a meaningful life may be willing to speak up to convince those thinking about suicide that their lives matter. [If you or a loved one have thoughts of suicide, call the National Suicide Hotline at 800-273-8255.]Are there any TED Talks that you would add to the list? Let us know in the comments.
      If you or a loved one need help with mental health issues, consider contacting a qualified telebehavioral health professional
      If you’re a client, request an appointment online or call our live support for assistance in scheduling care today. Our mental health professionals are trained in multiple mental health disorders and have experience treating them via online appointments - from the convenience and privacy of your home or wherever works for you. If you’re a behavioral health provider looking to join our network, see all the benefits and learn how to apply here.
    10. Using an HSA or FSA to Offset the Cost of Mental Health Care

      Mental health care is critical to maintaining overall wellness - just as important as caring for your physical health. And as we noted in a recent article, 1 in 5 of us live with mental health issues on a daily basis. As many as 30% of those with a mental health issue don’t seek treatment, and a common obstacle to that care is cost. 
      The good news is that you can pay for some mental health treatments and services with your Flexible Spending Account (FSA) or your Health Savings Account (HSA), to offset out-of-pocket expenses. This week’s article summarizes what mental health services qualify for coverage with FSA and HSA funds and how to use these accounts for mental health care. Be sure to click on the links included in this article, as we’ve referenced the original IRS and government sources for further information.
      What’s the difference between an FSA and an HSA?
      FSAs are an arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. You decide how much to put in an FSA, up to a limit set by your employer. Employers may make contributions to your FSA, but aren’t required to. 
      An HSA is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. HSA funds generally may not be used to pay premiums. While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to an HSA only if you have a High Deductible Health Plan (HDHP) — generally a health plan that only covers preventive services before the deductible. 
      It may sound complicated - but FSAs and HSAs are often a win-win for many people, as they allow you to reduce your tax liability and pay for your mental health care expenses, using pre-tax funds.

      Is mental health treatment eligible for HSA or FSA funds?
      According to the IRS, mental health therapy and treatment that is deemed ‘medically necessary’ is eligible for reimbursement with an FSA or an HSA - things like psychiatric care, and treatment for drug or alcohol addiction. So therapy such as marriage or family counseling - that is not required for a medical or mental purpose - may not qualify. The actual wording from the IRS is this: “treatment provided by a psychologist or psychiatrist is eligible for FSA or HSA reimbursement if the purpose of the treatment is for medical care and not for the general improvement of mental health”. Sound a bit murky? The best thing to do is to speak with your your health insurance directly to understand how to approach the situation first. 
      Regardless of the kind of health care services you are getting, an administrator may require you to get a ‘Letter of Medical Necessity’ in order to get coverage. This is a letter written by your doctor that verifies the services you are purchasing are for the diagnosis, treatment or prevention of a disease or medical condition.
      Make the most of your HSA to cover mental health expenses
      The IRS-approved list of mental health care expenses on which you can use your HSA includes services like psychologist visits (including online therapy), psychiatric care, alcoholism and drug treatment, and prescription drugs related to psychiatric care. You can pay for these with an HSA card or by getting reimbursed, but either way, always save your receipts. You’ll need these when you file your tax return each year. You can ask your health care provider for itemized receipts after each service, or a total record of all services at the end of the year.
      If you have health insurance (and remember, it must be a High Deductible Health Plan in order to be allowed to contribute to an HSA), you can use your HSA funds for any qualified expense that’s not paid directly to the provider or for which you’re not reimbursed by your insurance company. This includes co-pays and expenses to meet your deductible, as well as any uncovered medical expense.
      Using an FSA to cover mental health expenses
      Eligible mental health care expenses for which you can use your FSA account include alcoholism and drug treatment, psychiatric care (including online therapy), and prescription drugs related to psychiatric care. You use your FSA by submitting a claim to the FSA (through your employer) with proof of the medical expense and a statement that it has not been covered by your plan. You will then receive reimbursement for your costs. In addition, according to the IRS, you can use FSA funds to pay deductibles and copayments, but not for insurance premiums.
      In summary, understanding how to use FSAs and HSAs to help offset the cost of behavioral health may feel confusing or overwhelming - but it's worth digging into, as these accounts may save you money. For more help, you can ask your employer, an accountant, reference IRS Publication 969, or research online yourself. Here’s a good article that goes into more detail - in an understandable way - about the differences between HSAs and FSAs.
    11. Understanding Post-Traumatic Stress Disorder (PTSD)

      It's normal to have upsetting memories, to feel stressed, or even to have trouble sleeping after experiencing a traumatic event. But most people start to feel better after a few weeks or months. If you still have intense, disturbing thoughts and feelings related to that experience long after the traumatic event, you may have Post-Traumatic Stress Disorder, commonly known as PTSD.
      Definition of PTSD
      PTSD is a mental health disorder that occurs after experiencing or witnessing an upsetting traumatic event such as a natural disaster, accident, sexual assault, terroristic act, deployment into a  combat zone, or being threatened with death or serious injury. Individuals who have been diagnosed with PTSD may relive the event through flashbacks or nightmares; feel continual sadness, fear, or anger; or an overarching detachment toward those they previously held closest. Strong negative reactions to sensory cues that remind them of the event is another common effect; seemingly “ordinary” loud noises or even an accidental touch could cause a trigger. 
      PTSD affects 3.6% of the U.S. adult population. About 37% of those diagnosed with PTSD are classified as having severe symptoms. If you or a loved one are in the military, the statistics are even higher: 11-20 out of every 100 veterans who served in the wars in Afghanistan and Iraq have PTSD in a given year.
      PTSD often occurs with other related conditions, such as Depression, substance abuse, memory problems, and other mental health problems.
      Know that PTSD is not a weakness. Anyone who experiences trauma is susceptible to developing it. We don’t yet know why some experience stronger PTSD symptoms while others are able to seemingly move past the events, but research continues to be conducted for improved treatment.
      Symptoms of PTSD
      According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), in order to be diagnosed with PTSD, an individual must have all of the following for at least one month:
      At least one re-experiencing symptom (e.g., flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating, bad dreams, or frightening thoughts)
      At least one avoidance symptom (e.g., staying away from places, events, or objects that are reminders of the traumatic experience, or avoiding thoughts or feelings related to the traumatic event)
      At least two arousal and reactivity symptoms (e.g., being easily startled, feeling tense or “on edge”, having difficulty sleeping, having angry outbursts)
      At least two cognition and mood symptoms (e.g., trouble remembering the key features of the traumatic event, negative thoughts about oneself or the world, distorted feelings like guilt or blame, or loss of interest in enjoyable activities)
      Many individuals develop symptoms within three months of the trauma, but symptoms can appear later and often persist for months or years. It’s best to speak with a behavioral health professional to get a clear diagnosis and to find how best to approach a treatment plan that’s right for you.
      Causes And Risk Factors
      Anyone can develop PTSD at any age after a triggering event, but multiple risk factors play a part in determining whether an individual will develop PTSD after a traumatic event or not, including:
      Childhood trauma (related or unrelated to the triggering trauma)
      Feeling horror, helplessness, or extreme fear during and after the event
      Having little or no social support after the event
      Dealing with additional stress after the event, such as loss of a loved one, job or home, or medical injury
      A history of mental illness or substance abuse
      Scientists believe that our “fight-or-flight” instincts – which can be life-saving during a crisis – when extended past the event, can leave us with ongoing, unhelpful symptoms. 
      How Does PTSD Impact Daily Life?
      PTSD can impact our day-to-day routines in many ways, making it difficult to do daily tasks, such as sleeping, eating, or concentrating. It can impact relationships, and our outlook on life. For example, remembering and reliving the initial trauma may cause problems at work or at home – triggering an out-of-perspective or inappropriate emotional response to everyday experiences. Individuals who have avoidance symptoms may do things like avoiding driving or riding in a car. Other individuals may feel stressed and angry all the time or isolated from friends and family. Left untreated, PTSD can cause dependence on drugs or alcohol or avoidance of activities that once made us happy. 
      Treatment for PTSD
      It’s important to know that it’s never too late to get help for PTSD! While it cannot be cured, PTSD is treatable and mitigated in several ways. Treatment typically combines therapy, medication, and self-management strategies, such as self-soothing and mindfulness. Service animals, particularly dogs, often help with reducing symptoms of PTSD.
      Please note, if you or a loved one have thoughts of suicide, you should contact the National Suicide Prevention Hotline at 1-800-273-TALK (8255), Option 1.
      Do You Or A Loved One Have Symptoms Of PTSD? 
      Telemynd is a national telebehavioral health provider covered with many insurers. You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists from the convenience of your home. Click here to find your current insurance provider and request an appointment today!  
      Sources
      NIH | National Institutes of Mental Health: Post-Traumatic Stress Disorder
      American Psychiatric Association: What is Post-Traumatic Stress Disorder?
      Department of Veterans Affairs, National Center for PTSD: PTSD
    12. Understanding Major Depressive Disorder

      Feeling “blue”, “out of sorts”, or “down in the dumps” are ways we describe feelings of sadness or melancholy. Most of us have felt this way at one time or another. However, what’s known as Clinical Depression or Major Depressive Disorder has multiple symptoms in addition to sadness. As well, individuals with true Depression feel these symptoms much more intensely and experience them for longer periods of time.
      Depression is a clinical mood disorder that affects how you feel, think, and behave and can lead to a variety of other problems if left untreated. Depression isn't a weakness and you can't just "snap out" of it. In fact, it may cause you to have trouble doing normal day-to-day activities. Fortunately, with early detection and a treatment plan consisting of medication, therapy, and healthy lifestyle choices, many people can and do manage their depression.
      Definition of Major Depressive Disorder
      After Anxiety, Depression is the most common mental health disorder. According to the American Psychiatric Association, Depression affects an estimated one in 15 adults in any given year, and one in six people will experience it at some time in their life. Depression can occur at any time, but typically first appears during the late teens to mid-20s. People of all ages and all racial, ethnic, and socioeconomic backgrounds experience Depression.
      Depressive Disorders are defined as “feelings of sadness intense enough to interfere with functioning and/or a decreased interest or pleasure in activities”. There are several types of Depressive Disorders and all are commonly called “Depression”. Major Depressive Disorder, the subject of this article, is defined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as experiencing at least 5 of the symptoms listed below nearly every day for a 2-week period, and one of them must be depressed mood or loss of interest or pleasure.
      Symptoms of Major Depressive Disorder
      Multiple, persistent symptoms are required for a diagnosis of Major Depression:
      Persistent sad mood
      Feelings of hopelessness, or pessimism
      Irritability and/or anxiousness
      Feelings of guilt, worthlessness, or helplessness
      Loss of interest in hobbies and normal activities
      Decreased energy or tiredness
      Moving or talking slowly
      Feeling restless
      Difficulty concentrating, remembering, or making decisions
      Difficulty sleeping or conversely, frequent oversleeping
      Appetite changes
      Aches or pains, headaches, cramps, or digestive problems without a clear physical cause 
      If you’ve been experiencing some of these symptoms nearly every day for at least two weeks, you may be suffering from Depression. A behavioral health professional can make an official diagnosis.
      Causes and risk factors
      The exact cause of Depression is unclear, but reduced levels of key neurotransmitters like serotonin, noradrenaline, and dopamine in the brain are believed to play a part in most cases. These are hormones that stabilize your mood, your feelings of well-being, pleasure, happiness, and your capacity to feel energized, so lower levels can have a very negative impact on your well-being and ability to function on a daily basis.
      A number of risk factors may make Depression more likely:
      Heredity (genetic factors contribute to Depression in about half of individuals diagnosed)
      Significantly emotionally distressing events, particularly those involving a loss
      Certain physical and anxiety disorders
      Substance and alcohol use disorders
      Side effects of certain drugs
      Social class, race, and culture do not affect the chance that people will experience Depression during their lifetime.
      How does Depression impact daily life?
      Even though there are many situations in life that can cause sadness and in which we might describe ourselves as being “depressed”, it is important to know the difference between “everyday” sadness and Clinical Depression. Understanding this difference can assist people in getting the help, support, and treatment they need. If you have any doubts about what you are feeling, contact a behavioral health professional who can make an official diagnosis and suggest the best treatment.
      Without treatment, individuals with Clinical Depression may be more likely to use alcohol or other drugs in an attempt to help them sleep or to feel less sad. It’s also been found that those with undiagnosed Depression are more likely to smoke or to neglect their health in other ways. Depression may also reduce the immune system's ability to respond to infection; as a result, people with untreated Depression are more likely to get sick more often.
      All of these things impact our ability to function well on a daily basis, to do our jobs, and to be the best parent, spouse, son, daughter, caregiver, or friend that we can be. Therefore, getting an early diagnosis and treatment plan is critical.
      Treatment for Major Depressive Disorder
      Most Depressive Disorders can be treated with a combination of support, therapy, and medication. Speak with a behavioral health professional on how best to approach treatment that is right for you. They will assess your current symptoms and your history of Depression in order to determine the best treatment plan. Once it is chosen, the plan may change over time depending on how well you respond to the care provided. 
      Expect your mood to improve gradually, not immediately. In some cases, a healthy lifestyle including a good diet, exercise, and healthy sleep habits can also help reduce symptoms. In addition, behavioral health specialists may recommend spending time with good friends and family, rather than isolating yourself, as well as continuing to educate yourself about Depression, as information can feel empowering.
      Please note, if you or a loved one have thoughts of suicide, contact the National Suicide Prevention Hotline at 1-800-273-TALK (8255), Option 1
      Do you or a loved one have symptoms of Depression?
      You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists from the convenience of your home. Click here to find your current insurance provider and request an appointment today!
    13. Understanding Common Phobias

      Over 12% of adults in the US meet the diagnostic criteria for a specific phobia. However, phobias come with much misunderstanding: some people believe they are just ‘overrated fears’ while others believe phobias can’t be overcome. On the contrary - phobias are a mental health issue. And they can be treated. In this article, we’re setting the record straight about common phobias - what they are, what they aren’t, how they are diagnosed, and how to get help.
      What is a phobia?
      Phobias are a kind of anxiety disorder; so they’re in the same diagnostic category as generalized anxiety disorder, but manifest differently. A phobia is defined as an overwhelming and debilitating fear of an object, place, situation, feeling or animal. But phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object. If a phobia becomes very severe, a person may organize their life around avoiding that thing that's causing them anxiety - so phobias can become debilitating. And in some cases, even thinking about the source of a phobia can make a person feel anxious or panicky (known as anticipatory anxiety).
      Types of phobias
      According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), there are three main types of phobias: 
      Specific phobias. Refers to an intense, persistent, and marked fear of a specific object or situation (such as flying, insects, or heights). People with specific phobias may be aware that their anxiety is out of proportion but feel helpless to control it. Agoraphobia. Refers to a deep fear of being in an environment (often outside or with many other people) where escape might be difficult or help unavailable in the event of developing panic-like symptoms. Social phobia. Also called social anxiety disorder; involves acute fear and self-consciousness in social situations. Can lead people to avoid attending events, meeting new people, or even seeking employment. Studies indicate that specific phobias concerning heights and animals/insects are the most common, but here is a list of other common specific phobias for which people seek treatment:
      Acrophobia - fear of heights Aerophobia - fear of flying Aquaphobia - fear of water Astraphobia - fear of storms Claustrophobia - fear of confined or tight spaces Dentophobia - fear of dentists Hemophobia - fear of blood Nosocomephobia - fear of hospitals Zoophobia - fear of animals In all cases, these intense fears are real for the people experiencing them. They are not figments of imaginations nor deliberate exaggerations of fear.
      People with phobias feel very specific and often debilitating symptoms when they come into contact with the source of their fear. Symptoms may include the following if you find yourself around the phobia source:
      unsteadiness, dizziness, lightheadedness nausea sweating increased heart rate or palpitations shortness of breath trembling or shaking upset stomach Risk factors for phobias
      The causes of anxiety disorders like phobias are unknown but likely involve a combination of genetic, environmental, psychological, and developmental factors. Anxiety disorders can run in families, suggesting that a combination of genetics and environmental stresses can result in a diagnosed phobia.
      Help for phobias
      Mental health professionals can diagnose a phobia - and they can be treated successfully. Often treatment involves a combination of exposure, medication and coping strategies - all of which a qualified professional can provide. 
      Scientists are finding that the phobias start out less intense and grow in acuteness over time - suggesting the possibility that interrupting the course of phobias with treatment early on could reduce their prevalence. A recent study, published in Lancet Psychiatry found that, “phobias can persist for several years, or even decades in 10-30% of cases, and are strongly predictive of the onset of other anxiety and mood disorders. Their high comorbidity with other mental disorders, especially after onset of the phobia, suggests that early treatment of phobias could also alter the risk of other disorders.”
      The key takeaway? Consult with a mental health professional as early as possible if you or a loved one believe you have symptoms of a phobia.
      Sources
      Lancet Psychiatry
      Current Topics in Behavioral Neuroscience
      National Institute of Mental Health
    14. Trouble Sleeping? How It Relates To Your Mental Health

      Do you have trouble falling asleep or staying asleep? You may be one of the 50 million adults in the United States with a chronic sleep disorder. For healthy adults, the recommended amount of sleep is seven hours per night. But if you suffer from a sleep disorder, squeezing that many hours into a single night is a real challenge — but shouldn’t be ignored, because our body’s inability to rest could be linked to underlying mental health conditions. A lack of sleep only exacerbates mental health disorders like depression and anxiety, leading to a negative cycle between overwhelming feelings of hopelessness or stress, and restlessness. 
      So, what are sleep disorders, how can we manage mental health symptoms, and what can we do to achieve better sleep?
      Common Sleep Disorders
      In general, sleep disorders are characterized as chronic sleep conditions that impact your quality of life or ability to function. These include trouble falling or staying asleep, falling asleep at the wrong times, and abnormal sleep behaviors. According to the International Classification of Sleep Disorders (ICSD-3), the official description is a “curtailed sleep pattern that has persisted for at least three months for most days of the week, along with complaints of sleepiness during the day”.
      The five most common are:
      Insomnia. Characterized by the inability to initiate or maintain sleep, it may also take the form of very early morning awakening. Often causes excessive daytime sleepiness, which results in functional impairment throughout the day. 
      Narcolepsy. A neurological disorder that affects the brain’s ability to control sleep-wake cycles. People with narcolepsy may feel rested after waking, but then feel very sleepy throughout the day. They may fall asleep even in the middle of an activity.
      Restless Legs Syndrome (RLS). Characterized by an unpleasant “creeping” sensation, originating in the lower legs, but often associated with overall leg pain. This sensation is seemingly only relieved by moving your legs, walking, or kicking - which of course, prevents sleep. 
      Sleep Apnea. People with sleep apnea often make periodic gasping or “snorting” noises while asleep, during which their sleep is momentarily interrupted. If you snore loudly and feel tired even after a full night's sleep, you may have sleep apnea.
      REM Sleep Behavior Disorder (sometimes called Parasomnia). Characterized by abnormal sleep behaviors which manifest in vivid, often frightening dreams associated with movement during REM sleep, people with this kind of sleep disorder appear to “act out their dreams”. Common symptoms include: movement such as kicking, punching, or jumping from the bed in response to action-filled or violent dreams; making noises, such as talking, laughing, or shouting; and being able to recall dreams if you awaken during an episode. 
      The Link Between Sleep Disorders, Depression, & Anxiety

      Scientists have found that 75% of individuals with depression experience sleep disturbances. And unfortunately, the relationship is bi-directional - meaning that not only does depression exacerbate sleep disorders like insomnia, but having a sleep disorder first can actually help bring on depression (if a person is already predisposed). And like the proverbial chicken and egg, often it’s hard to know which came first.
      Researchers believe sleep problems may contribute to depression by way of abnormal changes in the functioning of the neurotransmitter serotonin, the key hormone that stabilizes our mood and provides feelings of well-being. They have found that not enough sleep impacts the way serotonin works, disrupting our circadian rhythms and increasing vulnerability to depression.
      Sleep problems are also a common symptom of anxiety disorders. If you’ve had anxiety, you know that feeling of your brain “racing”, making it almost impossible to sleep. And even after falling asleep, you may wake up with anxiety in the middle of the night. Sleep disruption like this can lead to sleep fragmentation, which reduces both the quantity and quality of sleep. 
      Scientists say that individuals with anxiety disorders have high sleep reactivity - sleep reactivity being the degree to which stress disrupts sleep, manifesting as difficulty falling and staying asleep when a person is highly stressed. Compounding this is something called anticipatory anxiety, which is when individuals with anxiety know they’ll have problems falling asleep, and so their anxiety increases when they go to bed, causing sleeplessness, and ultimately a downward spiral of anxiety and lack of sleep.
      There’s a clear link between sleep disorders, depression, and anxiety. As a result, taking steps to sleep better can have a significantly beneficial effect on quality of life, so it’s important to seek professional help if you’re experiencing sleep problems or think you recognize any of the symptoms discussed above. And fortunately, once diagnosed, sleep disorders are treatable.
      Tips For Achieving Better Sleep
      Persistent problems sleeping increase the risk of relapse for those who’ve been treated for depression or anxiety, but practicing healthy sleep habits can reduce those feelings and can have a beneficial effect on your overall mood.
      Establish a sleep schedule. Creating a routine to sleep can help your brain get accustomed to getting the full amount of sleep. This means having a set wake-up time regardless of whether it is a weekday or weekend. 
      Follow a routine each night. Building a consistent routine such as washing your face and brushing your teeth can reinforce in your mind that it is time for bed.
      Unplug from devices. Set a buffer to unwind without electronics that can cause mental stimulation. Making it harder to calm thoughts. The blue light emitted from these devices can also decrease melatonin production, taking longer for you to achieve REM.
      Don’t force it. If you’re still tossing and turning after 20-minutes, consider getting up and stretching, reading a book, or doing something that calms you using soft lights before returning to bed to try again. This will help build a healthier mental connection between being in bed and falling asleep.
      Diagnosis & Treatment In Conjunction With Mental Health Issues
      In order to diagnose a sleep disorder, a doctor or mental health professional will gather information about your symptoms, as well as medical and mental health history. They may also order tests, such as a daytime or overnight sleep study to determine a diagnosis. Because of the multifaceted relationship between mental health and sleep, it is common for treatment to include both cognitive behavioral therapy (CBT) and prescription medication. With proper treatment underlying causes of disruption can be addressed; allowing you to achieve better quality sleep. 
      Consider Telebehavioral Health
      Telemynd offers patients the ability to connect with providers from the safety and convenience of their homes. If you’re a patient, request an appointment online or call our live support for assistance in scheduling care today! If you’re a behavioral health provider looking to join our network, see all the benefits here & apply. 
      Sources
      American Psychiatric Association
      Sleep Foundation
      Sleep Foundation
      National Institutes of Health (NIH)
    15. Trauma-Informed Care: Understanding Patients’ Life Experiences to Deliver Better Treatment

      Health care providers in the medical and behavioral health fields are increasingly recognizing that experiences of past trauma significantly influence our overall health, our relationships, school, work, and our ability to adopt healthy behaviors. And while we often associate trauma with things like soldiers in war settings, victims of crime, or the death of a loved one, it turns out that multiple life experiences clinically qualify as traumatic. In this article, we explore how the concept of holistic, trauma-informed care can improve the outcomes of mental health treatment.
      What is meant by ‘trauma’?
      Recent studies show that by the time they reach college, 66-85% of 18 year-olds report lifetime traumatic event exposure, with many reporting multiple exposures. That’s a lot. According to the American Psychological Association, trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. But a person may experience trauma as a response to any event they find physically or emotionally threatening or harmful - for example, bullying and other character attacks; loss of a friend or loved one whether through death, moving, or a break-up; emotional, physical or sexual abuse; or even seeing something violent or disturbing. What matters is how the individual perceives an event, not how society judges how an individual should perceive an event.
      According to the Substance Abuse and Mental Health Services Administration, “the effects of traumatic events place a heavy burden on individuals, families and communities. Although many people who experience a traumatic event will go on without lasting negative effects, others will have more difficulty. Emerging research has documented the relationships among exposure to traumatic events, impaired neurodevelopmental and immune systems responses and subsequent health risk behaviors resulting in chronic physical or behavioral health disorders.”
      What is a trauma-informed approach to care?
      Trauma-informed care changes the opening question for those seeking mental health services from “what is wrong with you?” (i.e., patient or consumer) to “what has happened to you?” (i.e., survivor). Trauma-informed care is based on the assumption that every patient seeking services is a trauma survivor who can inform his or her own path to healing, facilitated by support and mentoring from a mental health provider.  A trauma-informed approach to care acknowledges that providers “need to have a complete picture of a patient’s life situation — past and present — in order to provide effective health care services with a healing orientation.”
      The six key principles of a trauma-informed approach are:
      Safety Trustworthiness and transparency Peer support Collaboration and mutuality Empowerment, voice, and choice Humility and responsiveness In addition, potential biases and stereotypes based on race, ethnicity, sexual orientation, and age are recognized and addressed within the context of trauma-based care.
      Clinicians who train in trauma-based care also learn there are 10 domains of implementation of this approach, including governance and leadership, policy, physical environment, training and workforce development, progress monitoring and quality assurance, and more.
      Why is trauma-informed care important?
      It’s a win-win for everyone. For patients, trauma-informed care offers the opportunity to engage more fully in their own mental health care, develop a trusting relationship with their provider, and improve long-term outcomes. Studies have found that adopting trauma-informed practices can potentially improve overall patient engagement and adherence to treatment. It also reduces the need to relive experiences and retraumatize the patient. In addition, trauma-based care has been found to improve provider engagement. 
      Overall, adopting a trauma-informed approach to care has the potential to improve patient health outcomes as well as the well-being of providers. If you feel you or a loved one could benefit from trauma-based care, consult your doctor or mental health provider.
      If you or a loved one need help with mental health issues, consider contacting a qualified telebehavioral health professional
      If you’re a client, request an appointment online or call our live support for assistance in scheduling care today. Our mental health professionals are trained in multiple mental health disorders and have experience treating them via online appointments - from the convenience and privacy of your home or wherever works for you. If you’re a behavioral health provider looking to join our network, see all the benefits and learn how to apply here.
      Sources
      Substance Abuse and Mental Health Services Administration (SAMSA)
      Center for Health Care Strategies
      National Council for Mental Wellbeing
    16. These Films Got it Right: Top Films About Mental Health

      This week, we continue our mental health resources series by curating 8 inspiring and engaging films about mental health topics - from PTSD to depression to bipolar disease and more. We think these films are sensitive and worthy portrayals that explore the nature of mental illness - and ultimately help us get the word out - and more exposure equals greater understanding. 
      Most of these films can be found on the major streaming networks. Share the list with friends and family, or if you are a clinician, with patients who may also benefit. Then grab the popcorn (and possibly a box of tissues) and start watching.
       
      Silver Linings Playbook - This popular, Oscar-winning 2012 romantic comedy is based on Matthew Quick's novel of the same name, and follows two main characters dealing with mental illness. Bradley Cooper plays Pat who is diagnosed with bipolar disease, and Jennifer Lawrence plays a widow dealing with her own mental illness in the aftermath of her husband's death.
       
       
       
      The Perks of Being a Wallflower - 2012 was a good year for quality films addressing mental health issues and this one continues the trend: it explores the social-psychological effects PTSD has on young adults and how love can help heal the wounds. Based on a novel of the same name.
       
       
       
       
      Girl Interrupted - This best-selling memoir turned movie is a firsthand account of a young woman's experience inside an American psychiatric hospital in the 1960s. Care wasn’t as good as it is now - which is hard to watch in the film - and although we still have a long way to go, it's good to see how much treatment for mental illness has improved. 
       
       
       

      Good Will Hunting - The main character (Will - played by Matt Damon, who also wrote the screenplay with friend Ben Affleck) was abandoned as a young boy and suffers from attachment disorder because of it. The film details how his mental health has an impact on the choices he makes - he’s clearly a genius who belongs inside the classrooms that he cleans for a living at MIT. The success of his work with a local therapist ultimately gives viewers hope for the future.
       
       
       
      A Beautiful Mind - Tells the true-life story of brilliant mathematician John Nash (Russell Crowe), a Nobel Laureate in Economics and Abel Prize winner, who develops paranoid schizophrenia and endures delusional episodes while watching the burden his condition brings on his family and friends.
       
       
       
       
      The Soloist - A Los Angeles Times columnist (Steve Lopez) finds and writes about a homeless street musician (Nathanial Ayers) who possesses extraordinary talent. In his attempt to help Ayers, Lopez has to also deal with the mental illness that landed Ayers on the street in the first place, as well as the stigma against those with mental health issues.
       
       
       
      When Love Is Not Enough: The Lois Wilson Story - Deals sensitively with addiction. Winona Ryder plays the wife of the founder of Alcoholics Anonymous, Bill Wilson, who made it big on Wall Street before the Crash of 1929 - which wreaked havoc on his sense of worth  - and founded Alcoholics Anonymous in 1935 after getting sober himself. Lois Wilson later founded Al-Anon to help the loved ones of those struggling with addiction.
       
       
       
      Cyberbully - Takes a realistic and thoughtful approach to the issue of online bullying as seen through the eyes of a teen victim who attempts suicide. Ultimately has positive messages about tolerance, resilience, getting help and support, and standing up to peer pressure. This would be a good film to start a discussion with any teens in your life.
       
       
       
      Are there any films that you would add to the list? Let us know in the comments.
      If you or a loved one need help with mental health issues, consider contacting a qualified telebehavioral health professional
      If you’re a client, request an appointment online or call our live support for assistance in scheduling care today. Our mental health professionals are trained in multiple mental health disorders and have experience treating them via online appointments - from the convenience and privacy of your home or wherever works for you. If you’re a behavioral health provider looking to join our network, see all the benefits and learn how to apply here.
    17. The Science Behind PTSD: How Trauma Changes The Brain

      A few months ago, we wrote about Post-Traumatic Stress Disorder, commonly known as PTSD, a mental health disorder that occurs after experiencing or witnessing a traumatic event such as a natural disaster, accident, assault, terroristic act, or military combat. 
      Common symptoms of PTSD involve re-experiencing the trauma (e.g., nightmares, flashbacks, or emotional flooding), attempts to avoid reminders of the event, hyperarousal (e.g., feeling constantly on edge), and distressing thoughts or emotional reactions. In order to be diagnosed with PTSD, symptoms need to last for at least two weeks and interfere with daily functioning. It’s estimated that almost 4% of the general US population is affected by PTSD — a number that rises to 55% of those who are serving or have served in the military.
      For those experiencing, living with, or treating someone with PTSD, it may be helpful to learn how trauma affects specific parts of the brain in order to better understand the symptoms and treatment options.
      PTSD Is Unique Among Psychiatric Diagnoses
      First, it's important to note that PTSD is unique among psychiatric diagnoses because of the significance placed on the cause of the condition (i.e., the trauma itself - more on that below), rather than merely the condition. In fact, with the advent of DSM-5, PTSD is no longer classified as a type of Anxiety Disorder but its own designation: Trauma and Stressor-Related Disorders — which acknowledges that its onset is preceded by “exposure to a traumatic or otherwise catastrophic, adverse environmental event”.
      Start By Understanding How Trauma Affects The Brain
      Over the past several decades, research using neuroimaging has enabled scientists to see that PTSD causes distinct biological changes in the brain; and in fact, functioning is impaired in areas responsible for threat detection and response, and emotion regulation — which accounts for most outward PTSD symptoms. Not everybody with PTSD has exactly the same symptoms or same brain changes, but there are definite “typical” observable patterns that can be seen and treated.
      To put it simply, when trauma first occurs, our “reptilian brain” takes over — that part of the brain known as the brain stem which is responsible for the most vital functions of life (breathing, blood pressure, heart rate, etc.). The brain stem kicks in the “fight or flight" response and all nonessential body and mind functions are shut down so that we can focus only on what we need to survive. Then, when the threat ceases, the parasympathetic nervous system steps in again and resumes those higher functions that were recently shut down. 
      However, for some trauma survivors, after effects remain, which we now know is PTSD. In these people, the brain’s “threat and alarm system” becomes overly sensitive and triggers easily, which in turn causes the parts of the brain responsible for thinking and memory to stop functioning correctly. When this occurs, it’s hard to separate safe and “normal” events happening in the present from dangerous events that happened in the past.
      PTSD Impacts Three Parts Of The Brain Significantly, Causing Disruption To Normal Life
      Research shows PTSD mostly impacts three parts of the brain: the amygdala, the hippocampus, and the prefrontal cortex (PFC). Here’s how these three parts of the brain work (or don’t work) together to cause symptoms of PTSD:
      Amygdala: a collection of nuclei located deep within the temporal lobe (the lobe of the brain closest to the ear). The amygdala is designed to detect threats in the environment and activate the “fight or flight” response, and then activate the sympathetic nervous system to help deal with the threat. Those with PTSD tend to have an overactive amygdala, causing irrational thoughts and primal reactions. For example, a harmless loud noise could instantly trigger panic. 
      Prefrontal Cortex: covers the front part of the frontal lobe located just behind the forehead. The PFC is designed to regulate attention and awareness, make decisions about the best response to a situation, determine the meaning and emotional significance of events, regulate emotions, and inhibit dysfunctional reactions. In those with PTSD, the PFC is underactive, meaning that regulation of emotion and dysfunctional reactions does not occur when it should. An overactive amygdala combined with an underactive prefrontal cortex creates a perfect storm, causing those with PTSD to feel anxious around anything even slightly related to the original trauma, and/or have strong physical reactions to situations that shouldn’t provoke a fear reaction.
      Hippocampus: a complex brain structure also located deep in the temporal lobe. The hippocampus regulates the storage and retrieval of memories, as well as differentiating between past and present experiences. After a trauma, the hippocampus works to remember the event accurately and make sense of it. But because trauma is typically overwhelming, all the information doesn't get coded correctly, meaning that someone with PTSD may have trouble remembering important details of the event and/or find themselves overthinking a lot about what happened because the hippocampus is working so hard to try to make sense of it.
      Consequences Of PTSD Brain Dysfunction On Quality Of Life
      Understanding how the after-effects of trauma impact the brain so significantly helps explain why PTSD causes such serious disruption in daily functioning. PTSD often affects the ability to have healthy, satisfying relationships or tolerate uncertainty and rejections without excess distress. It causes sleep disturbances, negative mood, anxiety, and attention/concentration difficulties that often interfere with academic or career success. 
      Other Disruptive Symptoms Of PTSD Include:
      Extreme startle response
      Heart Palpitations
      Shaking 
      Nightmares
      Hypervigilance
      Hyperarousal
      Reactive Anger
      Impulsivity
      Increased Fear
      Decreased Positive Emotions
      Self-Blame
      Detachment From Others
      PTSD also often occurs with other related mental and physical health conditions, such as depression, substance use, and memory problems.
      PTSD Is Treatable
      The good news is that PTSD is treatable by trained behavioral health professionals. Treatment may include a combination of medications and behavioral therapies which have been proven effective on those with PTSD. And it goes without saying that each PTSD treatment and management plan should be tailored to meet an individual's specific needs since everyone is impacted differently. 
      The important thing to take away is that PTSD is real, it is explained by highly-studied changes in the brain, and that millions suffer from it.
      Considering A Career In Telebehavioral Health Or Know Someone Who Could Benefit From Virtual Access To Licensed Behavioral Health Professionals
      Telemynd offers patients the ability to connect with providers from the safety and convenience of their homes. Providers can join our network by applying online. If you’re a patient, choose your current insurance provider to request an appointment or call our live support for assistance in scheduling care today!
      Sources
      National Center for Biotechnology Information - National Institutes of Health (NCBI - NIH): Traumatic stress: effects on the brain
      American Psychiatric Association: What is PTSD?
      US Dept. of Veterans Affairs: PTSD History and Overview
    18. The Impact Military PCS Moves Have On Family & Kids

      According to the Department of Defense, 37% of active-duty military families have children, and like their active-duty parents, military kids make sacrifices in their own ways too. From coping with the challenges of a parent’s deployment to starting a new school to accommodate a recent move (known as a Permanent Change of Station or PCS), military kids commonly experience stressors that can impact their mental health. On average, military kids attend up to nine different schools before graduating high school due to relocations. What kind of impact do these frequent moves have on the mental health of military kids and their families? And what are some ways to cope with the stress?
      Military Kids Move Every Two to Four Years, On Average 
      Military families typically make a PCS move every two to four years (this is over 3 times the civilian family average), which means that the kids are constantly adjusting to new schools and environments, making new friends, and leaving old ones behind. In some cases, PCS moves can occur quickly and unexpectedly, leaving little time for closure, for kids to fully process what is happening to them, or to say goodbye. 
      Multiple studies have been conducted to measure the impact on mental health of PCS moves. The Journal of Adolescent Health published findings that military kids who move frequently were significantly more likely to have a mental health issue. In addition, it found that age was a powerful predictor of the impact on mental health, i.e., military kids aged 12-17 were four times as likely to need help from a mental health professional as military kids aged 6-11. This makes sense intuitively, as teens are already going through the changes and stresses of puberty. Add in the need to rebuild their social connections and form new friendships, and one can see why PCS moves impact teens harder.
      The stress of PCS moves affects parents too. Another study by the School Psychology Review found moving increases tension in the home in general. Kids reported feeling anger or resentment toward their parents and the military because of the disruption to their lives. Some kids reported telling their parents that they refused to move or would run away to avoid moving entirely. 
      Ways The Disruption Of A PCS Move Causes Stress
      What is it about frequent moves that causes so much burden? First, change itself is stressful to us all, as numerous studies have found over the years. And when families make a PCS move, they must adjust to a new home, new school, address, neighborhood, friends, teachers, religious community, routines, and potentially new local culture and weather. That’s a lot of change! In addition:
      Students involved in sports who move later in the year can miss team tryouts, or the new school may not offer the same athletic programs.
      They may feel the loss of having to end close relationships with friends at a previous school.
      It’s more difficult to gain acceptance in a new school where cliques and social networks are already established.
      Because of potentially limited experience with military families, civilian school staff may have a knowledge gap that affects their effectiveness working with military students.
      Parents themselves are swamped with new jobs and to-do lists, and may not have the patience or time to consider a kid having trouble with the transition.
      If one parent is deployed or at risk of being deployed, kids may experience further stress from the constant fear for a parent’s safety.
      All can lead to considerable stress, as kids find they lack a feeling of connection to others in their new community. As a result, symptoms of depression and anxiety can appear, such as separation anxiety, excessive worry, sleep problems, and physical complaints such as headaches or stomach pain. 
      Tips For Coping With The Stress Of A PCS Move
      PCS moves are not all doom and gloom. Research suggests that many kids develop strength and resilience from adapting to frequent military moves. And there are steps parents and schools can take to support them through the moves in order to reduce the impact on their mental health. Number one is simply to be aware of the potential mental health impacts and to watch for signs and symptoms of distress. Our previous release discussing different symptoms of mental health conditions is really helpful. Parents can read up on the impact of PCS moves, and educate themselves on ways to support kids during the transition. And as with all mental health issues, the earlier that symptoms are noticed for intervention and treatment to begin, the better the prognosis and outcomes.
      Experts Suggest These Tips For Coping With The Stress Of PCS Moves
      Keep up established routines and rituals as much as possible, and start new rituals in the new place that encourage parent-child bonding time.
      Talk about the move as much as possible and give kids the opportunity to vent their negative feelings (and help them find positive ones too). Parents are advised to let kids in on a little of their own misgivings about the move and to find ways to address them as a family. This provides more positive feelings of validation and control.
      Connect with other military children and families when possible. As well, in the military community itself, most installations have a resource officer or School Liaison Officer who may be able to suggest appropriate resources.
      Even in a civilian school where there are few military kids, school guidance counselors are the best place to start a conversation between the family and the new school, as they are the gatekeepers to community mental health resources. Even if the counselor does not have experience with military students, he or she may be able to suggest local resources with more expertise.
      Finally, although it may seem simple, making sure that kids get enough sleep, eat healthy foods, and get out and exercise will go a long way toward maintaining better mental health. And when kids do exhibit symptoms of transition distress, seek out a mental health professional as early as possible.
      Sources
      Military Spouse
      Journal of Adolescent Health
      School Psychology Review
    19. The Anxiety Gender Gap: Societal Conditioning & Seeking Help

      Anxiety is a common disorder - an estimated 31.1% of U.S. adults experience anxiety at some time in their lives. In our previous post, we defined Anxiety Disorders as “6 months or more of chronic, exaggerated worry and tension that is unfounded, or much more severe than the normal, everyday worry most people experience”. This can manifest in symptoms such as feeling restless, irritable, or on edge’, having a hard time concentrating, feeling tired all the time, and experiencing headaches stomaches, or other muscle aches.
      Women Are Diagnosed With Anxiety Disorders At 2X The Rate Of Men
      Multiple studies have found that women are twice as likely as men to be diagnosed with an Anxiety Disorder — and this holds true for adult women as well as girls under 18. In addition, women diagnosed with one type of Anxiety Disorder are more likely than men to be diagnosed with an additional Anxiety Disorder.
      Researchers have also found differences in the way women experience anxiety:
      Women report more body-based symptoms - specifically, women who have panic attacks report more shortness of breath and faintness.
      Panic Disorder, a type of Anxiety Disorder, appears to be more chronic in women.
      Women report a greater number of worries and more separation anxiety than men.
      Women tend to deal with their anxiety by avoidance, while men more often turn to substance abuse.
      Multiple Theories As To Why Women Are Diagnosed More Than Men
      Some researchers theorize that women’s monthly cycle can affect anxiety levels, or that female hormones may contribute to a more quickly activated, longer-acting fight-or-flight response, or that the hormone testosterone — more abundant in males — may help ease anxiety symptoms for men. Other studies revealed women are more likely to experience physical and mental abuse (as children and as adults) than men, and abuse is commonly linked to the development of anxiety disorders. 
      Digging Deeper Into The Anxiety Gender Gap
      However, one of the biggest differences researchers found is that women are more likely than men to seek help when they experience symptoms of anxiety, and therefore get diagnosed. So the question becomes: are women actually experiencing anxiety more often, or are they more likely to discuss their symptoms with a health professional than men ? In other words, is there a societal influence on the levels of Anxiety Disorder diagnoses between genders?
      In his book, Invisible Men: Men's Inner Lives and the Consequences of Silence, author and professor of psychology at Clark University, Michael Addis postulates that "when men struggle with fear, and depression, it can tend to come out more as anger and aggression. And men in our culture are more encouraged to use, let's say, strategies such as substance use... to suppress those emotions...They are more encouraged to talk to their friend and to bottle it up, and to perhaps kind of withdraw and become passive” rather than reporting symptoms to a medical professional.
      In fact, a recent study looked at whether male leaders within organizations are penalized by asking for help, and found that in fact, sometimes men “may face backlash when they don’t adhere to masculine gender stereotypes — when they show vulnerability, act nicer, display empathy, or express sadness.” Unfortunately, this may play out by by impeding mens access to treatment, and therefore their overall mental health.
      Ultimately, whether in men or women, early recognition of anxiety symptoms is important so that treatment can start. A combination of cognitive behavioral therapy, medication and lifestyle changes (more physical activity, improved eating and sleeping habits) has been shown to be effective in reducing most symptoms of anxiety. 
      Considering A Career In Telebehavioral Health Or Want To Access Virtual Care With A Licensed Professional?
      Telemynd offers patients the ability to connect with providers from the safety and convenience of their homes. Providers can join our network by applying online. If you’re a patient, choose your current insurance provider to request an appointment or call our live support for assistance in scheduling care today!
      Sources
      National Center for Biotechnology Information - National Institutes of Health: Gender Differences in Anxiety Disorders: Prevalence, Course of Illness, Comorbidity and Burden of Illness
      Journal of Brain and Behavior: A systematic review of reviews on the prevalence of anxiety disorders in adult populations
      NPR: Understanding How Anxiety Might Be Different For Men
    20. Telebehavioral Health Will Continue Strong in 2022

      Where is telehealth in 2022? The pandemic showed how telemedicine could change how we think about health care interactions, with virtual visits increasing almost 40 times, according to data from McKinsey. Today, telehealth utilization has stabilized at levels 38 times (yes, that’s 38 times!) higher than before the pandemic. And consumer and provider attitudes toward telehealth have also improved since before the pandemic. Telemynd’s CEO, Patrick Herguth, said only 6 months ago, “between third quarter 2020 and second quarter 2021 we experienced 4X growth in new patients seeking mental health services, an upward trend we continued to see as we move through 2021 at a record-setting 61% increase in demand. Both clinicians and patients have demonstrated their ability to quickly adapt to telemedicine with no sign of slowing down.” 
      In this article, we look at the most recent trends, why telebehavioral health works, how to address any remaining barriers, and predictions for the future.
      Consumer demand for virtual health care remains high going into 2022
      One study found that 78% of patients who currently use telebehavioral health are very or extremely satisfied with their telehealth experiences, and 75% are more likely to continue to use it going forward. In another recent study, 40% of surveyed consumers (including those who have never used telehealth) said they would try it or continue using it — up from 11% prior to the pandemic.
      Why has telebehavioral health been so successful?
      For providers, it remains a convenient, cost-effective way to diagnose and treat many behavioral health issues. As well, it removes the overhead and upkeep of a physical location.
      Consumers continue to see the following benefits of telebehavioral health:
      Creates unprecedented convenience - appointments can be done wherever and whenever is most convenient. Removes the stigma associated with physically going to an office or treatment facility. Saves time with virtual screenings and evaluations. Expands access for those who live in a rural area, have limited mobility, or reside in long-term care facilities. Shortens delays to meet with providers. What’s the future of telebehavioral health?
      Most experts who study trends in health care see telebehavioral health expanding further in the future, where it makes sense. The American Medical Association says that providers and practices “have built successful telehealth systems that are making care more accessible and convenient for patients—there should be no turning back now.” Telemynd’s Patrick Herguth says, “The pandemic exposed and exacerbated the mental health crisis. It is a highly personal matter that requires a real human connection in order to succeed. Telemedicine expands our ability to match the right provider to patients, irrespective of where they’re located. People-oriented technology advancements will lead to even greater innovative care models that improve outcomes while lowering the cost of care for everyone.”
      Telehealth issues like the following will need continued work to create an even better experience for providers and consumers:
      technology security care payment mechanisms patient feedback methods  education and promotion so that more Americans know they can access telehealth As long as we continue to address these, what started off as just ‘a necessity’ during the pandemic will become the norm for health care even beyond 2022. 
      If you need help with mental health issues, consider contacting a qualified telebehavioral health professional
      If you’re a client, request an appointment online or call our live support for assistance in scheduling care today. Our mental health professionals are trained in multiple mental health disorders and have experience treating them via online appointments - from the convenience and privacy of your home or wherever works for you. If you’re a behavioral health provider looking to join our network, see all the benefits and learn how to apply here.
      Sources
      McKinsey
      TechCrunch
      Yale Medicine
    21. Telebehavioral Health — The Accelerated Adoption & Growing Demand

      I believe it is safe to say that Covid-19 has caused widespread disruption to life as we knew it. School, work, travel, relationships - all shaken up during the pandemic - and with it, our mental health. Some of the latest research has found that 25% of US adults are experiencing significantly more anxiety this year than in the past, and 20% are experiencing more symptoms of depression now than in the past. The research also shows that the volume of calls to helplines has increased significantly over the past year.
      The disruptions to everyday life have increased the need for behavioral health care – which has put an even greater demand on what was an already limited supply of mental health providers. Here at Telemynd, we’ve found that providing mental health care virtually, also known as telebehavioral health, has proved to be an effective way to make sure everyone seeking quality care has access. In fact, we believe that if there’s a silver lining to the pandemic, it’s that the adoption of telemedicine by the industry and consumers alike, has been accelerated by at least 5 years. Every indication points to telebehavioral health being here to stay, and if you’re a provider, there may be no need to return to your brick and mortar office.
      Research Supports Overall Satisfaction & Effectiveness For Patients & Providers
      One study published in JIMR Formative Research suggests that more than half of people using telehealth want to keep receiving that care virtually post-pandemic. Another study found that 78% of patients who use telebehavioral health are very or extremely satisfied with their telehealth experiences, and 75% are more likely to continue to use it after the pandemic.
      In addition, in a recent survey of employers who offer healthcare benefits, 90% report that their focus on telemedicine increased during the pandemic, and 52% say virtual medicine will continue to be an important priority within their organization’s health care activities following the pandemic.
      It’s clear that the demand is there for telebehavioral health - but is it effective? The answer is a resounding ‘yes’. A published literature review found without question that “behavioral health virtual visits deliver the same outcomes as in-person visits for many conditions, and meet the same standards of care set by the National Committee for Quality Association.” 
      Our Own Data Shows Record Growth Levels Beyond The Pandemic

      At Telemynd, we’re seeing strong indications from payors and patients that telemedicine is their preferred method for the delivery of behavioral health care services. Between third quarter 2020 and second quarter 2021 we experienced 4X growth in new patients seeking mental health services, an upward trend we continued to see as we move through 2021 at a record-setting 61% increase in demand. Both clinicians and patients have demonstrated their ability to quickly adapt to telemedicine with no sign of slowing down, even in a post-pandemic world. 
      Telebehavioral Health Benefits — For Patients & Clinicians
      Many challenges have been addressed through the implementation of telebehavioral health, including:
      Minimal wait to connect with a quality mental health professional
      Expanded access for patients who may live in a rural area, have limited mobility, or reside in long-term care facilities
      Saving time with virtual screenings and evaluations
      Better treatment for chronic conditions and medication management
      Personalized care from home, which promotes willingness to share in settings they’re already comfortable in
      Eliminating the stigma often associated with seeking mental health services and providing additional patient privacy
      For clinicians, telebehavioral health has many benefits as well, such as:
      Removing the overhead and upkeep of a physical location
      More flexibility to schedule clients at a pace and level that supports your needs
      Added freedom to travel while seeing patients anywhere in the country
      Simple and reliable weekly income direct deposited with complete remittance reports from our finance team
      All of these benefits lead to a true work-life balance. Telebehavioral health is a win-win for clinicians and their patients!
      Telebehavioral Health Allows Clinicians To Be Better At What They Do
      With all the benefits and studies showing adoption and effectiveness, telebehavioral health can now be considered a fundamental component of our healthcare environment – in other words, it’s here to stay. Telemynd helps each provider who joins to expand their practice and eliminate the administrative burden. Giving reliable income and the ability to focus on what matters most — delivering quality mental health care to patients.
      Sources
      Futurity
      Willis Towers Watson
      American Psychological Association
      Journal of Internal Medicine
    22. Study Correlates Stress & Lack Of Sleep To Experiencing Concussion-Like Symptoms

      Most of us know that a good night’s sleep is important to good health. It’s critical to maintaining brain cognition, concentration, and productivity. Sleep also improves immune function, staves off serious conditions like diabetes and stroke, and maintains our ability to deal with the challenges of everyday life. A new study has also found that many of us could be coping with concussion-like symptoms such as confusion, low energy, and memory loss due to a lack of sleep and compounded stress. 
      Participants Included Cadets From U.S. Military Academies & College Athletes
      The research published in the January issue of Journal Sports Medicine was conducted by the Concussion Assessment, Research and Education (CARE) Consortium, a founding alliance between the NCAA and U.S. Department of Defense. Participants included cadets within U.S. military service academies – who undergo rigorous training and are required to participate in athletics – and students who competed in NCAA sports at 26 U.S. colleges.
      Study Results
      Researchers found between 11% and 17% of healthy college or military academy athletes with no history of recent concussion were reporting multiple symptoms – such as memory loss, low energy, and dizziness – that met the criteria for post-concussion syndrome (also known as PCS). The study found lack of sleep, pre-existing mental health conditions, and stress were the most common predictors for these concussion-like symptoms. Furthermore, between 50% and 75% of the athletes surveyed had at least one concussion symptom, with the most common being fatigue, low energy, or drowsiness.
      Women who participated in the study reported more symptoms than men: among cadets, 17.8% of men and 27.6% of women experienced concussion-like symptoms, and among NCAA athletes, 11.4% of men and 20% of women. The study concluded that a history of depression or ADHD were key contributing factors for NCAA athletes who experienced PCS-like symptoms.
      "The numbers were high, and were consistent with previous research in this area, but it is quite shocking," said lead researcher Jaclyn Caccese, assistant professor at The Ohio State University School of Health and Rehabilitation Sciences. "These are elite athletes who are physically fit, and they are experiencing that many symptoms commonly reported following concussion. So looking across the general population, they'd probably experience even more."
      What Are Typical Symptoms?
      A concussion can affect your memory, judgment, reflexes, speech, energy level, balance, and muscle coordination. Individuals who have had a recent concussion or are experiencing PCS-like conditions may act confused or dazed. Other symptoms can include:
      Headaches
      Nausea or vomiting
      Memory loss
      Ringing ears
      Difficulty concentrating
      Sensitivity to light
      Loss of smell or taste
      Fatigue and drowsiness
      A key takeaway related to those who have not had a recent concussion may be experiencing identical symptoms due to lack of sleep and/or the burden of stress being carried.
      What Do Experts Recommend?
      The research was originally designed to gather additional information regarding the effects and recovery of concussion for student-athletes at colleges and military service academies. Concussions are a known problem in sports, particularly contact sports such as football. 
      Scientists who performed the research stated the results have implications for how we treat concussions in college athletes as well as how the general population manages sleep and stress.     For example, they suggest athletes recovering from concussions be assessed and treated on a highly individualized basis. In addition, knowing athletes' medical history and baseline symptoms can help clinicians predict which pre-existing factors contribute to concussion recovery times, and ultimately improve treatment and recovery.
      For those of us who’re not college athletes, self-awareness and recognizing when our sleep cycle is being disrupted or how stress has been negatively impacting our daily lives is essential. Place greater emphasis on addressing the issues as they arise or develop healthier mechanisms for coping with the guidance of a mental health therapist. Difficulty sleeping or stress related to underlying mental health disorders such as anxiety or depression should always be diagnosed by a qualified and licensed behavioral health specialist.  
      Consider Telebehavioral Health
      Telemynd offers patients the ability to connect with providers from the safety and convenience of their homes. If you’re someone seeking mental health services, request an appointment online or call our live support for assistance in scheduling care today! If you’re a behavioral health provider wanting to join our network, apply online. 
      Sources
      Journal Sports Medicine, 01.11.21: Factors Associated with Symptom Reporting in U.S. Service Academy Cadets and NCAA Student-Athletes without Concussion: Findings from the CARE Consortium
      Concussion Legacy Foundation: What is Post-Concussion Syndrome
    23. Studies Show Link Between Traumatic Brain Injury & Mental Health Disorders

      Much has been written about returning military personnel and Traumatic Brain Injury (TBI) because it’s important to raise awareness of this issue as so many of our men and women who have served overseas live with the lingering effects of serious head injuries. And depending on what part of the brain is injured, TBI is often correlated with mental health problems. In fact, studies show that when people without any prior mental health issues or history of mental illness suffer a TBI, their risk for depression and other mental health issues increases significantly – up to two to five times higher than the general population. In this post, we review the link between TBI and mental health, how to look out for symptoms, and treat them if they develop.
      What Is Traumatic Brain Injury & Why Do So Many Military Personnel Get Them?
      The TBI Centers of Excellence (part of the Office of the Secretary of Defense) reports nearly 450,000 TBIs among U.S. service members from all branches between 2000 and 2020 - that’s a significant number of our service men and women living with the repercussions of a serious head injury. The CDC defines a TBI as a disruption in the normal function of the brain that is caused by a bump, blow, or jolt to the head, or a penetrating object. Military service members are especially at risk from explosions experienced during combat or training exercises, and in fact, currently, approximately 80% of new military TBI cases occur in non-deployed settings, most often sustained during training activities.
      TBIs have persistent, and sometimes progressive, long-term debilitating physical and emotional effects. Typical physical symptoms include headaches, seizures, weakness, numbness and loss of coordination, to name just a few. A TBI may also trigger cognitive symptoms including confusion, frequent mood changes, memory loss, executive dysfunction, behavioral changes and difficulty reasoning or learning.
      The Link Between TBI & Mental Health Disorders
      Scientists have found that living with a TBI may also lead to mental health disorders, including Major Depressive Disorder (most common), PTSD (second most common), Anxiety Disorder, Panic Disorder, and to a lesser extent, Bipolar Disorder and Schizophrenia – all most likely caused by damage to brain tissue during the original head injury.
      Following Is More Detail About The Two Most Common Mental Health Disorders Associated With TBI
      Major Depressive Disorder — The prevalence of depression within the first year after brain injury is 33%–42%, and within the first 7 years is 61%. Depression may slow the pace of cognitive recovery, impact social functioning, and lower overall health-related quality of life. In addition, people recovering from TBI who also have depression are 3 times less likely to stay on their prescribed medication. They also report more severe physical symptoms (like headache, blurred vision, and dizziness) compared to non-depressed TBI patients. Depression after TBI may result in part from direct or secondary injury to brain tissue, and it also may result in part from the TBI patient’s frustration with the pace of recovery and loss of “normal” routine and ability to participate in activities of daily life.
      PTSD — Studies show that military personnel who suffer a TBI are almost twice as likely to have developed PTSD one year later than those with no TBI. One of the problems in diagnosing PTSD in these situations though, is that post-acute symptoms following TBI overlap somewhat with those associated with PTSD itself. Fortunately, clinicians with solid experience treating PTSD are more apt to be able to tell the difference. Scientists believe that PTSD may develop following TBI due to several factors: unconscious or conscious “encoding” in the brain of sensory factors (the sights and smells) associated with the event that caused the TBI, reconstruction of the trauma memory from secondary sources (for example, other people who were there), and memory of circumstances surrounding the event that also may be emotionally traumatic (like seeing others hurt).
      Looking at this issue from another perspective, researchers have also found that veterans seeking help from the VA for mental health issues, were found to have undiagnosed TBI in 45% of the cases studied. In other words, symptoms of depression and other mental health disorders were the tip-off that something was significantly wrong medically; in this case, the patients had suffered a TBI at some point in their military service that had not been diagnosed or treated.
      Watch For Symptoms Of Mental Health Disorders If You Have Been Diagnosed With A TBI
      Making progress in rehabilitation from a TBI can be especially challenging when it’s complicated by an undiagnosed mental health disorder. That’s why it’s so important for people with TBI to be screened for mental health disorders too, and for loved ones and clinicians to watch for signs of mental health problems after TBI. If you see general symptoms such as the following, consult with a qualified mental health provider (and when in doubt, go ahead and get checked out):
      Feeling especially sad or down
      Excessive fears or worries, or extreme feelings of guilt
      Extreme mood changes
      Withdrawal from friends and activities
      Detachment from reality, paranoia, or hallucinations
      Inability to cope with daily problems
      Problems with alcohol or drug use
      Excessive anger, hostility, or violence
      Suicidal thinking
      Mental Health Disorders Associated With TBI Are Treatable
      For people with a TBI who are also diagnosed with a mental health disorder, it’s important that treatment for that disorder be integrated into the overall TBI rehabilitation treatment plan as prescribed by a qualified mental health provider. Treatment may include a combination of medications and therapies such as Cognitive Behavioral Therapy (CBT) or Eye Movement Desensitization and Reprocessing therapy (EMDR) — treatment options similar to those recommended for people who are not dealing with a TBI. So, the good news is that mental health disorders associated with TBI are treatable, but it’s critical to be on the lookout for symptoms so they’re not missed.
      Sources
      Journal of Neuropsychiatric Disease and Treatment
      Centers for Disease Control
      Journal of Neuropsychiatry
    24. Social Media, Body Image, & Mental Health

      We spend an average of 2.5 hours per day on social media in the US. And that’s up 31% from 2015. According to the Pew Research Center, 70% of adults and 81% of teens in the U.S. use social media daily. And of course, we all post our best - the best vacation pics, the best party pics, the best outfit pics - it's a recipe for unrealistic comparison on a daily basis. 
      Why do we do it? To boost self-esteem and feel a sense of belonging in our social circles, we post with the hope of receiving positive feedback. But there’s a downside - research shows that time spent on social media has an adverse effect on mental health. The effort spent to achieve and maintain the ideal body so that we look “as good as” others we see on social media, can trigger significant anxiety and depression. In this article, we dig into the research and share suggestions to mitigate the negative impact of social media.
      What the science says about social media and mental health
      Facebook, Instagram, Pinterest, Twitter, YouTube, Snapchat, and more recently TikTok (whose use is up 800% in the US since 2018) - all provide an easy means to post, view, and compare ourselves to others, 24/7. Filters that provide the ability to airbrush photos, whiten teeth, and more, are easy to find and use. Now, it’s not only celebrities who look perfect—it’s everyone. In fact, plastic surgeons have seen an uptick in requests in recent years from patients who want to look like their (unrealistic) filtered Snapchat or Instagram photos.
      Logically, we know this can’t be healthy behavior. And the science backs this up. Research has linked social media use to decreased sleep, increased anxiety and depression, and significant body dysmorphia - which often leads to eating disorders. 
      One study, published by the Public Library of Open Science (PLoS One), found the prevalence of depression and anxiety to be over 48%, for those of all ages and genders who looked at social media frequently. Another study, published in Computers and Human Behavior, found that individuals who used social media over 2 hours per day reported significantly higher body image concerns and internalizing symptoms than peers reporting no use of social media. A 2018 British study tied social media use to decreased or disrupted sleep, which can be associated with depression, memory loss, and poor work or academic performance.
      One study, published by the Public Library of Open Science (PLoS One), found the prevalence of depression and anxiety to be over 48%, for those of all ages and genders who looked at social media frequently. Another study, published in Computers and Human Behavior, found that individuals who used social media over 2 hours per day reported significantly higher body image concerns and internalizing symptoms than peers reporting no use of social media. A 2018 British study tied social media use to decreased or disrupted sleep, which can be associated with depression, memory loss, and poor work or academic performance.
      How social media’s ‘ideal body image’ portrayal impacts different communities
      Some communities are impacted more than others - for various reasons they are more likely to feel pressure to look good on social media and/or more vulnerable to the effects of constant comparison. For example, studies have found that social media use has been linked to higher rates of depression in teens, which in turn has lead to a higher suicide rate among the age group. When there’s a ‘filter’ applied to the digital images, it can be hard for teens to tell what’s real and what isn’t, which comes at an already difficult time for them physically and emotionally.
      A Pew Research study of teens, technology, and friendships revealed a range of social media-induced stressors:
      Feeling pressure to post attractive content about yourself
      Feeling pressure to get comments and likes on your posts
      Seeing people post about events to which you weren’t invited
      Having someone post things about you that you cannot change or control
      Another community adversely affected by the need to achieve a perfect body for social media is the LGBTQ community. For example, research published out of Dalhousie University found that social demands placed on gay men, based on social media images, to achieve a perfect body, have serious mental health consequences. The men in this study talked about how “constantly thinking about food and body ideals often lead to losing themselves in feelings of inadequacy, anxiety, low self-esteem, and depression.” The National Eating Disorder Association similarly found that those who identify as LGBTQ+ experience unique stressors that may contribute to the development of eating disorders - these stressors include the inability to meet body image ideals within LGBTQ+ cultural contexts that are promoted in social media.
      Women in general, and young black women in particular, are also at greater risk for developing mental health issues due to unrealistic body image portrayals on social media. One study found that celebrity culture, as portrayed on social media, perpetuates the ideology that young black women can only achieve beauty through changes in skin color, extended artificial weaves, and a thin body frame. Another study out of Yale University School of Medicine found that as black teen girls navigate social media, “they are aware that they are seen as less desirable than their white teen counterparts.” Of course, all of this leads to significant mental health issues.
      How to mitigate the negatives effects of social media
      Can anything be done to mitigate the downsides of social media? While the biggest changes need to come at a societal level, it turns out that there are some tactics that individuals and families can take - starting with something as simple as monitoring social media use. In an article from Harvard’s McLean Hospital, psychologist Jacqueline Sperling, Ph.D., says “it’s probably unrealistic for most social media users to quit completely. However, they can monitor their behavior to see how their use impacts them.” She adds, “if someone notices that they feel less happy after using social media, they might consider changing how they use the sites, such as viewing them for less time and doing other activities that they enjoy instead.” 
      Experts also suggest the following options:
       
      Find and follow body-positive accounts and influencers, or join support groups - this can help shift our mindset about the ideal body image set by society.
      Take an ethical stand and refuse to read, or view media, or buy advertised products that do not promote a healthy and diverse body image.
      Use your own social media accounts to become an advocate for positive body image. Give a shout-out to retailers, advertisers, or celebrities who promote natural looks, healthy body size, and diverse body shapes.
      Consult with a behavioral health specialist if you or someone you love is finding it hard to disconnect from social media overuse.
      If you recognize some of these signs for anxiety or depression, consider consulting a behavioral health professional
      Request an appointment online or call our live support for assistance in scheduling care today. Our mental health professionals understand the link between social media and mental health. Seeking a meaningful career in behavioral health? Consider joining our national team of providers making a real impact on the lives of thousands, learn more about the benefits here.
    25. Setting Healthy Boundaries for Your Mental Health

      Are you one of the many people who have a hard time saying “no”? You’re not alone! There are many reasons experts say we don’t always set the boundaries that we need for good mental health - including wanting to people-please, playing the role of ‘rescuer’, feeling manipulated, or being put on the spot. In this week’s article, we explore ways to set healthy boundaries for better mental health, and why setting boundaries is important for self-care.
      What are boundaries and why set them?
      A boundary is a limit or space between you and another person, or persons; a clear place where you begin and the other person ends. Setting boundaries is an important part of establishing one’s identity and is a crucial aspect of well-being. Boundaries help us feel safer and more comfortable. Boundaries can be physical or emotional, and they can range from loose to rigid, with healthy boundaries often falling somewhere in between. When healthy boundaries are not present, people may feel angry or sad due to interactions that create a feeling of being taken advantage of, devalued, or unappreciated. In addition, we often feel exhausted by the responsibilities brought on by saying “yes” all the time - leading to what some experts call the “treadmill of over-commitment”.
      So why don’t we set boundaries more firmly and frequently? Sometimes we think that saying “yes” will make other people happy regardless of our own feelings. Sometimes, we think saying “yes” all the time confirms that we are needed. And sometimes we respond to the guilt that others may employ to try to break down our boundaries. When we say “yes” for these reasons, we’re out of balance - we’ve inadvertently placed more value on the needs of others than on ourselves.
      How to set healthy boundaries
      First, know the characteristics of effective boundaries:
      Limits are clear and decisive, yet reasonable Value is placed on your needs The focus is on authenticity and self-care, not on pleasing others or playing the rescuer Next, give yourself permission to set personal limits with people. If you feel that love and approval are tied to pleasing others, or that you’re somehow being selfish for setting boundaries, or if it feels “risky” to set boundaries, then consider consulting with a mental health professional who can help you see that it's not selfish to take care of your own needs. 
      Next, define your boundaries. This might include things like:
      How you will and won’t spend your time and energy Who you will or won’t engage with and when What types of interactions you will or won’t engage in What activities and projects you will or won’t participate in You may find it helpful to practice communicating your boundaries beforehand. Practice staying calm in the face of others’ reactions to your boundary-setting. They may be surprised at first especially if they have come to believe you will always say “yes”, but don't let that stop you! It may feel uncomfortable in the short-term, but there’s definitely a long-term payoff.
      And finally, heed the warning signs - and stay away from those who repeatedly don’t respect boundaries you’ve set; who may be invading your space for their own end. 
      If you find this all difficult to do, you’re not alone. It’s a big - but very positive step - to take for better mental health. Qualified behavioral health counselors can help with things like learning how to set and maintain boundaries, and recognizing when and what to do when others try to cross those boundaries. As part of improving self-care, consider getting guidance about this from a mental health professional.
      Sources
      Forbes: The Importance Of Setting Healthy Boundaries
      Harvard Business Review: Set Better Boundaries
      Psychology Today: 7 Tips to Create Healthy Boundaries
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