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    1. 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
      Reactive Anger
      Increased Fear
      Decreased Positive Emotions
      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!
      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
    2. 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
      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!
      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
    3. Finding The Right Mental Health Specialist For Your Child

      Last week we talked about how to spot the warning signs of mental health issues in children and adolescents. This week, we’ll address how to go about finding the mental health professional that can best help.
      One in six children in the U.S. between six and seventeen years old have a treatable mental health issue such as Depression, Anxiety, or Attention-Deficit/Hyperactivity Disorder (ADHD), so understand that you are not alone - there are many parents and caregivers looking for help for a child or adolescent in their lives.
      But where to start? There are a bewildering array of specialists who can help. To help you sift through the wide-range of information out there, we’ve provided a list of the different types of professionals who can diagnose and treat your child, as well as questions to ask those providers during your search.
      Getting Started
      For most parents and caregivers, consulting your family or child’s physician can be a good first step. The benefit to starting with someone who knows your child is that they may be able to confirm or recognize when behavior is beyond the typical range. They can also conduct medical testing to rule out possible non-psychiatric causes for the symptoms you’ve noticed.
      The disadvantage is that family physicians or pediatricians may have limited experience in diagnosing psychiatric and developmental disorders; or may not have the proper time to allocate for lengthy assessments often required for accurate diagnosis. Best practices in diagnosing children and adolescents include using rating scales to get an objective take on symptoms, as well as collecting information from multiple sources, including the child, caregivers, teachers, or other adults in their lives. Other types of mental health professionals may be better able to assess and treat your child.
      Understanding The Different Types Of Mental Health Professionals
      Most professionals who diagnose and treat mental health issues in children and adolescents have at least a master's degree or more advanced education, training and credentials. Below you'll find some of the most common types of providers.
      Child & Adolescent Psychiatrist: A medical doctor with specialized training in general psychiatry, psychiatric diagnosis and treatment in young people; able to diagnose the full range of psychiatric disorders recognized in the Diagnostic and Statistical Manual (DSM); fully qualified if they have completed national examinations that make them board-certified in child and adolescent psychiatry as well as general psychiatry; can prescribe medication.
      Psychopharmacologist: A medical doctor who specializes in the use of medications in order to affect feelings, cognition, and behavior. Although they specialize in the use of medications, they should know when other kinds of therapy should be integrated with medication into the treatment plan and be able to refer patients to other professionals for that therapy.
      Child Psychologist: Trained to diagnose and treat psychiatric disorders, but are not medical doctors so cannot prescribe medication; have a doctoral level degree and may hold either a PhD or a PsyD; often work together with psychiatrists to provide care to patients who benefit from a combination of medication and cognitive behavioral therapy; can coordinate necessary evaluations and assessments.
      Neuropsychologist: Psychologists who specialize in the functioning of the brain and how it relates to behavior and cognitive ability; have completed post-doctoral training in neuropsychology with either a PhD or a PsyD. They perform neuropsychological assessments, which measure a child’s strengths and weaknesses over a broad range of cognitive tasks, and provide results in a report which forms the basis for developing a treatment plan.
      Pediatric Psychiatric Nurse Practitioner: Has either a master’s or a doctorate, and can prescribe medication depending on the state; has training in treating and monitoring children and adolescents with psychiatric disorders; may work as part of a team in a pediatricians’ office, or practice independently.
      School Psychologist: Trained in psychology and education and may receive a Specialist in School Psychology (SSP) degree; can identify learning and behavior problems, and evaluate students for special education services.
      Social Worker: A licensed clinical social worker (LCSW) has a master’s degree in social work and is licensed by state agencies; required to have significant supervised training; does not prescribe medication, but may work with the family and treating physician or psychiatrist to coordinate care. 
      Questions To Ask Prospective Mental Health Specialists
      It's especially important to look for a child or adolescent mental health professional who has the right background and experience to treat the specific issues your child is exhibiting. Arming yourself with the knowledge to be able to ask the right questions and know what to look for in a professional will help you feel more confident that you are getting a specialist that's right for your child. 
      Ask the following questions when meeting with prospective treatment providers:
      Tell me about your professional training?
      Are you licensed, or board-certified, and if so, in what discipline?
      How much experience do you have diagnosing children whose behaviors are similar to my child?
      How do you arrive at a diagnosis? What evidence do you use?
      Do you provide the treatments you recommend, or do you refer to others?
      How will you involve the family in the treatment?
      Will you be in contact with my child’s teacher or guidance counselor?
      How long do children usually stay in treatment with you?
      What are your thoughts about medication?
      Can I speak with a parent whose child has worked with you?
      Looking For A Qualified Mental Health Specialist For Your Child Or Adolescent?
      Telemynd is a nationally delegated telebehavioral health provider. You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists – all the specialists discussed above – who can evaluate, diagnose and provide treatment for mental health issues in children and adolescents from the convenience of home. Find your current insurance provider to request an appointment today.
      National Institute of Mental Health (NIMH): Children and Mental Health
      American Academy of Child and Adolescent Psychiatry: Family Resources
    4. Mental Health Issues in Children and Adolescents: Watch for Warning Signs

      According to the CDC, it’s estimated that one in six children in the U.S. between the ages of 6 and 17 has a treatable mental health issue such as Depression, Anxiety or Attention Deficit/Hyperactivity Disorder (ADHD).
      Mental health disorders in children and adolescents are generally defined as delays or disruptions in developing age-appropriate thinking, behaviors, and social skills. These issues can contribute to difficulty in school and in relationships with friends or family. The earlier a diagnosis is determined, a treatment plan can be started. Studies have shown that early treatment can help prevent more severe, or lasting problems. However, that’s sometimes easier said than done, as it can be hard to discern indicators of underlying mental health issues in children and teens from typical childhood “growing pains”. This article will help you learn what symptoms to watch for.
      Common Mental Health Issues In Children & Adolescents
      The most common behavioral health disorders experienced by children and adolescents fall into the following categories:
      Anxiety disorders 
      Depression and other mood disorders
      Obsessive-compulsive disorder
      Attention-deficit/hyperactivity disorder (ADHD)
      Autism spectrum disorders
      Eating disorders
      Schizophrenia and related psychotic disorders (but to a much lesser degree)
      Compounding the complexity of identifying common issues is the fact that it’s very common for children and adolescents to have symptoms that cut across multiple disorders. For example, more than 25% of children with ADHD also have Anxiety, and another 25% meet the criteria for Depression and other Mood Disorders. Additionally, even though children can experience the same mental health issues as adults, their symptoms may be different.
      Mental Health Issues In Children May Be Hard To Identify; Therefore Initial Evaluations Should Be Done By Clinicians Who Specialize In This Age Group
      Evaluation of children and adolescents with mental health symptoms is typically more complex than that of adults. According to the National Institutes of Mental Health (NIMH), evaluation differs in the following ways:
      Developmental context is critical when evaluating children; for example, behaviors that are normal at a young age may indicate a serious mental disorder at an older age.
      Children exist in the context of a family system, and that system has a significant impact on their symptoms and behaviors; for example, children living in a family with domestic violence or substance abuse may superficially appear to have one or more mental health issues. In these cases, clinicians rely on direct observation, corroborated by observations of others, such as other relatives and teachers, to determine whether to make a true mental health diagnosis or not.
      Developmental and behavioral problems, like poor academic progress, or delays in speech and language can sometimes be difficult to distinguish from those that are in actuality due to a mental health disorder. In these cases, it's not unusual for formal developmental and neuropsychological testing to be recommended as part of the evaluation process.
      Watch For These Warning Signs Of Mental Health Issues In Children & Adolescents
      So how do you know if a symptom is just part of being a kid, or should be treated as a mental health symptom? How do you know when to request a formal evaluation for potential mental health issues? According to the National Institutes of Mental Health (NIMH), children and adolescents may benefit from an evaluation (and ultimately treatment) if they have more than one of these symptoms:
      Have frequent tantrums or are intensely irritable much of the time
      Talk about fears or worries frequently
      Complain about frequent stomach or headaches with no known medical cause
      Are in constant motion and cannot sit still 
      Sleep too much or too little, have frequent nightmares, or seem sleepy during the day
      Are spending more and more time alone, are not interested in playing with other children or have difficulty making friends
      Struggle academically or have experienced a recent decline in grades
      Repeat actions or check things many times out of fear that something bad may happen.
      Have lost interest in things that they used to enjoy
      Fear gaining weight, or diet or exercise excessively
      Engage in self-harm behaviors (e.g., cutting or burning)
      Smoke, drink alcohol, or use drugs
      Engage in risky or destructive behavior alone or with friends
      Have thoughts of suicide
      Have sudden periods of highly elevated energy and activity, and require much less sleep than usual
      Say that they think someone is trying to control their mind or that they hear things that other people cannot hear
      Have You Noticed Any Of These Warning Signs In A Child Or Adolescent In Your Life?
      Telemynd is a nationally delegated telebehavioral health provider for Tricare members. You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists who can evaluate, diagnose and provide treatment for mental health issues in children and adolescents from the convenience of home. Click here to find your current insurance provider to request an appointment today!  
      CDC: Data and Statistics on Children’s Mental Health
      Merck Diagnostic Manuals: Overview of Mental Disorders in Children and Adolescents
    5. Advantages Of Telemedicine For Mental Health Professionals & Their Patients

      The Covid-19 pandemic has led to a dramatic increase in the use of virtual mental health services, (also known as telemedicine or telebehavioral health). The lockdowns and fear of infection have left patients in need of more care, yet with little choice but to move away from in-person care, and clinicians to quickly figure out how to adapt to new technology to order to offer it.
      The CDC has urged greater adoption of telemedicine, saying it “can facilitate public health mitigation strategies during the pandemic by increasing social distancing. These services can be a safer option for clinicians and patients by reducing potential infectious exposures.”
      Among the benefits, many clinicians are finding that telemedicine has allowed them to make behavioral health access available to more patients than ever before – which has positive implications for addressing the well-known shortage of mental health services in the US (which we wrote about in last week’s blog).
      Studies Show Patients Prefer Virtual Visits With Their Clinicians
      How well does telebehavioral health work? And are patients receptive to it? A resounding ‘yes’ say multiple studies done over the past few years. Overall, most show virtual mental health care to be as effective as in-person care in treating disorders such as Depression, Anxiety, and PTSD.
      For example, a 2016 meta-analysis of 452 studies of telepsychiatry found high patient satisfaction and quality equal to in-person care. A 2020 Veterans Administration study found telemedicine was as effective as in-person office-based care for treating Depression and PTSD in veterans and military personnel. And in another recent study on telebehavioral health, Accenture reported that 46% of patients “would choose to receive mental health appointments virtually.”
      What Are The Benefits To Telemedicine When Treating Mental Health Issues?
      Obviously, telemedicine isn’t appropriate in some cases  – for instance in most emergency situations we recommend patients seek immediate help. But for many others, the convenience and accessibility make Telemedicine a preferred care solution.  Benefits for patients and clinicians alike include:
      Improves affordability of care.
      Enables screening and evaluations to be done virtually, saving time, and getting patients quicker access to care.
      Offers more access for those with chronic conditions and medication management needs.
      Expands access for patients who have difficulty accessing care (e.g., those who live in rural areas, older adults, or those with limited mobility). Allows access to residents in long-term care facilities or other specialized residential facilities.
      Enables access to mental health specialists and specialized treatment centers that normally are geographically distant from some patients.
      Provides more personal care: patients receiving care from the comfort of their own homes feel more relaxed and open to new ways of thinking.
      Helps remove the “stigma” of mental health: patients can seek care from their homes rather than having to drive to an office where they may feel more “out in the open” or “exposed”.
      In addition, telemedicine has these further benefits to clinicians:
      Clinicians don’t need the overhead of a brick & mortar practice.
      Enables greater flexibility in scheduling and a better work-life balance.
      Removes the need to commute.
      For those clinicians who want to and are able to travel, they can see patients from virtually anywhere within the country.
      With Telemedicine, Clinicians Can Be Better At What They Do
      With all its benefits, study after study reveals that telemedicine is now a fundamental component of our healthcare environment. The American Journal of Managed Care says it predicts that telemedicine will continue to gain adoption and become a staple of modern-day patient care, even post-pandemic. And given that, telemedicine with an easy-to-use, award-winning EHR platform like Telemynd is a great way to expand your practice geographically and demographically - allowing you to reach new populations of patients you may not have had access to before. 
      And With Telemynd, Clinicians Build A Practice On Their Terms
      Telemynd clinicians say things like “...plenty of referrals to choose from so my caseload was full within two months. Gentle entry into telehealth with user-friendly EHR”, and “...work-life balance… family and community atmosphere even though I am states away”, and “...feeling like you did something worthwhile that day”.
      If you’re a mental health professional and are looking for a way to expand your career or practice, Telemynd is a nationally delegated telebehavioral health provider offering a better way to see patients and deliver care through our secure cloud-based solution. Check out more recent reviews from your peers, and consider joining our network with access to millions seeking telebehavioral health!
      Centers for Disease Control (CDC): Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic
      Harvard Business Review: Digital Tools Are Revolutionizing Mental Health Care in the U.S.
      American Journal of Managed Care (AJMC): Patient and Clinician Experiences With Telehealth for Patient Follow-up Care
    6. Choosing A Career In Mental Health - The Guide To Making A Difference

      Thinking about a career in mental health? Good! You are needed! An estimated 31% of U.S. adults experience an Anxiety Disorder at some time in their lives, and almost 20% will experience Major Depressive Order. Mental health disorders are not at all uncommon, yet over 89 million Americans are not able to find or get the treatment they need from mental health professionals because there just aren’t enough. This article provides an introduction to the types of jobs available in the field, the traits needed, and general schooling and licensure requirements.
      “Making A Difference” Is The Biggest Reason Many Chose This Career Path
      Clinicians already in the field say that their desire to help people better their lives is the biggest reason why they chose a mental health career. They agree that personality traits like compassion, empathy, patience, caregiving, and good communication are typical of those in the field. And while those traits may seem obvious, there are other less obvious traits necessary for a successful career in mental health:
      Flexibility - The field is ever-evolving, clients’ needs change, and your own daily work schedule may need to adapt to your patients’ schedules - ‘nine to five’ is not typical in this field.
      Confidence - You’ll be helping clients to reconsider and relearn their thinking patterns, so you’ll need to be aware of your own issues, challenges and expectations before treating others.
      Tech-Savvy - Not only is the field itself making more and more use of technology to solve privacy, productivity, and access issues, but you’ll need to understand your clients’ technology habits as it may impact their mental health.
      Life-Long Learner - The requirements for licensure and accreditation are typically ongoing annual coursework in updated theory and treatment, so a natural curiosity and openness to new ideas is an important trait for anyone considering the field.
      Multiple Types Of Professionals Can Choose A Career In Mental Health — Each Has Its Own Schooling & Licensing Requirements
      If you feel these traits describe you, you’ll have multiple paths to choose from as you think about what kind of mental health professional you want to become. Professional job titles and specialties can vary by state, but the list below is a general overview of the most common, along with schooling and licensure requirements. 
      Regardless of job title, as a mental health professional, you may work in an inpatient facility (hospitals and psychiatric facilities) or an outpatient facility (community mental health clinics, schools, private practice) depending on what patient population you want to serve. You may even choose to see and treat patients virtually as the technology to do so has matured and the pandemic has created the need for remote patient visits.
      Psychiatrist - licensed medical doctor who has completed psychiatric training; can diagnose mental health conditions, prescribe and monitor medications, and provide therapy; MD plus completion of a residency in psychiatry required; need to be a licensed physician in the state where they practice; may also be designated as a Board Certified Psychiatrist.
      Psychiatric Nurse Practitioner (NP) - can provide assessment, diagnosis, and therapy for mental health conditions; qualified to prescribe medications depending on the state; requirements also vary by state as to the amount of supervision by a licensed psychiatrist; requires M.S. or Ph.D. in nursing with a specialty in psychiatry; must be a licensed nurse in the state where they are practicing. 
      Psychologist - trained to evaluate patients’ mental health using clinical interviews, psychological evaluations, and testing; can make diagnoses and provide individual or group therapy but not prescribe medicine; need a Ph.D. in clinical psychology or other specialties such as counseling or education; licensed by licensure boards in each state.
      Counselor, Therapist - trained to assess mental health and use therapeutic techniques based on specific training programs; requires master’s degree (M.S. or M.A.) in a mental health-related field such as psychology, counseling psychology, marriage or family therapy, among others; licensure varies by specialty and state but examples include LPC (Licensed Professional Counselor) or LMFT (Licensed Marriage and Family Therapist).
      Clinical Social Worker - trained to evaluate mental health and use therapeutic techniques based on specific training programs; are also trained in case management and advocacy services; master’s degree in social work (MSW) required; licensure examples include LICSW (Licensed Independent Social Worker) and LCSW (Licensed Clinical Social Worker).
      Social Worker - provide case management, inpatient discharge planning services, and other placement services; requires B.A. or B.S. degree in social work.
      Job Growth Outlook For Careers In Mental Health: Excellent
      The field is experiencing growth, so if you’ve been thinking about jumping in, now is the time. In fact, employment for all professionals in the field of mental health is expected to increase 22% through 2028, according to the Bureau of Labor Statistics. 
      If you’re considering a career in mental health, take a look at the types of jobs available with Telemynd - to get an overview of the number and range of choices in this field. 
      Already a mental health professional and seeking a way to expand your career or practice? Telemynd is a nationally delegated telebehavioral health provider offering a safe and convenient way to see patients or meet with providers using our secure cloud-based solution. Check out recent reviews from your peers, and consider joining our network with access to millions seeking virtual behavioral health!
      Substance Abuse and Mental Health Services Administration (SAMSA): Behavioral Health Workforce Report
      National Alliance on Mental Illness (NAMI): Types of Mental Health Professionals
    7. How COVID-19 Is Contributing To Increased Mental Health Issues & What You Can Do About it

      No one would argue that it's been a tough year for all of us. We’ve never experienced a global pandemic to this extent in our lifetime. In addition to medical fears and loss associated with the COVID-19 virus itself, health experts say Americans are experiencing Anxiety and Depression made worse by pandemic-related stressors, including job loss, evictions, remote learning, travel restrictions and limits on gatherings with family or friends. As well, the length of time the pandemic has gone on is causing many of us to have increased feelings of emotional exhaustion and hopelessness. 
      Survey Confirms Symptoms Of Anxiety & Depression Are Up
      A Census Bureau - CDC survey conducted over the past Summer and Fall found that expanded symptoms of Depression and Anxiety have been seen in all 50 states. The survey concluded that 1 in 4 of us reported feeling anxious more than half of the previous week, and 1 in 5 of us reported feelings of depression during the same time period. Results also showed the volume of calls to help lines have increased significantly compared to previous years, driven by COVID-19-related concerns.
      The Study Further Found That The Increased Stress, Anxiety & Depressed Feelings May Be Causing:
      Heightened fear and worry about health, finances, jobs, and loss of support services
      Changes in sleep or eating patterns, as well as difficulty sleeping or concentrating
      Worsening of chronic health problems
      Increased muscle tension and pain
      Increased use of tobacco, and/or alcohol and other substances
      What Can You Do To Relieve Stressful Feelings During The Pandemic?
      Focus on things you can control rather than the constant barrage of negative information coming at you through the media, colleagues, family, and friends. When you move the center of control from something outside yourself to inside yourself, you can help reduce anxiety. Try the following:
      Limit news and media consumption, including social media. When we constantly check our newsfeed and see bad news, it activates our sympathetic nervous system, and can send us into fight-or-flight mode. Doing this hour after hour can exacerbate mental health issues. Experts recommend limiting news and social media checks to once or twice a day, turning off news alerts, getting your information from one or two credible news sources, and only posting positive messages and comments on social media.
      Keep your routine, even if it feels disrupted. Experts say establishing and keeping consistent daily and weekly routines is a way for people to feel there is some certainty during the pandemic. Even if you work from home now, try to get up at the same time as before the pandemic and keep as much of your normal morning routine as possible - go for a walk or run, eat a healthy breakfast, and drink that cup of coffee or tea. Keep up regularly-scheduled medical and therapy appointments (most can be done online now). If you used to grocery shop once a week for example, but now are isolating at home, try using an online grocery delivery service, but do your online shopping at the same day/time you used to go out to the store.
      Make social connections by checking in with loved ones regularly. While social distancing and limits on gatherings are essential to slow the spread of the virus, you can still check-in with family and friends by phone, Zoom or Facetime, text or email. You might even consider taking live cooking or craft classes online (or whatever aligns with your hobbies) - you’ll connect with the teacher as well as the other students while in the class. Science shows there’s a clear connection between mental health and social contact, so make formal time in your schedule to for social activities, as it's one of the things that can easily fall off your to-do list. 
      For most people, the stressful and depressed feelings will resolve on their own over time, but for some, they may not. Health experts recommend you seek professional help if you find yourself overwhelmed by continuing or increasing symptoms like exhaustion, fatigue, guilt, irritability, sleep problems, intrusive thoughts, and a reduced capacity to experience pleasure. 
      Are You Noticing Signs Of Increased Anxiety Or Depression During The Pandemic? 
      You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists who provide treatment for depression from the convenience of your home. Click here to find your current insurance provider and request an appointment today!  
      CDC: Mental Health and Coping with Stress During the Pandemic
      The Lancet: The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders
      CDC - Census Bureau: Anxiety and Depression Household Pulse Survey
    8. 5 Self-Care Goals For The New Year & How They Can Help Manage Depression

      Have you made your goals for the New Year? Make sure self-care is on the list! Looking after yourself (self-care) is critical to your physical, emotional, and mental well-being. Most often we read about practical self-care practices that keep us healthy, like balanced eating and good sleeping habits. But it's also important to identify and make time to do things that really nurture you, like connecting with friends and family, doing hobbies, or just sitting still with a good cup of tea.
      Living With Depression Can Make Self-Care More Difficult
      However, when you live with Depression (sometimes called Major Depressive Disorder), the idea of self-care may feel like adding another burden to your already heavy load. 
      And here’s why. 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. It’s defined by the medical community as “feelings of sadness intense enough to interfere with functioning and/or a decreased interest or pleasure in activities”. You can find the symptoms of Depression here. And it’s not uncommon - 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.
      Often, Depression leaves you feeling like your physical and emotional self is “running on empty”, and so you’re drained of the ability to look after yourself. Self-care takes a back seat. And to complicate things, when you start to feel better, you may even ditch certain self-care habits - thinking you don’t need them anymore. It’s common when people start to improve, to get relaxed about therapy and treatment plans, and before you know it, you’ve suffered a relapse.
      Scientists say there's a neurobiological reason for this. The frontal lobe region of our brain is responsible for executive function—a set of skills that involves judgment and reasoning. The issue is that Depression is associated with dysfunction of the frontal lobes, so it's no surprise that people with depression find it hard to judge whether they need self-care or not.
      Skipping Self-Care Is A Slippery Slope To Relapse
      But There Are Ways To Prevent it
      As a whole, the best thing you can do to stave off a relapse is to stick to your treatment plan and create a healthy environment with basic self-care goals. Try not to think of self-care as a big, burdensome project, but rather a series of small choices that add up to a healthier lifestyle. And set realistic goals for yourself - don’t aim so high that your goals are unattainable or you may end up disappointed.
      Here Are 5 Attainable Self-Care Goals To Try In The New Year That Can Help Manage Depression:
      Stay tuned to your body. Mental illness doesn’t impact our brains alone; it’s physical, too. Depression can decrease energy, make you feel exhausted, and experience body aches or headaches. Start by noticing how you feel – both physically and emotionally – on a daily basis. Watch for physical symptoms that may provide clues as to what is happening in your brain. Noticing symptoms early can help you practice better self-care and potentially stave off a full-blown episode.
      Attend your therapy sessions consistently. Even if you’re tempted to skip a session or two, trust the process and attend them all. Consider discussing your reluctance with your therapist. He or she may be able to spot some faulty reasoning on your part. Or, if indeed you are better and changes are warranted, you and your therapist can make those necessary adjustments together.
      Take your meds as prescribed. Missing a dose can interfere with the medication’s effectiveness, and symptoms may return. Always talk to your behavioral health provider about stopping or changing doses. And remember, alcohol or drugs can also interrupt the efficacy of prescription medications, so avoid them.
      Learn deep-breathing or meditation and practice it every day. Scientists say this is one of the most effective self-care methods. Even though it seems unnatural at first, taking a series of deep breaths can help slow down racing or irrational thoughts. The act of slowly and deliberately inhaling and exhaling increases circulation releases endorphins, and relaxes muscles. And do this throughout the day - even just for 30 seconds - not just when you start to feel anxious or depressed. It will make a big difference in the way you feel.
      It’s the little things. Finally, self-care doesn’t have to mean fancy spas, big vacations, or running a marathon. Taking better care of yourself can happen at home. Making time regularly to take a walk, read a book, play with an animal, chat with good friends on the phone, watch a movie, or practice a hobby can help you cope with Depression more effectively. If you’re lonely, volunteering can be a great way to meet people and feel better about yourself - and again, it doesn’t have to be a big time commitment - maybe it’s just one or two hours every couple of weeks.
      Do You Recognize Any Of These Signs Of Depression? 
      You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists who provide treatment for depression from the convenience of your home. Click here to find your current insurance provider and request an appointment today!  
      CDC: Mental Health and Coping with Stress During the Pandemic
      CDC: Taking Care of Your Emotional Health
      NIH | National Institutes of Mental Health: Self-care for anxiety and depression: a comparison of evidence from Cochrane reviews and practice to inform decision-making and priority-setting
      NIH | National Center for Complementary and Integrative Health: Meditation in Depth
    9. 6 Signs Of Holiday Anxiety

      Holiday songs, the media, friends and co-workers urge us to be merry during the holiday season. However, that’s not always easy to do! As much as we love the holidays, they are invariably a stressful time of year. According to the American Psychological Association, 61% of us describe our anxiety as elevated during the holiday season.
      What causes this extra anxiety? Many things. The additional financial demands of the season, travel, interpersonal family dynamics, balancing work, shopping, cooking and decorating, too many social events, memories of past holidays, as well as unrealistic expectations can contribute to creating the perfect storm of emotions.
      Even in normal times, many living with Generalized Anxiety Disorder – a chronic state of anxiety and stress which can make a person feel constantly worried even when there is little to no reason to. The stress can become debilitating and can lead to a loss of perspective on the current situation. GAD is treatable by a behavioral health specialist but nonetheless requires those who live with it to take extra care of themselves with a balance of healthy diet and exercise. The added psychological pressure of the holidays can present a special challenge for those struggling with GAD. You may feel like crawling under a comforter and sleeping until the new year!
      It’s important to recognize key signs that things are becoming overwhelming and to know some coping skills to reduce the anxiety as it happens.
      6 Signs You Are Experiencing Extra Anxiety During The Holidays
      Key signs to look for are changes in mood or behavior that differ from your norm.
      Be On The Lookout For:
      Erratic or unusual behavior, irritability or impulsivity.
      Physical symptoms of anxiety, such as a rapid heartbeat, shortness of breath, shaking, dizziness, sweating, an upset stomach, or a dry mouth.
      Social withdrawal as some individuals try to avoid situations that will bring on feelings of anxiety or panic. You may also lose interest in activities you used to enjoy.
      Changes in appetite and weight – either up or down.
      Insomnia, extra exhaustion and other sleep disturbances.
      Panic attacks that cause faintness, trouble breathing, pounding heartbeat, or nausea.
      How To Cope With Holiday Anxiety
      Below are some practical tips you can do to decrease stress during the holidays. We also recommend creating an Anxiety Action Plan containing helpful coping mechanisms beforehand, so that if you start seeing some of the early anxiety indicators listed above, you can put it into place. 
      Prioritize your health. Make sure you are eating healthy foods, staying physically active, and getting enough sleep. Think twice about overindulging in alcohol—as it can worsen anxiety symptoms.
      Plan ahead. Think about your triggers and try to head them off. For example, if you're worried about money, put together a budget before the holidays. If holiday shopping causes stress, try to do it early, and avoid the stores by shopping online. If social situations make you uncomfortable, accept just a few invitations in advance and ask a good friend to attend with you. Use a calendar to plan specific days for shopping, baking, or gift-wrapping.
      Stick to a routine as much as possible. Wake up at the same time, try to eat at the same time every day, take your regular walk, and journal if you normally do that. Don’t schedule a new hair style or make drastic changes to your environment during the holidays!
      Schedule worry time. Yes, you read that right. Instead of worrying all the time, schedule a dedicated time –maybe even once a day – to do nothing but worry for a few minutes. Write the  worries down if possible and even brainstorm solutions. This way, constant worrying won’t burn you out.
      Make time for self-care. Schedule time in your day to relax with yoga or meditation, drink a cup of coffee or tea, listen to a podcast, play with the dog, or even take a quick nap. Choose something that relaxes your body and calms your mind.
      Ask for support. Let your friends and family know that you might need extra support. It’s always ok to ask for help. Some experts even suggest practicing a secret signal with someone you trust who can help you during events if you become overwhelmed or anxious. And don’t forget to reach out to a behavioral health professional for additional help and resources.
      In general, experts advise lowering your expectations during the holiday season, try to keep things as simple as possible, and remember that you're not alone – many others are experiencing holiday anxiety like you.
      Do You Recognize Any Of These Signs Of Anxiety? 
      You can access licensed psychiatrists, psychiatric nurse practitioners, and therapists who provide treatment for anxiety from the convenience of your home. Click here to find your current insurance provider and request an appointment today!  
      National Alliance on Mental Illness (NAMI): Mental Health and the Holiday Blues
      Harvard Women’s’ Health Watch: A Holiday Advisory for Your Emotions
      Harvard Mahoney Neuroscience Institute: Holiday stress and the brain
      U.S. Army Health: Handling stress and anxiety during the winter holidays
    10. 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!  
      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?
    11. 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!  
      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?
    12. 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!  
      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
    13. 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!
      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
    14. Differences Between Adjustment Disorder, Anxiety Disorder, & Depression

      You or a loved one just received a diagnosis of Adjustment Disorder (AD) from a behavioral health professional. What does it mean? And how is AD different from Anxiety Disorder or Depression? 
      Definition of Adjustment Disorder
      Adjustment Disorder is a condition that can occur when you have difficulty coping with a specific, stressful life event - for example, a death or illness in the family, getting fired or laid off from a job, significant relationship issues like break-ups or divorce, or sudden change in social settings (more isolation, for example) due to the pandemic. Because of this, Adjustment Disorder can also be referred to as “situational depression.” The inability to adjust to stressful events like these can cause one or more severe psychological and/or physical symptoms. 
      According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), in order to be diagnosed with Adjustment Disorder, individuals must have emotional or behavioral symptoms within 3 months of having been exposed to a stressor (like those mentioned above), and symptoms must be clinically significant as shown by one or more of the following: 
      Marked distress that is out of proportion to the stressor
      The symptoms significantly impair social or occupational functioning.
      Stressors that cause AD can even reoccur over time, for example, seasonal business crises, or recurrent hospitalizations for an illness or disability.
      Adjustment disorders can affect both adults and children. It’s estimated that each year, almost 7% of adults in the US are diagnosed with AD. These disorders typically resolve over time and with treatment by a behavioral health professional.
      Symptoms of Adjustment Disorder
      Symptoms vary depending on how the disorder manifests. Adjustment Disorder can be present with these symptoms: 
      Depressed mood, sadness
      Feelings of hopelessness
      Severe changes in emotions manifesting in things like frequent crying
      Feeling or acting unusually argumentative
      Changes in conduct (i.e., acting up in school or work)
      Worry, nervousness, jitteriness
      While the symptoms of Adjustment Disorder can be short-term and usually improve over time, they may resemble other psychiatric conditions, such as Major Depression or Anxiety Disorders. So, how can you tell the difference?
      How to tell the difference between Adjustment Disorder, Depression and Anxiety Disorder
      Individuals with Generalized Anxiety Disorder often have a lengthy and consistent history of anxiety and excessive worry, whereas individuals with Adjustment Disorder only experience their symptoms in times of or in response to stress or change.
      You can have both disorders, and Anxiety Disorder can be made worse by stressors such as change or adjusting to new routines. But if you have Adjustment Disorder, you’ll typically see a reduction in your anxiety as you adapt to the change or learn to cope with the stressor, while anxiety and related symptoms are continual for those with GAD.
      Similarly, there are key differences between Adjustment Disorder and Major Depressive Disorder, with the two differentiating factors being duration and cause. While Adjustment Disorder traditionally resolves within a matter of months, Major Depression tends to last much longer and only resolves with professional treatment. And while AD is triggered by a specific event, Depression seems to be caused by genetic and psychological factors, and cannot be attributed to a specific event.
      Summary of the differences between Adjustment Disorder, Depression and Anxiety Disorder

      Regardless of whether you have symptoms of Adjustment Disorder, GAD, or Depression, it is important to know that treatment is available and feeling better is possible. It’s important to start by having a behavioral health professional diagnose your condition, they can then help to manage your symptoms and learn coping skills. Like GAD and Depression, treatment for Adjustment Disorder is typically a combination of individual therapy, family therapy or group therapy, and to a lesser extent, medication.
      Has a recent stressful event caused you or a loved one to have symptoms of Adjustment Disorder? 
      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!  
      Johns Hopkins Medicine: Adjustment Disorders
      Merck Manual 2020: Adjustment Disorders
    15. 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!
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