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I was recently interviewed by Meredith Carroll for her article in Redbook, “My 6-Year-Old Is Obsessed with National Tragedies — and I Doubt She’s Alone,” which is based on the author’s experience that “it’s practically impossible to go outside, online, open a newspaper, or turn on the TV and not have to pick your jaw up off the floor over an international crisis, natural disaster, or a national tragedy.” The article specifically discusses how to talk to young children about tragedy or disaster in the news, especially in the context of recent events that have dominated the news cycle.

The gist of the article, and comments from me and another child psychiatrist, encouraged parents to try to limit exposure to the news, reassure children of their safety, identify their own feelings as a way to help children label and process their emotional responses, and talk together with children about ways that people can help each other.

The discussion and the article got me thinking about how adults respond to an onslaught of death and destruction in the news, especially adults who live with depression, anxiety, and histories of personal trauma. Bad news can trigger feelings of fear, sadness, hopelessness, and powerlessness. Finding the right balance between awareness/knowledge and the care and support of your mental health can be a challenge.

Following are four suggestions to establish the right balance:

  • Manage your exposure to the news. With 24-hour news cycles and social media feeds endlessly scrolling on all of our devices, we can have constant input of news and commentary. Self-dosing is important; shut off the television, phone, and computer well before bed time, and resist the urge to check your Twitter feed or Facebook account when you first wake up. Give yourself time limits for how long you spend online or watching TV news.
  • Load up on more positive, optimistic stories. You can Look for “good news” stories and talk about those with others. Spread those stories.
  • Look for “helpers” — people who respond to bad events with kindness and generosity. This is advice that Mr. Rogers said his mother had given him when he was a child. In other words, look at bad news with a wide-angle lens that captures the goodness and generosity in people. This is an especially wonderful strategy with children, and it’s easy for them to understand.
  • Build your own life with compassion for yourself and others. Participating in activities you enjoy and spending time with people you love are the best antidotes for bad news. Working to make positive change in the world and engaging with others to be a helper can feel good and bring more goodness into the world. When things are not in your control, keeping your brain and body grounded (through mindfulness) and creating your own life worth living are keys to resilience and to improving your sense of well-being.

You may not be able to control the world around you, but when bad news is the news of the day, you may be able to tune some of it out and strive to bring more goodness to your corner of the world.

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Jake and his parents arrive early for their appointment with a list of concerns to review in our limited time together. I encourage patients and families to bring lists; a list keeps all of us focused. Their number one concern is Jake’s weight, which has increased significantly since he started on Abilify (aripiprazole). We tried to avoid using a medicine like this that causes weight gain, but he was still struggling tremendously. The addition of Abilify changed things dramatically for the better. Jake can regulate his emotional responses much more effectively, and he is experiencing many more successes at school and home.

Jake is ten years old, and he has gained about 20 pounds in the last four months. His weight stabilized between last month and this month, but he is certainly heavier. His parents worry about his health — and also about his appearance — especially because other kids have started to make fun of him about his weight. Jake’s psychiatric symptoms are much better with this medicine, but it’s causing weight gain.

Jake’s parents and I grapple with this dilemma together. We consider other options. One option is to add a medication that might help him lose weight or stop gaining, but adding a medicine carries its own risks. We could change him to a different medicine in this family; we discuss Geodon (ziprasidone), because it has almost no risk of weight gain, but it also carries other medical risks and is not as well studied in children as Abilify is. We talk about exercise — trying to help Jake move more. He is an active kid though, and he is only ten. He is playing sports and having fun.

Weight gain is a problem with this family of medications, and this dilemma comes up all the time in my office with Abilify and almost every other medicine in this class. How much risk does 20 pounds actually cause for him, compared to the risks of the low energy and depressive symptoms he had before? What is the balance between the risks of this weight increase and the risks related to the persistent feelings of failure and frustration when he would lose control many times a day?

The medical risks longer term for this and similar medicines are related to insulin and glucose metabolism — risks of type 2 diabetes in particular. This can cause other problems. The acute medical and safety risk to gaining 20 pounds, in itself, is limited. The bigger risk is the shaming and social stigma. I often wonder with parents about how they would respond if the weight gain were a more invisible side effect. If Jake had this positive response to the medications around his mood symptoms and had some increased risk of metabolic disorder later in life, but we could not see that risk in the form of weight gain, would we feel as pressured to address this side effect?

I am not saying that the metabolic risks are unimportant. They certainly are a valid concern. But right now the 20-pound gain is related more to social problems, not acute medical ones. Jake is actually more active and energetic even with the weight gain. We need to manage these side effects with long-term health in mind, and we want him off of this medication as soon as we can make it happen safely. But the social stigma of weight gain — the kids bullying him, the parents fear of him being bullied, and the absolute horror his parents (and all of us) experience at the idea of weight gain of any kind, regardless of context or balance or other medical concerns — can’t be left out of the story here.

Because his weight has stabilized in the prior month, we make a decision to give it another month before we make any changes. Family will encourage more physical activity, and I will look into options for changing the medicine or adding something to reduce weight gain. (Note the absence of talk about diets or calorie restrictions, because those are counter-productive, even dangerous. That is a topic for another post.)

I am hoping Jake can start the school year feeling well and that the social challenges of the weight do not overwhelm the benefits in his life from the medicine. I want us to stop talking about his weight. I want everyone to stop talking about his weight. I will stop talking about his weight — right now.

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Can the bacterial community that lives in your gut actually be related to psychiatric illnesses such as schizophrenia and bipolar disorder? Research on the human microbiome and its effects on health and illness has exploded into the worlds of medicine and research. It is increasingly clear that the microorganisms in the human intestinal tract, and the genes produced by all of these microscopic living things, play critical roles in an individual’s patterns of overall wellness — far beyond helping us digest food effectively.

Microbiota and Microbiome Defined

Microbiota is the ecological community of microorganisms (mostly bacteria, but also fungi, viruses, and so on) that live in a particular location, such as your gut. Microbiome refers collectively to the genes harbored in these microorganisms. Researchers must understand the patterns of both the organisms and the genes to help clarify the roles these microscopic creatures play in the body’s health and function. So, if you read something about the microbiome that’s about only the bacteria and not the genes, you know it is an incomplete discussion. Also, while most of the discussions are about the gut microbiota and microbiome, humans actually have colonies of microorganisms living in other areas in and on their bodies, including their skin, reproductive tract, and the mouth and throat (which are technically part of the gut but sometimes are not thought of in that way).

A study in the journal Brain, Behavior, Immunology (May 2017), entitled “The microbiome, immunity, and schizophrenia and bipolar disorder,” summarizes some of the current research looking at the microbiome as it relates to schizophrenia and bipolar disorder. The article reports that many studies in animal models have shown that the gut microbiome could affect thinking and behavior through effects on the immune system. Some human studies have shown that people with psychiatric conditions took antibiotics more frequently than people without these disorders. Humans take antibiotics to kill off unwanted bacterial infections, but these medications also kill off some of the microbiota, changing the person’s microbiome. The question that comes up then is whether these microbiome changes were related to the development of the psychiatric conditions. This article also points to studies that found different microbiota in the mouths and throats (oro-pharyngeal microbiota) of people with schizophrenia compared to those without.

Babies are born with “sterile” guts; they don’t have any gut microbiota. But in the birth process, microorganisms colonize the baby’s mouth and intestine, starting off their process of building a microbiome that eventually looks like an adult’s. Many researchers are exploring how the developing microbiome might affect the developing brain and nervous system. While it seems clear that there are effects, the exact processes mediating the effects and what exactly gets changed or affected remains very unclear. While the immune system is thought to be one pathway, other mechanisms are also being investigated.

Many other areas of research show promising results when looking at the microbiota, microbiome, and illness. Autism researchers are looking at the “gut-microbiome-brain” connection, and there are strong indicators that the microbiota and microbiome have some relationship to autism. Obesity — not a mental illness but of concern to so many people living with mental illness — has been shown to have some very interesting connections to the microbiota in mouse studies. Changing the patterns of bacteria in mouse guts can transform the mouse from lean to obese and vice versa without changing diets. A study from China last month in the World Journal of Gastroenterology reports a case of a 20-year-old with Crohn’s disease and seizures. They treated her with fecal microbiota transplantation — giving her the gut microbiota of a healthy person — and her gastrointestinal symptoms and seizures improved significantly.

The potential benefits to understanding how the microbiota and microbiome interact with the brain and central nervous system could be enormous. Understanding microorganism mechanisms that increase the likelihood of mental illness such as bipolar disorder or neurodevelopmental condition like autism would make room to build new interventions that target those mechanisms. The research in these areas is still in early stages, and there is much more to do, but this is an intriguing and promising story in the quest to understand and treat disorders of the brain.

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Helen, a 22 year old young lady, leans forward toward me — she is sitting in the chair I usually occupy during our sessions — and spills out details of an interaction with a customer she helped at her retail job. She speaks quickly and loudly and offers rich, often excessive details about what happened. I interrupt occasionally to ask for clarification or to redirect her back to our conversation about her medications, and she stops to answer my question but makes sure to come back to finish her story. Helen swivels around in the chair, she fusses with her bag and her phone case, and she often stretches her legs while talking. She moves or talks, or both, throughout our visit.

A few months earlier, Helen had been in the office and was overactive but at a completely different level. Instead of swiveling and fidgeting, she paced the room, often opening the door to the waiting room and pacing between there and my office. She left several times to pace outside and smoke a cigarette. She spoke so fast it was hard to understand her words, let alone follow what she was saying. She changed topics constantly and there was no space for me to redirect or ask for clarification. Her thoughts were full of ideas about religion and politics and the end of the world, and she told me she had come to understand things in a way that the whole world had to know, because she was the only one who had this figured out. Helen’s mood varied from happy and wildly excited to irritable in response to even minor frustrations or input from me. She had burst into a classroom at her college, planning to “teach” a class about her new insights and findings — that was when she was taken to the emergency room.

Helen’s most recent visit with me was typical for her. I have known her for a few years and this was her usual self. She is a super-energetic, highly animated young lady who has been diagnosed with and treated for ADHD since she was quite young. Sitting still and paying close attention in class or to homework were major challenges throughout her school years. She told me she always had lots of thoughts in her head and often felt like she could not keep up with them.

The visit a few months ago was the beginning of a manic episode — her first. She went into hospital and got started on medications for her bipolar disorder. Her ADHD medications were stopped, because they can make mania worse or be a trigger for manic episodes. Once her mood was stabilized, she returned to her usual high energy state.

High energy states can be part of several medical conditions, including ADHD or mania, but key differences distinguish the two.

The Big Difference between ADHD and Mania

Here’s the biggest difference between ADHD and mania:

  • In ADHD, the high energy is chronic and generally even. It may vary from day to day but only by typical ups and downs related to things like fatigue and stress. People with ADHD are always busy — often both physically and mentally.
  • Mania occurs episodically. By definition, it includes a change in energy that is different from the person’s baseline.

For Helen, even though her baseline is highly charged up, to those around her, the manic episode clearly looked and felt different from her usual patterns. Her pressured speech and racing thoughts were much more severe during this episode than they are when she’s not experiencing mania.

Other Differences between ADHD and Mania

A high energy manic episode differs from ADHD in several other ways. Such an episode is characterized by symptoms that may include:

  • A visible and sustained difference in mood — often excited or euphoric, but sometimes raging and angry.
  • Thinking is different — more disorganized and hard for listeners to follow or make sense of. Interrupting a person who is experiencing mania is nearly impossible.
  • The content of one’s expressions may be more typical of mania — with “grandiose” thinking that is often disconnected from reality — delusional or psychotic.
  • Judgment and impulse control, which are sometimes mildly impaired in ADHD, are profoundly disrupted and markedly change the person’s usual ability to make safe and healthy decisions.

Both high energy states can cause problems. ADHD hyperactivity often interferes with school, work, and relationships. But manic high energy, along with the changes in thinking and impulse control and judgment, are acutely and extremely damaging to life and day to day function. While the “charge” of the person with ADHD can have positive features such as passion and creativity, manic episodes so severely disturb thinking and behavior that any positives are vastly outweighed.

Accounting for Hyperthymia

People with bipolar disorder often have a high-energy baseline self, called hyperthymia. Often, even without ADHD, they’re full of energy and animation and ideas — this is their usual self. Their thoughts and bodies and moods may move and change gears quickly — but not at the same level or with the same damaging patterns as a manic episode. These qualities are not “pathology” themselves and are often positive and important parts of a person’s identity and life. Not everyone who is hyperthymic will develop bipolar disorder, and not everyone with bipolar disorder has a hyperthymic baseline.

Low energy is a common problem in our sleep deprived, anxious world. Depression and low “charge” are frequent complaints. Too much energy sounds like a dream come true to many, and it can be a positive, but it can also be dangerous. Teasing out different patterns of high energy is an important step in making correct diagnoses of psychiatric disorders — or in realizing there is no diagnosis at all.

Photo by Biker Jun

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Is your child, tween, or teen struggling with homework in addition to other challenges, such as bipolar disorder, anxiety, depression, or ADHD? If so, then maybe it’s time to say, “Enough is enough.” In my practice, I often see frazzled children and their frazzled parents, who tell me about their battles to beat the homework blues.

Mom and dad return from a long day at work, and junior comes home from a long day at school, typically followed by some sort of after-school activity that may have added to an already hectic day. Instead of coming home and breathing a sigh of relief as they collapse into their respective lounge chairs and bean bags, they now have the sword of Damocles hanging over them in the form of completing that %$#@*&! homework assignment, not to mention cooking, eating, cleaning up after dinner, doing chores, and getting ready for bed. Ugh!

The parents are frustrated and aggravated, the child hates school, and everyone is exhausted. Mission accomplished? Hardly. Maybe the homework gets done, maybe not. Maybe it’s done well, maybe not. Regardless, the homework and ensuing battles are usually counterproductive. A student who resists isn’t going to learn much, and the next day at school, she’s more likely to be tired and irritable from the previous evening’s battle. That’s not even considering the emotional fallout and the toll it takes on the family.

What to do?

I recommend that homework take a backseat to bedtime. Spend some planned and measured time on the homework and reading and then put it away — yes, even if it’s not done. The solutions offered at school are often about how to make the child do the work — what can be rearranged to make sure it gets done. But this misses the bigger picture. A better approach is to consider modifications so your child can master his homework without extreme distress.

Here are two practical solutions:

  • Reduce the amount of homework — fewer math problems, fewer sentences to write, break up the spelling words over the course of the week, ten minutes of reading instead of 20.
  • Allocate a set amount of time to each subject, and whatever gets done in that time is enough for the night.

While parents are encouraged to be active participants in homework and support it getting done, there’s a point at which it’s okay to shut down the work for the night. It’s okay if it’s not all finished or not all correct. The teacher needs to know where your child is struggling, so she can adjust instruction or alter supports based on your child’s needs.

Less is more

Homework, especially in younger children, but even into high school, needs to be a part of life outside of school, but when it’s hijacking every spare moment it’s counterproductive and harmful. Some children meet the expectations without excessive distress, but many, many kids and families are overwhelmed much of the time with homework demands. We have to expand the discussion to consider solutions that are not just telling the child and family to “Try harder” or “Do more.” We harm our kids and our families this way.

Burnout and alienation from school are huge problems. When we just keep blaming the children and families for not getting homework done and we don’t look at the reality of what we are asking of them, we are setting up children and families to fail.

We’d like to know what you think. Do you think homework is an overwhelming burden or an essential component of education? Have you battled the homework blues? Do you have any suggestions to share? You might just help another frazzled parent become unfrazzled!

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A common refrain I hear from my patients’ loved ones — and especially from parents of teenagers with depression — is that if their child or spouse would just get up and work out they could stop being depressed. “Dr. Fink, please tell my daughter that if she just came out of her room and went for a walk (or a run or played tennis or rode her bike) she would not be depressed.” “Maybe my husband would not have to depend on medicine if he got on the treadmill.” “Exercise cures depression, right”?

I wish it were that easy. While the benefits of exercise (or any physical movement) should not be diminished or understated, exercise is not a cure-all. Exercise alone cannot put severe depression or bipolar depression into remission. It can be a critical part of recovery, but it is not a magic bullet.

It is also true that when a depressed person rejects or resists or simply cannot bear the thought of exercise these are responses that are deeply rooted in the depressive brain circuits. Being told that they could cure themselves if they just “tried harder” adds insult to an already deeply injured sense of self. Shame about not doing what they or other people say will help them can trigger more feelings of helplessness. Resistance to being told what to do is an adolescent headline anyway. A depressed teenager may often feel even more anger and resentment at being told to do something that they are one hundred percent certain they do not want to do.

I try to approach this very difficult paradox from a few different angles:

  • Acknowledge that both things are true at the same time; a person can feel that movement is impossible and be well aware of the likely benefits of movement at the same time.
  • I try to avoid defaulting to “Exercise” as the “prescription” because it can carry the tone of high school gym class, calisthenics, or other punitive interventions — especially when someone can’t really stand up off the couch for very long, let alone “exercise.” I prefer “movement” or I try to find other language that the person living with depression finds more appealing or at least neutral. Language is important in problem solving.
  • I remind the group or individual that even small periods of movement — even one minute of intense movement — can have health benefits. And even beyond that, standing up and walking around the room gives some benefits over lying or sitting still for extended periods. Bring the starting point into reach. Set goals that are small (sometimes extremely small) steps from where the depression has taken you or your loved one.
  • I encourage looking for types of movements that feel bearable or even wonderful, but at the very least not terrible. One person may find yoga insufferable while another finds doing a single sun salutation pose a vast improvement over depressed stillness. Being outdoors may be essential for some but may be far too much sunlight or activity for another. Sometimes kids with depression have avoided movement since an early age, so finding something that feels good can be a real challenge.

Moving your body is crucial for health improvement and maintenance. It is important for recovery from many illnesses. Moving our bodies is a natural action that usually feels good. But when it doesn’t — or when it is hard to even imagine it feeling good — see if there is a place to start the tiniest bit of “action.” Doing, rather than not doing. Finding joy and pleasure in movement can be a key part of recovering from depression, bipolar depression, and other forms of mental illness, but it may be best to begin with the tiniest of steps.

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Living with bipolar disorder often means taking medications regularly. That alone is a tough pill to swallow. Finding the right medicine “cocktail” often involves a month (or longer) journey of trials and adjustments. But once you find the right medicine and dose(s), taking your medication every day, as prescribed, drives the recovery and mood maintenance engines. Missing medicine or taking it at wildly different times each day makes it hard for the medicine to do its job and for you and your doctor to get a clear picture of what’s working, what’s not, and which medication may be causing undesirable side effects.

Coming to terms with taking medication daily and remembering to take it every day is not easy, especially when starting a new medicine. Building a new routine into your day takes practice. It’s even harder if you take medicine more than once a day. Some simple steps can be very helpful in keeping you on track with your medications, allowing the medicine to be as effective as possible and reducing potential problems from missed doses.

These steps start at the doctor’s office and follow you home.

Before you leave the doctor’s office
  • Understand names and doses of your medications.
  • Be sure you understand any titrations or tapers — exactly how and when you are supposed to increase or decrease doses of a medicine.
  • Be clear on the timing for your medicines — when to take and how long to wait between doses.
  • Ask about special instructions:
    • Should I take this with food or on an empty stomach?
    • Is this okay to take with coffee/tea?
    • Is it okay for me to drink alcohol with this med? If yes, how much is okay?
    • What if I need a cold medicine or pain reliever — are these okay?
    • Do I need to avoid any supplements or over the counter (OTC) medicines?
    • Are there certain foods I need to avoid?
  • Ask your doc to give you a written sheet of instructions with these details- there is a lot to remember and more than will be on the medicine bottle. She can give you more details this way, and you have something to remind you of what she said.
  • Ask your doctor to put her contact information on that sheet. Know how to reach her if you have questions or concerns about medicine.
  • Take a picture of this sheet of instructions in case you lose it. And/or ask your doc to email you a copy.
At home
  • Use a medication box that you fill each week. This keeps track of the medicines and lets you know if you missed a dose.
  • Use a separate medication box for each time of day — a morning box and an evening box, for example.
  • Keep your medication box near something you do every day. Put it next to the coffee maker or your toothbrush, your phone, or where you charge your phone.
  • Use your phone/computer/tablet to set alarms to remind you.
  • Change your phone alarm sound every week or so; otherwise your brain may get used to the sound and ignore it.
  • Go old-school and put sticky notes on your bathroom mirror, fridge door, coffee maker (can you tell I like coffee?).
  • Keep a backup medication box in your car, purse, backpack, or briefcase.
  • Recruit friends or family members to remind you or double check that you took meds (assuming you can find medication buddies who are competent without being overbearing).
  • Consider using a medication reminder app on your phone. Some apps will text you and won’t stop texting until you have acknowledged taking your medicine. Some can text both you and your medication buddy(ies).

Remember that what works for someone else may not work for you. And you may have to try different strategies to find the best solution for you. Think of this as an active process that will need to change and adjust over time. Communicating with your doc is most important, and she may well have some other techniques and tips about medication mindfulness. If you continue to have trouble remembering to take your medicine, don’t be afraid to let your doc know! She may decide to make changes on her end — the med, the dose, the timing — that can help you. But she can’t make those changes unless she knows you are struggling.

Let us know your tips for medication mindfulness!

Photo by Rob Ireton

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Sleep is restorative. It heals us. It grants our brains and bodies needed downtime for recovery from the stress and demands of our waking hours. Our circadian rhythms (our sleep/wake cycles) regulate core components of our human selves. And beyond all of sleep’s mechanical importance to our bodies, a good night’s sleep feels amazing; it is a gift to drift off to sleep easily and to awaken refreshed.

Manic episodes disrupt sleep/wake cycles — our internal clocks. When you experience a manic episode, you typically need little to no sleep for days at a time. These sustained sleepless periods rob you of the healing and peaceful benefits of sleep. Bodies, brains, and lives suffer as a result.

Unfortunately, in our busy world, prioritizing sleep may be associated with weakness. “I’ll sleep when I’m dead” means that a person is super productive and getting everything they can out of life. This myth is dangerous for all humans, but it carries particular risks in bipolar disorder. Sleepless people make more mistakes and get into more car accidents. Sleep deprivation increases obesity and other metabolic disorders. And for people living with bipolar disorder sleep deprivation carries a very high risk of triggering mania or mixed episodes.

Managing bipolar disorder and reducing the likelihood of manic episodes requires taking good care of your sleep. It is just as important as taking your medication regularly.

Protecting sleep requires some planning and strategizing. Following are the do’s and don’ts of getting the right quantity and quality of sleep followed by a few additional techniques you can try.

Do…
  • Try to get to sleep and wake up around the same time every day.
  • Sleep at least seven hours per night — most people need more.
  • Allow some “de-stim” time before bed without close-up screens like phones and computers. (The light from such screens stimulates the brain.)
  • Take any sleep medications as prescribed and when prescribed.
  • Keep the room a comfortable temperature for you.
  • Darken the room as much as possible.
Don’t…
  • Drink caffeine after mid-day.
  • Take stimulant related medications or other substances after mid-day.
  • Exercise vigorously within a couple hours of bedtime.
  • Drink alcohol right before bed — it helps you fall asleep but then you wake up a few hours later.
  • Use your bedroom for anything other than sleep and sex.
Try
  • Use a meditation or relaxation app for a few minutes before resting.
  • Recruit people you live with or sleep with to help with your sleep goals.
  • Reduce high stimulus content before bed, such as the news or intense conversations.
  • Stop any work-related activities at least an hour before bedtime.
  • Read or listen to audio books to help you drift off to sleep.

If you are struggling to maintain a regular sleep pattern, or you notice any sustained changes in your sleep such as needing a lot more or a lot less sleep, speak to your doctor and therapist about this so you can work on solutions.

Tip: CBT-i Coach is a Cognitive Based Therapy (CBT) sleep management app created by the Veterans Administration that teaches about sleep and offers some specific cognitive behavioral strategies to reduce insomnia. It is free, and anyone can use it. Try it out yourself or ask your doctor or therapist to look at it with you. You can find CBT-i Coach on the iTunes or Google Play app store.

Happy sleeping!

Photo by Sean MacEntee

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When you have a child with bipolar, parenting advice is never in short supply and is understandably not very welcome. However, in my practice, I spend far more time undiagnosing “the bipolar child” than I do diagnosing bipolar in children (see my previous post, “Childhood Bipolar or Something Else?”). The fact is that many children have a variety of challenges that share some characteristics with bipolar disorder, including anxiety, depression, and plain old frustration and anger. And while standard effective parenting techniques alone may not be an effective intervention with a child who may or may not be experiencing a clinical brain disorder, such techniques can certainly help.

I recently had a visit from one of my patients, Katie, and her father. Katie is about eight years old and is in treatment for anxiety and mood difficulties. As Dad slumped in the recliner in my office, Katie was building a masterpiece with K’nex. Dad appeared frustrated and angry. “She is ruining our family,” he said, referring to Katie. I guided the conversation to Katie’s recent explosive meltdown at school when her mom was running late and almost did not make it with the toy Katie needed for show-and-tell. The outburst included property destruction and trying to leave the classroom. Katie is an anxious little girl, and I suspected she had a worry about being in trouble for not having the toy or about missing show-and-tell. I asked her what had stressed her out so much that her body and brain felt out of control. Katie said, “I thought Mommy was dead and was never coming.”

We spent the rest of our time discussing Katie’s severe worries and the ways we can help her, such as increasing her cognitive therapy work, adjusting medications that she is already on, and including the school so they understand that this extreme fear may be triggering some of Katie’s extreme behaviors. During our conversation I also focused on Katie’s K’nex creation, and she was delighted with the attention and feedback over the colors and details of her art project. Katie jumped on her dad’s lap, chatting away and showing him her work. He gently pushed her away and said sternly, “Not now Katie. We are talking about your very bad behavior at school.” Katie slumped down onto the floor, threw the K’nex in the box, and started to fuss.

When Dad and I met privately I asked about his response. I wondered if he was too sad and tired about everything to engage happily with her. But he told me that, actually, he thought he should not show any positive feedback or she would misunderstand and think he was encouraging her negative behavior. He said he wanted to smile and let her know how much he liked it but he did not want to give her the wrong message. He breaks into a big grin and lets out a sigh when I give him permission to be positive and loving even in the context of working to curb negative behaviors. He, like many parents, felt he must withhold affection to make sure Katie understood the seriousness of her negative behaviors.

I love it when I can relieve a parent of the burden they feel to be harsh, neutral, or even angry when correcting a child. A lot of parenting advice relies on firm/stern tones, separation, and withholding of affection as key elements in stamping out negative behaviors. I could not disagree more. Years of work with thousands of families, and up close/personal work with my own two daughters, as well as an understanding of the neuroscience involved in parenting, proves to me that it is essential to blend connection and positive tone — delight in the children themselves — with any interventions focused on changing child behaviors. Positive “charge” and maintaining connection in your interactions with your child fires positive brain circuits in a way that increases the likelihood of successful collaboration to change behaviors. Negative tone and withholding connection fires negative circuits, increasing distress and reducing the child’s ability to engage in problem solving.

Let’s be clear that I do not intend to parent bash here. Parenting is exhausting, and there are a million interactions a day. Most are short and direct. We give many instructions effectively without having to coach them in carefully crafted loving tones and delight. But when we are working on a problem behavior — something that keeps coming up and we are trying to figure out solutions — I like to remind parents that it is OK to still treat your child like the terrific kid they are. You don’t have to withhold your delight in them to be a “good’ parent when you are talking about negative behaviors. You must be clear about the outcomes — that the behavior may even be dangerous or harmful to others, that the behavior is unacceptable, and that you are working together to change it. But delighting in your child’s positives and keeping a loving connection is not a parenting crime; it is, in fact, the best thing you can do.

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We recently received an email message from Jeffrey Loeb, a film producer, announcing the release of his new film, A Light Beneath Their Feet. We haven’t had a chance to watch it yet, but here are the details from Jeffrey:

A Light Beneath Their Feet stars 2016 SAG Award-winning actress Taryn Manning (Orange Is the New Black) as a young mother with bipolar disorder struggling with the looming departure of her daughter, the one force of stability in her life. Seventeen-year old Madison Davenport (Noah in From Dusk Till Dawn, and Tina Fey’s daughter in Sisters), gives a breakout performance as a daughter struggling with the decision of whether to stay local for college where she can remain the stable rock in her mother’s life, or to detach and go to her dream college across country. Kurt Fuller, Nora Dunn, Kali Hawk, Maddie Hasson, and Carter Jenkins give standout supporting performances.

Authentic Portrayal of Bipolar Disorder

So often in films, the portrayal of mentally ill characters are overblown and played to be sensational. That is not what we wanted from our film; it was imperative that Taryn Manning’s performance as Gloria be subtle, nuanced, and most important — authentic. To ensure authenticity, we sought advice from psychiatric experts as well as from those living with bipolar disorder. We studied memoirs written by authors living with bipolar disorder to get a better understanding of how the condition not only affects a person’s inner thoughts, but also manifests in her physicality. Linea and Cinda Johnson, authors of Perfect Chaos, an extremely personal and detailed account of Linea’s struggle to survive bipolar disorder and her mother’s attempt to save her, were particularly gracious to speak with director Valerie Weiss and Taryn Manning and provide additional insights into specific thoughts and behaviors Linea experiences living with bipolar disorder and those leading up to her suicide attempts.

How to Watch It

A Light Beneath Their Feet is available to watch at home on TV and on any digital device through various streaming platforms:

Cable VOD: Rent the movie from your local cable provider

Buy DVD from Amazon

iTunes

VUDU

Vimeo On Demand

FandangoNOW

Post a Review

After watching the film, let us know what you think by posting a review of it as a comment below.

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